Scrubs vs. Suits — the Battle Inside the Nations’ Hospitals (Part 1)

Practicing Physicians of America Blog

Scrubs vs. Suits — the Battle Inside the Nations’ Hospitals (Part 1)

Marion Mass, M.D.,  PPA co-founder

The headline to a news article dated March 25 on a recent Gallup poll was “Coronavirus Response: Hospitals Rated Best,  News Media Worst.”

 

The public’s low opinion of much of the news media is no surprise.  In polls, journalists have managed to work their way into a special zone of disdain occupied by some salespeople, lawyers and members of Congress. 

 

But there is a reality underlying what this poll says that probably would surprise the public. The physicians and nurses who work in the hospitals of which the public thinks highly do not always share that opinion.

 

That’s putting it mildly.

 

If the public understood what physicians and nurses really think these days about many hospitals and the way they are managed, the likely result of polling would look very different. The treatment by some in hospital management of nurses, physicians and many other healthcare workers in the direct line of fire during the COVID-19 pandemic would probably make the public think long and hard about putting the words “hospitals” and “best” in the same sentence.

 

Cynics could even be excused for wondering whether a hospital corporation bought that headline about the Gallup poll. 

 

On one hand, in the modern, corporate hospital, which may be a hub in a regional healthcare system, we have the “suits,” the executives in the C-suites, with the administrative, bureaucratic structure in which they function. They run the hospitals.

 

On the other hand, we have the “scrubs”—doctors, nurses, and others who change into the uniforms for dealing directly with the sick, uniforms that must be changed frequently and cleaned. 

 

For many weeks, the scrubs, the people “on the front lines” of the fight against COVID-19, have been receiving well-deserved acclaim as HEROES and SHEROES, as the ones risking their health, perhaps even their lives, to take care of others.

 

Remember: the scrubs don’t run the hospitals. The suits run the hospitals.

 

The quiet conflict between these two classes has been building for decades as hospitals have become increasingly corporatized, and more and more doctors have abandoned private practice to become employees. The bitterness of the conflict is generally kept from public view as people bite their tongues and get on with the job, trying to make the best of increasingly difficult circumstances. In any case, it’s not a story that the public, which is most concerned with access to medical care and cost, finds especially interesting.

 

If your antennae have been up during the pandemic, you would have picked up on disturbing and noisy eruptions of the underlying conflict from reports (we may not like them, but the news media have their place) such as these:

  

·   Nurses having to remove their personal protective equipment (PPE) because they were ordered to ration it.

·   Physicians and nurses being threatened with termination if they brought their own PPE to the job.

·   Threats of firing against and actual firings of employees (physicians) who spoke about the actual conditions of their work during the pandemic. 

 

A prominent spokesperson for the suits in hospital administration, Dr. Laura L. Forese, executive vice president and chief operating officer of New York-Presbyterian Hospital, has offered a perspective on the recent problems as someone who left her scrubs behind some years ago for a $3.4 million position in the C-Suite. In a video, she spoke of how “dispiriting” it is for her and other hospital administrators to receive e-mails of protest from weary physicians, nurses, and others describing what they are actually up against, e-mails alleging a lack of respect on the part of management.

 

We note here that Dr. Forese has been adept for years at making high-minded statements about hospital culture. She is a skilled spokesperson for those who decided to lock up the PPE and then retreated to their homes to work in their PJs.

 

In assessing the words of Dr. Forese, there’s something important to remember. The modern hospital corporation has a public face–the people who speak on behalf of the suits in the C-suites. Those spokespersons are masters of serving up a product marked by what the British euphemistically call “an economy of truth.”

 

It would not be politic, for example, for such a spokesperson to mention that at least some of the inhabitants of the C-suite have an entirely too cozy relationship with the Group Purchasing Organizations (GPOs), the huge business entities that control the supply chain for PPE and other hospital equipment—a dysfunctional supply chain that now stands fully exposed by the pandemic.  The Wall Street Journal and others have reported on the dubious nature of the relationship between hospital C-suites and GPOs, about whom we will soon have more to say in another blog entry. 

