On episode 254 of The Nurse Keith Show nursing career podcast, Nurse Keith discusses how 21st-century healthcare delivery is predicated on the exploitation of nurses, nurse practitioners, physicians, and other clinicians. These spurious practices undermine care, drive provider attrition, and lead to unhappiness, stress-based illness, mental health issues, and even suicide. If we truly care about providers and patients, this cynical and greedy calculus must change.

On June 8, 2019, an article was published in the New York Times that clearly stated something I’ve been thinking about for quite some time. The article was titled, “The Business of Health Care Depends on Exploiting Doctors and Nurses“, and the subtitle was “One resource seems infinite and free: the professionalism of caregivers“.

This disturbing trend is apparent in the lives of so many nurse practitioners I’ve encountered, including dear friends, colleagues, and career coaching clients, and especially those who work in primary care. The complaints I hear are concerning NPs who have to see dozens of complicated patients per day with only 15 minutes allotted per visit.

Please click here to read the companion blog post to this podcast episode. Meanwhile, here are some salient excerpts:

This disturbing trend is apparent in the lives of so many nurse practitioners I’ve encountered, including dear friends, colleagues, and career coaching clients, and is especially apparent in those who work in primary care. The complaints I hear often concern NPs being forced to see dozens of complicated patients per day with only 15 minutes allotted per visit. With sicker patients, complex comorbities, and other factors that make care more time-consuming and complicated, our frontline medical providers are put in an impossible situation with only one certain outcome: provider burnout and the compromising of patient care.

The reality of medical and nursing care is far beyond what the corporate bean counters will acknowledge. When healthcare is corporatized to such an egregious level based on nothing but the financial bottom line, productivity becomes the keystone of every aspect of patient care, not to mention so-called “patient satisfaction”.

But what happens when providers are so burned out that they cannot provide the care they’re ethically bound to deliver? What about provider satisfaction? Do those watching the flow of money care that approximately 400 American physicians commit suicide per year? We don’t have accurate data on the number of nurse suicides, but we readily assume that this is an issue facing nurses and APRNs as well. How far does this calculation need to go before we notice and actually do something about it?

As Dr. Ofri points out, the EMR has revolutionized healthcare and few of us would voluntarily choose to revert to paper charts. However, the dark side of the EMR is that we can be forced to work from home because we now have 24/7 access to patient records.

If construction workers (who, by the way, experience far fewer on-the-job injuries than nurses due to strictly held safety standards) were asked to work three hours of unpaid overtime a night in order to document their work, what would they say and do? They’d probably tell you to stick your documentation where the sun doesn’t shine and then go on strike against their employer for unfair labor practices.

At face value, this situation seems untenable and intractable. The corporatization of healthcare will continue apace, more and more will be demanded of our NPs, RNs, and MDs, and we’ll continue to lose good people.

The notion of the “triple bottom line” is one concept that more healthcare institutions could adopt, and that means taking into consideration people, planet, and profits. While this may be anathema to those who watch the healthcare money flow, this is one way to humanize the way we deal with such a highly valuable workforce.

And while hospitals focus so terribly much on patient satisfaction scores in order to secure Medicare reimbursement, whatever happened to provider and employee satisfaction? Doesn’t the Center for Medicare and Medicaid Services (CMS) understand that burned-out nurses, NPs, surgeons, and physicians actually contribute to worse patient satisfaction? And what if employee satisfaction scores impacted Medicare reimbursement? How the accountants and executives might scramble to keep those providers happy.

This overly corporatized healthcare infrastructure is strangling the system and hobbling good clinicians who can’t take the strain. Yes, we can bill, bill, bill for those reimbursements, but when that final “bill” arrives and we realize that outcomes are plummeting and our employees are being driven away, perhaps then we’ll see the light and begin to brainstorm solutions.

Dr. Ofri’s New York Times article concludes:

The health care system needs to be restructured to reflect the realities of patient care. From 1975 to 2010, the number of health care administrators increased 3,200 percent. There are now roughly 10 administrators for every doctor. If we converted even half of those salary lines to additional nurses and doctors, we might have enough clinical staff members to handle the work. Health care is about taking care of patients, not paperwork.

Those at the top need to think about the ramifications of their decisions. Counting on nurses and doctors to suck it up because you know they won’t walk away from their patients is not just bad strategy. It’s bad medicine.


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Nurse KeithIn case you didn’t already know, Nurse Keith is a holistic career coach for nurses, award-winning nurse blogger, writer, podcaster, keynote and motivational speaker, and popular career columnist. With two decades of nursing experience, Keith deeply understands the issues faced by 21st-century nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast. Keith’s message of savvy career management and professional satisfaction reaches tens of thousands of nurses worldwide. Keith can be found on Facebook, Twitter, LinkedIn, and Instagram—as well as at NurseKeith.com.
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