Healthcare’s Nepotism Problem in the time of a Pandemic

The response to Covid-19 in the United States will depend on having world-class healthcare administration to support the efforts of medical professionals in the front lines. This alarms me, as my 20 years of experience in the healthcare industry has taught me that healthcare administration on both the provider and payer sides of the equation has been rotting from nepotism and incompetence for years.

Towards the end of my career, I became increasingly worried as I noted that Vice Presidents and C-level executives in healthcare weren’t being selected on their merits or their abilities but by their genetics. When I reported to a VP of IT at a health provider network/health insurance plan, his nephew was given a paid internship throughout his summer. The internship continued through his senior year in college. The manager that gave him that job was promoted to Director. He wasn’t the only one, two other unprepared nephews worked in the IT department as well. I was not surprised when our data was hijacked and our identities were stolen, as the data security department had two nephews in its ranks.

While many organizations will tout their nepotism policy, few are meaningfully written and enforced. The organization I cite above had an extensive nepotism policy that was followed to the letter, resulting in strange-looking organizational charts, and ‘off the book’ reporting relationships. The exact atmosphere that you need to create poor practices and processes. The larger the organization, the more difficult the policies can be to police (and the more complicated those informal chains of command become).

It’s not a surprise when a family physician hires their wife to do their reception desk and medical records. What becomes complicated is when large healthcare conglomerates, often associated with university health systems, purchase those physician practices with the intent to fold their patients within their referral system. Along with purchasing the practice comes converting the employees. When nepotism runs rampant, it’s patients that pay. When nepotism has been running rampant for decades and a pandemic hits — we will all pay.

Several contractors and deals where I worked were based on favorable recommendations of the CTO, despite the organization’s inability to meet any deadlines. Any deadline that wasn’t regulatory was arbitrary, and even then there was always the philosophy that ‘as long as we are working towards change and have a timeline, we’re okay.’ This has been the prevailing mentality regarding many regulations. This mentality is not improved by nepotism, as nepotism often encourages disengagement, and areas that require a nuanced understanding of policy and its implementation are not well-served by disengaged employees.

As I’ve watched various data trackers to get a handle on what the outbreak looks like, I think of the many crises that the healthcare organizations I worked for were tasked to handle before, and how many of them managed to pull it together just long enough. I am concerned that Covid-19 is going to hit the industry on enough fronts that it will be unable to appropriately sustain its true mission.

Our doctors, nurses, respiratory therapists, and other providers deserve the best support and administration we can give them. Before we can help the health care industry tackle its administration problems, Americans will need to learn how to have meaningful conversations around what healthcare is, who provides it, and what (if any) role insurers should play in that.