Hospitals serve to provide a buffer between life and death, and are a last resort when one is ill or suffers trauma.
They are perceived as towering buildings with sanitized rooms curing patients by providing medical skill and compassion for those entering their doors. This illusion is brought to you by the American Hospital Association.
Hospitals are a business. We worry these community facilities will fall into bankruptcy as they did a decade ago. From this instilled fear, the public has ignored and enabled the takeover of medical decision-making by hospital administrators to the detriment of reliable physician input.
Your doctor is no longer in charge of your hospitalization. Physicians are dependent on resources provided by the hospital, and services provided to you may be compromised by administrator influence. Ask your MD.
Unlike a clinic or doctor office, ailing patients in a hospital setting need that buffer between life and death. Long hours of training by physicians allows them to hone their skills and intellectual experience qualifying them to deliver this necessary care.
One difference between a doctor and nurse (RN) is the former prepares a methodical treatment plan from gathered information and gives orders, while the latter implements these orders. Between these two professions are physician assistants (PAs) and nurse practitioners (NPs) who must sharpen their skills to arrive at the analytic level of physicians.
RNs, PAs, and NPs are frontline caregivers when you are admitted to a hospital. Could there be an attempt by hospital administrators to affect decision-making made by these professionals?
You would hope applications from PAs and NPs for staff privileges are assessed by doctors. This has not been the case at our California hospital. This right was seized from physicians so administrators could handle screening and vetting of NPs, some of whom are employed by the hospital.
A State rule mandates doctors scrutinize applications from PAs. But administrators falsely accused executive committee physicians of delaying PA implementation, so this assessment was covertly transferred to the Board of Directors.
On some hospital shifts, over half of the RNs are new graduates. Since they are on the lowest rung of the pay scale, it is decidedly a hospital economic scheme to lower costs. Does inexperience have an effect on decision-making? Ask your teenage kid.
Why would hospital administrators want to affect frontline caregivers like RNs, PAs, and NPs? Control. Again, hospitals are a business. If they control who is hired and fired, dangle contracts and wages, and have leverage to arm-twist these highly educated professionals, then it ultimately enables administrators to boost their personal salaries, bonuses, and retirement plans.
Does it have an effect on medical decision-making by these professionals? Of course. How do I know? Because I already see hospital contracted physicians bowing to the same financial forces.
Whether it be RNs, PAs, NPs, or doctors, their role in your hospital care may be a business tool used by administrators to manipulate medical decision-making. Does this compromise patient care and diminish your buffer between life and death?
Ask your hospital.
Gene Uzawa Dorio, M.D.
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