How to Get Fired in Healthcare. Impossible?

Trust fund babies enjoy income for life, and almost no worries about appearance, job performance or promotion. If they avoid felony, regular cheques never stop.

A job in healthcare offers something similar: an unending supply of sick people, solid incomes and some respect. If you get even a few years’ seniority, a healthcare job lasts your whole working life, regardless of performance.

How to get fired in healthcare

Let’s look at bureaucrats, hospital administrators, unionized employees and doctors.

Bureaucrats

985 federal public servants were fired between 2000-2005. There were 210,000 public servants, 260,00 if we include separate agencies (What Is Government Good At?, p. 196-7).

That means 0.07% of federal public servants got fired for misconduct, or released for incompetence and incapacity, per year.

Maybe the fired employees did something really bad. Or perhaps the other 99.93% were really high performers. Or most likely, bureaucrats do not get fired.

Observation suggests bureaucrats in healthcare do not get fired either.

Granted, layoffs can come unexpectedly. In 2012, 19,200 federal employees were cut (7.3%). But overall, even former Prime Minister Stephen Harper increased the number of public servants by 30,000 during office. Still a pretty secure profession.

Challenge: Name 3 healthcare bureaucrats who lost their jobs for underperformance or a failed program.

Administrators

Hospital administrators usually get promoted from nursing or other allied health professions. They work hard and earn better incomes in management. By avoiding obvious errors, they get decades of solid earnings with job security.

Hospitals started to put 10–15% of administrators’ pay at risk against performance targets. This guarantees targets are modest at best. Why risk job security for 15%?

Only physician administrators can afford to take on real risks. When doctors assume part-time leadership roles, they can push for serious change, secure with their clinical jobs to fall back on.

Challenge: Name 3 hospital administrators fired for low performance.

Bonus: Name 3 that were promoted despite sub-stellar output.

Unionized Employees

Hospital leaders spend at least half their time, if not more, dealing with union leaders’ opinions about process, union member grievances and collective bargaining issues.

Unless they try hard, union members do not get fired.

True, workers risk being laid off during the first few years on the job. Collective bargaining often forces hospitals to hand out raises by firing junior staff. But after a few years of seniority, unionized employees are set for life.

Challenge: Name 3 unionized employees who lost their jobs for performance issues such as low productivity or bad attitude.

Doctors

Parents tell their children to study hard, get into medical school and they’ll never have to worry again. There will always be sick people, and doctors will never be out of work.

Actually, doctors can lose their jobs.

Doctors take on personal debt, so they can work in the public system. Beyond several hundred thousand dollars of school debt, most doctors finance new practices. If they expand a clinic, they get a second mortgage or dip into RRSPs.

Doctors must work hard to cover overhead, or they go out of business. Outside of academics and salaried positions, doctors shoulder the same pressure to produce as every other small business. If they survive, their gross billings become part of average billings the media loves so much, a case of survivor bias.

To be fair, many docs work in niche markets and survive while being rude to patients. This is wrong. In an open system without rationing and turf protection, all doctors would have to serve, or go out of business.

Some doctors commit a felony and lose their licence. But only a few leave this way. Far more close their clinics or change jobs due to business pressure.

Challenge: Name 3 doctors who had to close their clinic, change jobs or quit. (If you need help, check out this infographic.)

Reward for Success vs. Pain of Failure

Everyone champions accountability for doctors these days. But no one tries to make bureaucrats, administrators or unionized employees accountable. Never mind patients.

Hernan Cortes burned his ships in 1519. His sailors knew they had to conquer the Aztec empire or die trying. People never move forward if they see no reward for doing so; less risk in staying put.

As long as…

• bureaucrats never lose their jobs for underperformance and do not get bonuses for success,
• unionized employees get paid no matter how slowly they move and get raises regardless of performance,
• and administrators get promoted just for avoiding mistakes,

…medicare will continue to lag.

Either we put everyone’s job at risk based on performance, or we put all doctors on salary like everyone else. As small medical businesses die off, maybe doctors should work towards the job-security-regardless-of-performance that everyone else in healthcare enjoys?

Physician autonomy is fading into history. Doctors might want to consider trading up for the security everyone else enjoys.