Do you wonder why you cannot find a doctor or nurse to care for you? If you are one of the 15% of Americans who are uninsured, you assume it is your lack of health insurance. If you are in the 85%, you…just don’t understand at all.
Everyone knows that health care providers are in short supply. And the shortage is getting worse. While low pay is a factor, it is not the main reason why people are either leaving health care or not going into it at all.
In 1993, social scientist Carl Weick wrote an academic paper titled “The Mann Gulch Disaster” in which he described a “cosmology episode.”
That is the answer to the question, Why can’t I find a nurse or doctor?
While there are numerous reasons why people choose to work in healthcare, one stands above all others: moral clarity. From the boiler room through the operating room to the Board room, people in healthcare know – without question – that what they do when they go to work is good and noble: they are helping others.
So why, they cry, does it seem to get harder and harder? Why do people in healthcare feel under constant attack? Are they paranoid or is the attack real? The explanation is cosmology episode.
According to Professor Weick, every person on earth functions with certain basic, subconscious assumptions that make the world understandable. The cosmos is not arbitrary or capricious: it follows rules. The sun always rises in the east. If you throw a ball up in the air, it will come down. If you hold your head under water long enough, you will drown.
But…
What if you watch the sun rise from the south? How do you explain a ball that never comes down or someone who can live under water? You can’t. A world where there is no gravity or where you can breathe water…makes no sense. The cosmos is not following the rules. You are in a cosmology episode.
Now imagine that you are a health care provider, and you experience the following.
- The system that is supposed to help you help others, called healthcare, actually makes it difficult-to-impossible for you to do your noble work.
- When a patient has a bad outcome, you instantly change from fiduciary to perp.
- Even though you are working harder and patients are doing better, payers have reduced your revenue below a level where you can stay in business.
- As the number of nurses, doctors and other care providers keeps dropping, the number of overseers, regulators, and bureaucrats continues to rise. There seems to be unlimited money for them and no money for you.
Providers who experience the above are having cosmology episodes. They think they are dreaming a nightmare, but it is worse. They are actually awake and living the nightmare.
There is overwhelming evidence of provider shortages. Professional satisfaction has gone from 95% to 20% in thirty years. Forty percent of doctors over 50 years old are considering early retirement. Over five hundred thousand nursing positions are unfilled in the U.S.A.
Maybe, you muse, things are better in countries with universal health care. Unfortunately, they are even worse. In Canada, people are dying in line waiting for care that was approved but cannot be provided because of the shortages. In Great Britain, within three years after finishing training, doctors are looking for ways to get out of healthcare.
The Democrats’ “fix” for healthcare, disingenuously titled the Patient Protection and Affordable Health Care Act (PPAHCA or “Obamacare”), is making a bad situation worse. Insurance premiums are soaring, making insurance unaffordable even for those with jobs or money.
Payments to doctors are repeatedly being cut, forcing them to do one of two things: either 1) “make it up with volume,” meaning even less time per patient, or 2) leave healthcare altogether. Meanwhile, the bureaucracy is massively expanding with thousands of new rules and regulations (just what we need!)
If it is possible to exacerbate a cosmology episode, PPAHCA is doing it and making the shortages even more critical. Yet, PPAHCA is not the root cause. The problem started long ago, when the healthcare system grew without principles, guidelines or plan.
Healthcare is a system that is not a system. It works against the best interests of both patients and providers. Because it is contradictory and perverse, the healthcare “system” – or lack thereof – is root cause of cosmology episodes.
Assigning blame won’t work. There is no simple solution or quick fix. Until we replace the whole system – from tort reform through the financing structure to the culture of health care – cosmology episodes will become more frequent, and as a result, patients will suffer.
Would YOU voluntarily work in an industry where the pay is low and getting lower; where the rules and regulations are stifling, incomprehensible, and constantly multiplying; where the government steals all your resources; and where your customers (patients) blame you when they need you the most?
I did and I regret it.
(This article was excerpted from the book Uproot U.S. Healthcare.)