 

These relationships between suits in hospital C-suites and GPOs make those suits complicit with the GPOs in creating both the specific dangerous shortages that have been exposed by this pandemic and other shortages in recent years that have received almost no coverage. And this is to say nothing of the decline in the quality of what the GPOs supply to hospitals and other institutions involved in caring for patients.

 

But this is only one corner of a healthcare economy that has been emitting a stronger and stronger stench with the passing years.

 

In our next blog entry, soon to follow, we’ll discuss how this fetid complex has developed out of lobbying aimed at a receptive political class and at bending government agencies toward the service of very private interests. Fallen by the wayside in this process? The greater public interest in finding medical care at an affordable cost.

 

Until then, be safe. Protect each other and yourselves. Keep on being scrubs. It’s the honorable thing to do. 

 


 

4 Responses

  1. Mary Johnson, M.D. says:

    This article really resonates with me.

    For last month, I sent a letter to my Chief-of-Staff (COS) . . . a man I respected and trusted . . . quite literally begging for help, protection and fair play as it pertained to a job that was being taken away from me because I had dared stand up for my patients and my nurses.

    This was after two solid years of taking #13 24-hour in-house shifts-per-month of Pediatric Hospitalist call.

    I stayed in-house because I was afraid to be even 5-10 minutes away . . . after all the cuts the CEO had made to staffing/support.

    He gutted the place. As a result, HUNDREDS of years of nursing experience walked out the door.

    He kept asking me to “trust” his judgement. He kept telling me that things would “get better”. But every decision he made only made things worse. A once joyful/family-like unit felt like a prison.

    My contracting “Group” dropped a”notice” on my head in mid-January – just two days after I stopped talking to/skipped over the DEAF ears of administrators, and voiced my concerns directly to medical staff leadership about big problems with Pediatric preparedness at the hospital.

    What I tried to initiate is called medical governance . . . i.e. the MEDICAL staff policing the place in the interest of patient safety.

    Alas, it’s MUCH harder to do when EVERYBODY is “owned” by the hospital.

    The suits ALWAYS pull their triggers on doctors “without cause”. They never have a reason that they can defend. They NEVER talk to you before – or after.

    They bank on the doctor being too worn down or humiliated to fight back.

    It’s all about the cover-up. In all reality, employed/contracted Doctors (who take Oaths) trapped in “the corporate”, have no rights of due process or fair play.

    No one holds “the suits” accountable for anything – no matter how crappy their judgement turns out to be.

    Case in point: Randolph Hospital (Asheboro, NC) fired me for saving a baby’s life 22 years ago. The hospital declared bankruptcy early this year – after the overpaid “suits” who destroyed my dream of practicing in my hometown finally ran it aground. Karma is often slow, but she’s a real biotch when she shows up.

    Fast forward TWO DECADES. NOTHING has changed. Reform was a JOKE.

    After getting my letter – which he called a “masterpiece” – the Chief-of-Staff came to talk to me. This was just before I was set to go on a short leave for my Mother’s shoulder surgery.

    He asked me what I wanted. I told him him, “my job”.

    I cried (I NEVER CRY). I confided. He told me that “the Group” was willing to talk – after I got past the surgery. He gave me the impression there was reason to hope.

    Then I got sick. REALLY SICK. COVID19 style sick. Mother’s surgery was cancelled. I self-quarantined. I was terrified. For me. For my Mom (who I did not want to expose). “The suits” who ran the group/hospital did not offer to test me.

    They did not want to know.

    By the end of March I’d heard nothing from the people in HR that the COS had said were so willing to talk to me.

    The conversation the COS promised never happened. It was a total “bait and switch”.

    As of today, it was made clear it would not happen. That’s why I’m up at 2 AM composing a Facebook post on my cell phone. I cannot sleep (this post has been edited a few times in the light of day – and on a larger computer screen).

    The e-mail said, “Thank you for your service. We wish you the best. (KISS OFF).”

    Once again someone had lied to my face . . . this time someone I really trusted at a time when I was horribly vulnerable. He used my fear and exhaustion and vulnerability to glean information for the “Group” (for now, let’s call them “the collective” . . . as my resistance was clearly futile).

