Who Is The Boss? by Ted Bacharach MD (retired)

Administration and Medicine

Many years ago hospitals were run by physicians and an administrator was hired to help. Today this has changed considerably. Physicians are usually not very interested in administration and were happy when these functions were assumed by administrators. It did not take many years before these administrators realized they could take control. Initially administrators became the person in charge of the hospital, the medical staff and a chief of the medical mtaff took over decisions regarding medical matters. This seemed like a great system where physicians controlled medical decisions and care and the administration made administrative decisions.
The problems associated with HMO’s, insurance companies as well as Medicare and Medicaid all complicated hospital operations in both financial as well as medical matters. These problems made operations more complicated and the separation of medical from financial decisions became increasingly complicated. Administrators learned rather rapidly how to take control. Initially the process involved being in an advisory capacity to the medical staff but unfortunately they felt that the medical staff was not too pliable. One of the first methods commonly used to take control is where a hospital staff did not approve the individual that the medical staff had chosen for a chief. There was quite a reaction by many medical staffs in California where this had occurred. The outcome was not decisive and throughout California, and I suspect elsewhere, the medical staff is often not too well informed by administration and not asked for opinions. Medical staffs have quite effectively been excluded from administrative as well as medical decisions. I suspect that the outcome is not reflected in improvement in the care our patients receive.