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.
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.