It is without a doubt a sometimes obvious but curious necessity to call in an outside contractor for help. I’m very cognizant and transparent about who I am as a locum tenens provider and the role I play in helping to stabilize or “transition” the situation of a hospital, clinic or entire healthcare system. While some jobs of course require the help of a locum tenens provider due to life circumstances and changes in the workforce due to external influences (eg: death, maternity leave, or prioritizing other parts of one’s life), there is inevitably a need for workers as myself to fly in as rescue workers, not for a patient, but for a crumbling administration. It is not unheard of and often unpredictable to be cast into a sinking ship that is struggling to survive. Sometimes the ship is a small tugboat in the countryside and other times it is the Titanic barely afloat among staffing issues in a big city because of poor management, lack of evolving adaptation or resistance to listening to the plight of the workers on the ground floor by the higher ups. There are pros and cons to a hospital that is “transitioning” and healthcare is an ever-changing monstrosity with a seemingly perilous self-induced involuting path in the United States; but, as long as there is unrest and cacophony as such, there will be a need for outside help, a need for the travel nurse, the temporary respiratory therapist, and the locum tenens physician.
I am absolutely fascinated by healthcare administration, the creation of systemic protocols and the top to bottom flow of information with deaf ears to the voices on the ground floor. Over the decades, due to disconnect between clinical care and business administration, the roles of CEOs of hospitals has changed and the makeup of hospital boards that consist of medical providers versus not is quite diverse. Large organizations have privatized medicine and instituted contractor groups that have moved in to entirely wipe out workforces. At the same time, multiple hospitals are now owned by larger organizations and the power is no longer within the hospital workers themselves. It is one issue when a CEO doesn’t listen to the worker on the ground floor and makes changes that are profit-driven instead of quality-driven; but, it’s a much larger concern when the CEO is owned by an even greater entity and is now themselves Chief of Nothing. The levels of separation grow and eventually the phone tree becomes too large to efficiently transfer change or information in a productive way that moves the world forward. When you don’t listen to the ground floor, the changes at the top cause only destruction; it is of course, impossible to be strong without foundation.
Over the course of only 3 years, I have seen the entire world change in over a dozen hospitals. I have watched entire hospital units close, I have watched physician groups remove themselves from hospitals, I have heard of unsafe situations playing out in places where administration prioritizes profit over safety. I have walked into hospitals where the entire staff has been replaced by “travelers” as unrest has led to an upheaval of the permanent workers. Work is outsourced, communities are fragmented, and ultimately the patients are the ones that suffer. The problems are always multifactorial and I don’t claim to have the answer, but instead encourage a larger holistic understanding of the changes that occur in seeking to help and bail out these burning buildings. It is not the government that plays the most significant factor in the crumbling of these entities, most of the time.
While a CEO that lacks understanding of the ground floor may nose-dive a company, a medical provider by nature of being a medical provider won’t necessarily be able to rescue it. The hospitals that are successful have multiple disciplines that approach, digest and communicate needs effectively instituting changes for the greater good of the hospital. A medical provider would likely lose focus of finances and may lack the background of business and administration by nature of medical training alone. On the flip side, someone that has never been a clinician often makes unrealistic expectations for metrics that do not truly impact quality of care or patient outcomes; or, are unsustainable and exhausting of those asked to carry these tasks out.
As I walk in to these burning buildings, a spectre with the guise of help, I am witness to the collapse of hospitals and hospital systems among the shroud of stubbornness and blindness to the issues at hand. I offer third party perspectives for rescue and sometimes outside help is a time for fresh eyes, but it is often too late or falls on the ears of those unwilling to listen. When each person focuses on the one room on fire, they are unable to extinguish the inciting source, and eventually there is nothing left, except the lives that might have been.
The Nomadic Pediatrician 