Hospitals as businesses

There are about 6,500 hospitals in the U.S. About 300 of them (less than 5%) are run by people with medical training. This trend has been years in the making; there are now 30 times more non-medically trained CEOs than there were 30 years ago. Plus, the number of independent practices has gone way down as hospitals buy them up. 

The CEOs are pressuring the medical staff to be more aware of the economic impact of their decisions. For example, doctors are being pressed to discharge patients quickly and to concentrate on profitable procedures such as orthopedic and heart surgeries. Administrators are even exerting control over traditionally medical domains, such as the credentialing of new physicians with hospital privileges. 

The results have not been very good. A study in 2011 found “a strong positive association between the ranked quality of a hospital and whether the C.E.O. is a physician.” Overall hospital quality scores were about 25 percent higher when physicians, not business managers, were in charge.