Psychology of Success

Why Hospitals Don’t Want Employed Physicians to (Really) Succeed

March 5, 2011

You’d think that after spending millions of dollars setting up a foundation model entity to employ physicians, or even going out, in those states without prohibitions on the practice of medicine, and employing physicians directly, that hospitals would want you to succeed.

Well, they do, sort of — but only to a point.

Historically, physician practice was entrepreneurial.  For one reason or another, chiefly related to the complexity of running a practice in today’s economy, many physicians have chosen the hospital employment route.

But despite any assurance to the contrary, once within the hospital’s bureaucratic model the rules change:  You are managed because that is what bureaucrats do.

You’ll be free to develop your expertise but not to the point that you will become a star.  If you were allowed to become a star, you would obtain leverage and might leave.

There’s a tension to have scores of mediocre physicians on the team – entrepreneurial physicians and those striving for personal excellence are too much of a threat.

You’ll be paid fairly well, but not above what are actually mediocre levels such as the 75th percentile on employer-favorable surveys. At that level you will be paid more than most, if not all, of the bureaucrats in hospital administration and paying you more will be viewed as “unfair.”

Of course, over time, with more physicians being among the employed, the actual dollar amount of 75th percentile compensation will spiral downward. But not as low as that of physician assistants, specialty trained nurses armed with newly minted “doctor” degrees, and other physician extenders who will be used by your employer to muscle you out of a large part of your clinical role.

After all, to the bureaucrats in charge, even those bureaucrats in white coats, it will be done in the name of efficiency.

In a way, it’s like the classic Twilight Zone episode, To Serve Man:  You might feel that you are participating in something greater, but the reality is that you’re on the menu.

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