Doctor Cog

Who’d a thunk it?
Three months ago, I was laboring along in the traces, running my small Emergency Department, working my shifts, and oblivious to how life can change in a day. My hospital is under some stress. We are losing money, losing doctors, losing entire service lines. The Board fired a CEO they had just hired, gave him his golden handshake, and said “Enough!” The new CEO, incidentally the second choice at the hiring of the failed first CEO, came in to turn things around. Meanwhile, we had also lost our COO, CFO, CMO, CNO (chief nursing officer), all of whom were replaced by consultant temps. And they invited their buddies, more consultants, who jet in on Monday, and out on Thursday, all on the Hospital’s account, and tell us how to do everything, from recruiting to staffing to bricks and mortar and maintenance. So there is literally no institutional memory left in the Admin suite. The want to know “What have you done for me lately? And by the way, I am new here.” The consultants all recommend the same thing. Cut staff, cut costs, be more efficient. But the cuts go to bone, and whole floors are now closed, to the point that we cannot get a bed for a patient for 6 hours, because there are no nurses to care for them upstairs, but yet we are attacked in meetings for slow turnaround times. “Don’t bother me with the facts, I already know you are the problem.” It is disheartening. Any attempt to discuss things is characterized as "defensiveness". Any advocacy for patients or nurses is ruled as not in my purview, or "off the table". I used to have administrators who said no when they meant it, and yes when they could, but you could believe what they said. Now I know better than ever to go to a meeting without my tall boots and a forked stick. These new bosses have made it clear that nobody is individually important or respected, and anybody and everybody is replaceable, just a cog in the larger machine. I believe them when they say that, because they are proving it daily. The hospital is being gutted, strafed, and burned to ashes, and the people who have dedicated large parts of their lives to its success and survival are being cast aside like used Kleenex. The consultants are being paid, for sure, and right off the top. But I am left wondering, why do we need all these guys? Why are the folks hired to manage things unable to manage without all these consultants? Isn’t that their job? If they can’t manage, why are they still here, when people who can actually do something, like nurses and doctors, are gone? This Consultancy is starting to resemble the Consultancy which was rendered to Atlanta by General Sherman. We will be a forest of chimneys standing amid heaps of smoking rubble. And the CEO will move on to another hospital in trouble, and repeat the process, while the consultant sharks will swim to the next scent of blood in the water, right behind him.
Anyway, after a couple of discussions of problems in the ED opened with threats to fire my company and replace me, it became clear to me that my fifteen years of service here, and good reputation generally, meant nothing to these guys. Every day started as if with the premise, "We might get divorced today, Honey, but let's see how the day goes." Hard to endure a marriage on that basis. Hard to even finish your Cheerios. So I started looking for a new gig. Now that is stressful. I am not one who keeps an up-to-date CV all polished and ready to send out. I was planning on retiring out of here in eight or ten years. Putting all the gritty details of 23 years of practice onto paper, and finding and copying all the documents required by all the committees and state regulators is a tedious and painful chore. They want everything. They want dates of graduation, of starting and stopping residency, of each job, copies of every diploma, board certification, your latest Trauma Life Support and Cardiac Life Support cards, and copies every insurance policy ever issued in your name, even if paid for and held solely by your past employers, who have long since gone out of business. They want letters certifying competence, character, and moral fiber, and confirmation that you left each job in good standing, and not under investigation. They want a criminal background check, a National Practitioner Databank Search, and a record of every complaint ever filed against you. Then they want sworn statements verifying all the above, which they are verifying primarily anyway. It is a lot to assemble. But it is done, for now, and I await the judgment of the State, and various credentials committees at hospitals where I might be working soon. It takes 60-90 days, it turns out, no matter what state you go to. Like all Chinese food is ready in “ten minute”. Sixty to ninety days, they tell you, but they mean 120. Meanwhile, I labor on here, doing my best for my old, wounded hospital, for my soon-to-be bereft patients, who rightly wonder who will care for them, once I finally go. I can’t give them an answer, and their sorrow is both affirming, and depressing. I will miss them, they will miss me, and the whole thing should never have happened. At this point, the windbags who administer by threat are smug in their certainty they can replace me readily, and even trade up. If they are right, then good for them, and shame on me, I guess. But I have been in the recruiting business for fifteen years here, and it has never been easy. There are a lot of toads to kiss, and not many princes. So we will see what comes. But the lesson, whichever way it goes, will be too late to prevent my departure, and the consequent loss to the community. The Spinmeisters are already out there, planting the seeds of their future defense, spinning tales of my failings and of what a lousy administrator I really was. I expect that. I am a big boy in a big, cruel world. Still it hurts.
The good news is only that the new folks seem to like me. After a little break-in period, during which I will have to be at my very best, sharp and good, and running on the edge, I am sure we will love them, and I hope they will appreciate me. There is always an element of risk there, as one bad outcome in the early going can sour things in a hurry. Even if you do everything right, if a bad thing happens before the trust is built up, you can find yourself in a bad spot. So I will have to be on the top of my game, on best behavior, on hyper-vigilant alert, and then hope that luck follows. Generally it does, as Fortune does indeed favor the prepared mind, but she gives no money back guarantees. And maybe this will be for the best for me, forcing me to get out of my comfort zone, and really bring my brain to full function. Might just make me live longer. Might just kill me. At least I will no longer be an Admenstruator.
So, if you are wondering what the hell happened to me, and why in hell would I up and move three thousand miles at age 53, and start all over again, well there you have it. The moral of the story is: In chaos, there is opportunity.