The Professional in Bureaucracy

In order to understand what is going to be discussed we must first define bureaucracy. According to Wikipedia, bureaucracy is the combined organizational structure, procedures, protocols, and set of regulations in place to manage activity, usually in large organizations (Wikipedia 2010). Basically bureaucracy is a chain-of-command type of organization. Within this type of organization problems can arise between the physician and the organization in that the physician must also follow a chain-of-command role.

We are going to look at the physician within a bureaucracy and how certain bureaucracies of Medicare and hospitals affect the physician-patient relationship. According to Max Weber there are seven characteristics of a bureaucratic organization. They are a fixed division of labor, hierarchy of offices, authority of officials, rules that control performance, workers do not own the resources to do the job, business is done with written documents, and there are clear career paths one can follow.

Weber made it clear that the characteristics of the bureaucratic organization were developed to solve problems. According to Weber, these characteristics when executed effectively, would allow the organization to be highly efficient. If Weber’s type of bureaucracy is so effective then why are doctors leaving hospitals and joining other doctors to open specialty hospitals? Physicians are looking for ways to cut off the bureaucratic leadership in hopes to improve patient care and to create more time to spend with their patients.

Physician owners argue that physician owned hospitals are more efficient, provide better care, and have a higher patient satisfaction then community hospitals (Bristol 2005). One of the most important parts of a physician owned hospital is that if a change needs to be made it can be made and implemented in a few days. Within a major hospital system changes would take weeks, months, or sometimes years to implement. One major concern is that physician owned hospitals can pick and choose patients they want by what type of insurance the patient has.

Major hospitals claim that the physician owned centers take the healthy, well paying patients and leave the rest for the major hospital. Physician owners argue that competition will drive down costs and improves patient care (Bristol 2005). What is clear is that with the passage of the health system reform bill, more bureaucracy will be created. The bill also prevents any new physician-owned hospitals from opening after the end of the year (Page 2010). This type of bureaucratic control will not allow patients to seek out the best healthcare.

It will create more business for the major hospitals but it also leaves patient choice and quality of care out of the equation. What will happen is that major hospitals will have to become more patient care efficient and also become more cost efficient (Page 2010). By stopping or limiting physician owned hospitals, means that physicians and other major hospital staff must increase their productivity and offer a greater amount of service to make up for less hospitals. Physicians must step into the bureaucracy and fall in the chain-of-command with the other professionals they work with.

According to Dr. Steven Gaede of Tulsa, “There’s a huge disconnection between physicians and administration at hospitals all across the country that is frustrating, bad for patients, bad for medicine and ultimately bad for hospitals” (Bristol 2005). In today’s healthcare world the way hospital owned physician offices are run like what Henry Mintzberg called a “Machine Bureaucracy” (Savage 1997). The patient only gets about 15 minutes of time with the physician. In those 15 minutes the physician has to exam, listen to, and come up with a diagnosis and treatment plan for the patient.

This type of patient care mostly points back to the Medicare program. According to physicians surveyed, they say insurance companies and government payers, such as Medicare and Medicaid, take time away from patients who want to see their physician (Udall 2009). The physician’s time is tied up with having to do peer-to-peer conversations with a physician who works for the insurance company, in which the patient’s physician basically has to explain to another physician why they ordered a certain test.

Also, with all the red tape and policies that must be met to satisfy Medicare and Medicaid, the patient is not likely to receive the quality of care they need. Physicians are concerned with reimbursement of Medicare patients because of claims being denied, late payments, incorrect payments, and the high cost of hiring someone to review claims before they are summited for payment (Udall 2009). More and more physicians are beginning to limit the number of new Medicare patients they will see. They are getting tired of fighting for payments that will cover their costs and nothing else.

The bureaucracy of Medicare, with the help of Congress, creates such a complex system that even employees of the Center for Medicare and Medicaid services cannot answer questions about billing issues. This is a perfect example of a quote from George Van Valkenburg when he said, “Man creates problems. Government and bureaucrats magnify them 100 times. ” The bureaucratic organization, if done correctly, can be highly efficient and effective. Within our current system it seems that it is more of a disaster with a little bit of chaos mixed in.

Physicians have a hard time stepping into a role where they are not the leaders but simply an employee or actor performing a role. If there were a way to develop a relationship between the physician and the administrator where it is win-win for both sides then the healthcare system would be efficient and patient care would be a high priority. In our current system we are far from efficient or effective at offering quality patient care. We must eliminate some of the bureaucracy in our health system in order to better care for patients. WORKS CITED 1. ) Wikipedia contributors. “Bureaucracy.

” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 17 Oct. 2010. Web. 2 Nov. 2010. 2. ) Bristol, N. 2005. “Physician-owned specialty hospitals in the USA. ” The Lancet 366(9481):193-194. 3. ) Page, L. 2010. “What Health Reform will mean for physicians and hospitals. ” Becker’s Hospital Review. 4. ) Savage, D. , P. Robertson. 1997. “When Organizations Collide: The Case of Physicians and Hospitals in the United States. ” Business and Economic History 26(2):662-675. 5. ) Udall, P. , B. Annear. 2009. “Health Insurance and Bureaucracy Rob Patients of Their Doctor’s Time. ” Texas Medical Association.

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