black and brown analog desk clock

I was talking to two friends recently, both physicians in emergency medicine in different parts of the country. We periodically share our war-stories and assorted complaints. We also discuss the silly, and nefarious things that hospitals do at times which cross all corporate and geographical boundaries.

Most recently we talked about the idea of ‘flexing off’ workers. Since we all work in emergency departments we know how this looks.

Let’s say the emergency department usually sees 60 patients a day (which is a low to medium sized department). One day, however, it’s very slow and by about 3 pm, only ten patients have checked into the department.

Someone in administration looks at this number and says ‘well, we’re slow so we need to send people home.’

Subsequently, a nurse, a patient care technician or worse, a unit secretary are told to go home. It’s always nice to go home. However, since they aren’t salaried but are hourly, it means they aren’t being paid. They’re losing money.

Let me say right up front that this is a grave insult to people who are dedicated to their work and who don’t make much money. In particular, I’m thinking of secretaries and techs who are making in the range of $14-18 per hour. The $14 dollar per hour secretary goes home four hours early and the hospital has saved $56 dollars. A tiny fraction of what will be collected from patients during even a slow shift. That’s just mean.

For some perspective on the amount of money in healthcare, I offer these two links:

First, the 20 biggest healthcare companies by revenue.

Second, the seven highest paid health system CEOs.

Put that in the perspective of $56 dollars and think about it.

Of course, the other great madness of this is that we can never, ever predict what’s coming through those ambulance-bay doors. Unlike an office practice with scheduled appointments (for instance, a dermatology practice or an internal medicine office), volumes can vary wildly in the emergency department. It takes one bad car crash, one cardiac arrest, two overdoses or a mass shooting. And suddenly, the department is short of staff and struggling to stay afloat.

It seems sometimes as if the goal is to make work in emergency departments as close to miserable as possible in order to keep the finances in check. Just how few nurses, how few techs, secretaries or physicians can plow through the chaos and suffering? Based on the dedication and heroics of the people I have worked with for my 29 year career, a lot gets done very well with only a little. But it takes a toll, physically and emotionally. And it leads to good staff regularly for better jobs whenever possible.

The thing is, sometimes it’s OK to have a slow day at work. This isn’t a crime or a failure. Sometimes, it’s good to be a little bit ‘staff heavy.’ As we struggle to figure out why nurses, physicians, medics and all the rest leave their jobs, this might be a useful consideration. A slow day allows us to stock. It allows us to problem solve.

And it just gives an emotional break to people who routinely watch people die and listen to their loved ones weep, even as they try to offer those family members a cup of coffee or simply a hug.

I know that hospitals have to make money. I like it when they do because it helps me to do the same. That, in turn, allows me to support my family.

But given that healthcare is composed of what we called ‘heroic frontline workers,’ and ‘essential workers,’ it seems that we could routinely dispense with the whole idea of ‘flexing off’ those people who make very little, work very hard and now and then deserve a day that isn’t terrible.


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