A Physician Friendly Administrator Speaks

Administrators find themselves involved in every aspect of the hospital operation: clinical and non-clinical alike.  It seems elementary but hospital administration is one of the most complex beasts to overcome for most employees particularly physicians: Largely because they speak a different language.

As a former administrator for over a dozen years, I spent most of that time trying to break the dichotomy between MDs and Admin, but I found myself smack in the middle on most days.  It is often said that "never the 'twain shall meet."  Let's face it, competing views and strategies on the delivery of health care has pitted the two against each other more times than not.  For starters: administrators see physicians as another “cog in the wheel” in the overall healthcare operation while physicians see administrators as the “enemy.”

Statistics indicate that for every hospital based MD there are 16 staffers.  Six may be involved in clinical care and the remaining 10 are purely administrative.  Why?  Regulatory agencies, insurance company demands and the ever changing landscape of the industry has increased the layers of “stuff” that hospitals and physicians' offices must comply with. Let’s be clear, these added demands go uncompensated as hospitals and physician offices are vying for the same pool of limited dollars.  Volume has largely remained flat and reimbursement rates have dropped; not a good recipe for financial success.  Even in rural areas, hospitals are closing.

Administration is charged with carrying out the operations and establishing the rules and regulations that are bestowed upon them by the payers (3rd party) and regulators (JC, DOH, ACGME, and don’t forget the HR and federal labor laws, to name a few).  Department Administrators have responsibility for all the human resources, budgets, schedules, procurement, and contracts.  Behind every patient encounter there is a labyrinth of requirements to ensure payment.  Assuming the planets are aligned the hospital will get paid.

Talking to your administrator is often frustrating.  So what is the language that one needs to know to effectively manage those encounters?  Here are my top favorite lines:

  1.  “I’m working on it” – An all-encompassing phrase that is used most frequently to tell the receiver that I either forgot or got tied down with useless meetings or busy work and haven’t gotten around to it yet.
  2. “It’s not in the budget” – A classic line to tell the receiver that I like your idea but we are spending money on other things important to administration.

  3. “I’ll get back to you” – The usual response for being too busy to even think about your request.  This is a trap because you’ll have to remind me.  And when you finally remind me it would be the first time I thought about it since the last time you asked.

  4. “I’m on your side” – This means I want you to feel good about the bad news I’m about to bestow upon you; also, commonly used when I want you to do something that you don’t want to do.  Shallow attempt at showing feelings/compassion.

  5. “Let me check the contract” – Most of the time there is no contract but that’s not the point.  This is the way of saying no while passing the blame to some 3rd party piece of paper (see also #4 above as they can be used in sequence).

  6. “Your FTE count is maxed out” – FTE is Full Time Equivalency (employees).  Similar to #2 this is a mathematical calculation to sound important but since the formula is robotic, it does not account for people.  Therefore you always feel short staffed.  That said this line means - I know you’re short staffed but the numbers speak for themselves.

  7. “They are not patients they are customers” – this is a psychological attempt to level the playing field.  Meaning I, Mr. Admin, cannot take care of a patient but I can take care of a customer.   Since we want repeat customers I expect you handle it like I tell you and definitely prevents throwing the MD degree at me.

  8. “Providers” – These are all the folks who provide care to patients that hospitals can bill for including: MDs, PAs, NPs, and Midwives.  Intentionally lumping MDs into this mix is another attempt to level the playing field.  Yes, it is demeaning.

  9. “Senior admin wants us to do ( XY&Z )” – This is an attempt to speak in the 3rd person and take the onus off of me and deflect any personal criticism.  May also be followed by: “I know it’s not fair” or #4 above.

  10. “I feel the same way” – an attempt to show emotion despite our inability to feel anything. (see also #4 above).

  11. “We are not in a position to do that right now” – A clandestine response that combines #1 and #2 above.  It implies that I know something you don’t thereby giving me the upper hand and perception of power.

  12. “Patient satisfaction scores” – The ace in the hole when we need something accomplished.  We indicate that this will adversely affect physician and hospital satisfaction scores.  There is truth to this as patients are choosing where they get their care more and more.  This is not our doing and unfortunately it is tied to reimbursement

  13. “Core Measures & Best Practices” – This is ‘regulatory speak’ for initiatives that they want to ram down your throat and have no leverage other than to say “do it or I won’t pay you.  Obviously this cookie cutter approach to medicine then roles downhill to, you guessed it, the providers.  Now don’t get me wrong, there are many good things coming out of core measures but as we all know every patient is different.  Particularly in populations with high frequency of co-morbidities and complications.  This approach ignores that and levels the providers approach to patient care.

Hopefully this helps to translate some of our basic language.  Let’s be clear though, much of this is done because of the gauntlet of requirements that need to be negotiated just to get paid.  Many of my colleagues are genuinely good people with families and feelings and yes, we wear jeans and t-shirts and no we do not sleep in a suit.  For all the complications in the hospital the real enemy is not each other but those that mandate and dictate practice including insurance companies, government, or regulators that add layers of administrative crap to a point where we lose the simple notion of taking care of patients.

If you have a line that you are uncertain of, drop me a note for interpretation.