    I’ve got to say it’s a fairly personal “hit” given how highly I held the Chief in regard/esteem.

    Meanwhile, the hospital’s medical “parent” – a very big NC name . . . whose QA Department head was copied everything I sent hospital leadership . . . BEFORE the “notice” was dropped . . . and who was sent a copy of the letter I sent to the COS . . . has done NOTHING to intervene/STOP “the suits” or “the Group” from carrying out their retaliation . . .

    . . . again, retaliation for standing up for my patients and my nurses . . . not to mention me/my own safety.

    The medical “parent” company’s website says that quality assurance is a high priority.

    Their QA Director told me that doctors/nurses in their organization (including the affiliates they oversee) should have no fear to report.

    Except when it’s me, I guess. She didn’t help ME.

    I have spent well over SIX MONTHS just trying to SIT DOWN AND TALK TO SOMEBODY AT THIS HOSPITAL ABOUT THE PROPER/SAFE CARE OF INFANTS AND CHILDREN. OVER SIX MONTHS!!! That’s my SIN.

    It’s Ballad Health/Alan Levine, Part Two.

    These “suits” cannot understand why, in the face of this pandemic, SO MANY DOCTORS AND NURSES ARE TURNING TO SOCIAL MEDIA TO BE HEARD?!?

    And/so, after Saturday, when the “notice” that I was forced to work out (shorted on shifts and income even then) expires, there will be nothing to discuss – and nothing that can be fixed without adding lawyers to the mix.

    I hate lawyers.

    But the “suits” love them. They pay them small fortunes to cover up their literally EVIL deeds. It would be TOO SIMPLE to avoid all the mess/ugly/expense by just sitting down and TALKING to someone like they’re a HUMAN.

    The “suits” are actually PAID ridiculous sums of money to do exactly that – to “manage” and talk to people – but they just can’t do it. They don’t know how to listen or compromise.

    Doctors and nurses are commodities to be bought and sold.

    I can tell you this. If the COVID19 virus affected babies and children the way it does adults, the babies and children would JUST DIE. The country would be in even more of an uproar, but it would not matter because when it comes to Pediatric services, our community hospitals and Mother-baby services have been GUTTED. There’s NEXT-TO-NOTHING left on the front lines to fight with.

    NO ONE CARED as this happened – as we lost the ability to do even the BASICS. As a doctor, I am so tired of hearing that “the suits” care about patient care or “provider” well-being/safety, when everything they actually do screams otherwise.

    It’s their own checks and bonuses they care about.

    And/so a gifted Pediatrician with almost 30 years experience can be treated like dirt on the bottom of a “suit’s” shoe – cast to the curb for reporting bad things.

    All those years ago, the whole idea behind “managed care” was that “the suits” would make our lives and practice EASIER – not harder. It was the biggest LIE of all.

    I was actually told by the previous “Chief” (an ED physician) . . . the one I originally appealed to only to be immediately fired (maybe because what I was reporting reflected not so favorably on his leadership) . . . that I could be replaced by a nurse. It was clearly a threat (and kinda put a damper on our “relationship”).

    “Dime a dozen”. All that jazz.

    I am here because I want my friends and colleagues at work to know that I did not leave them of my own accord. This is the ONLY way to do that – to have the HUMAN connection. I NEVER would have cut, run and hidden (as “the suits” hide) in the face of a pandemic.

    But I was given no choice.

    I beg of my friends not to comment here (it will only make you a target – and I’ve already seen that happen to too many people under this hospital “regime”). But feel free to PM me.

    People tell me that I need SUE.

    Some people tell me that it’s time to walk away from what I love – what I am very good at – in order to be happy.

    They also tell me I need to write.

    So here I am. Writing. Something has to change. That usually starts with one person saying, NO!!!, and letting other people join in.

    I am one person. And I am saying, NO!”.

    I hope it matters this time. I hope that, after years of putting my patients first, I matter.

  2. The day physicians learn business is the day the scrubs become a force. Until then they are playing chess and we are playing checkers.

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