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Hospital CEO’s are fattening their wallets while physician and nurse income plummet and patient safety tanks. And, this report is only the “not-for-profit” hospitals in Boston. Can you imagine what is going on in the “for-profit” world?

Massachusetts Hospital CEOs Cash In

In Time to Heal, Kenneth Ludmerer traced the evolution, if that is the right word, of the academic medical center from a relatively “flat” organization dedicated to service and academics to a large, complex quasi-corporation. Ludmerer wrote:

The new hospital administrators assumed business titles (president or chief executive officer rather than superintendent or director), demanded and received corporate levels of compensation, and retained hordes of management consultants…. A corporate approach began to dominate the institutional culture of the academic medical center…. It became increasingly difficult to distinguish some academic medical centers from the for-profit hospital chains and HMOs they so often criticized.

Christopher Rowland, reporting in the Boston Globe last week, documented the latest step in this process. It seems that nearly every CEO of a Boston “not-for-profit” hospital got at least $1 million in total yearly compensation

It seems that the boards of trustees of nearly every non-profit hospital in Boston believe they have absolutely top-flight CEOs who must be paid handsomely lest they be tempted to bolt out the door. How quaintly old-fashioned seems the notion that leading a non-profit hospital is a sort of calling or community service that might inspire loyalty independent of a top-drawer corporate salary.

The ever-increasing largesse afforded to hospital CEOs stands sharply contrasts with the average compensation given to primary care physicians, whose pay fell about 10% adjusting for inflation from 1995 to 2003. In addition, a spokesman for the Massachusetts Nurses Association responded thus to the compensation given the CEO of UMass Memorial, “it’s obscene for him to take all that money when he’s asking nurses who provide the bulk of care at that hospital to accept concessions.”

A final contrast is with the extremely heavy work-load of physician trainees at these same hospitals. In JAMA this week is an article which documents how teaching hospitals have failed to reduce interns’ work-loads in response to recent regulations. 15 of 16 teaching hospitals in Massachusetts, and hence nearly all of the hospitals listed above, were reported to have violated regulations restricting work shifts to no more than 30 hours, and work weeks to 80 hours, and mandating at least one day off a week during the first year the regulations were in force. (Landrigan CP, Barger LK, Cade BE et al. Interns’ compliance with Accreditation Council for Graduate Medical Education work-hour limits. JAMA 2006; 296: 1063-1070.)

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