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Dialogues@RU is published annually
by the
Writing Program at
Rutgers, The State
University of New Jersey
Volume One
Spring 2002
The Routinization
of Health Care and the Professional Calling -
Page 6
by Megan H. Johnson
Twenty-first century nurses and doctors face professional challenges that penetrate to the very core of the work they do, in which involvement in patients' lives can make a profound impression. The impact of HMOs and the nursing shortage is far reaching, affecting communication between health care providers and the greater community they serve. As a result, not only can the relationship between the two falter, but the actual health and well-being of the community can be put at risk, with doctors and nurses bound by limitations they encounter in the workplace. Methods of coping with HMO management and the nursing shortage differ for each profession. To attract more nurses to the labor force, hospitals presently concentrate on financial incentives for recruitment, the use of temporary and foreign nurses in conjunction with "auxiliary personnel," and increased autonomy in the workplace, which has been shown to "promote decision making, creativity and higher job satisfaction" (Cowart 24). Future positive changes in the nursing profession therefore seem possible, if not revolutionary. Health maintenance organizations, however, appear to be more permanent fixtures in the industry. As Eva Havas notes, "reforming health care is a complex task, and the political process that prefers simple solutions at the same time it favors vested interests mitigates against meaningful reform" (76). Insurance companies and HMOs are clearly two examples of these "vested interests," and these industries' enormous power, coupled with the reluctance of the government to take on such a complex, heated issue dictate that sweeping reforms are not likely in the near future. Some doctors, embittered at the loss of autonomy they have suffered at the hands of HMOs, have broken away from managed care group practices. So-called "white glove service" is growing in certain locales, whereby physicians set up pricey, specialized groups for wealthy patients with money to spare. Such patients pay a yearly fee around $1500, as well as per-visit fees between $50 and $75, in exchange for same-day or next-day appointments, special phone numbers and other high-end services (Pascual 10). Physicians may find the freedom and personalized atmosphere they crave, but fiscally-challenged members of the community are excluded from such a service. Other doctors with great concern for their communities have left health care systems, as was the case with Dr. Bill Davis of Winters, California. After abandoning Sutter West Medical Group, Davis banded together with supportive townspeople and opened a small office out of an abandoned shoe-repair shop with money earned at fundraisers. While a happy ending would be encouraging in such a situation, there isn't one guaranteed. Davis has yet to take home a real salary, and townspeople are unsure of how long they can pay via food, services, IOUs and cash (Lopez 8). While hopefully anticipating changes in the health care system, physicians currently seem to have few realistic options outside of practicing in a managed care workplace. In the meantime, though, the by-products of HMO management and the nursing shortage are forcing society to view doctors and nurses in a different light, and are requiring health care professionals to go to great lengths if they wish to invest their work with the type of moral connection that Robert Bellah would encourage.
Works Cited
Anders, George. Health Against Wealth: HMOs and the Breakdown of Medical Trust. Boston: Houghton Mifflin, 1996.
Arnold, Elizabeth and Kathleen Boggs. Interpersonal Relationships: Professional Communication Skills for Nurses. Philadelphia: W.B. Saunders, 1989.
Bellah, Robert N., et al. "Finding Oneself." Habits of the Heart: Individualism and Commitment in American Life. New York: Harper and Row, 1985. 55-84.
Cowart, Marie E. and William J. Serow. Nurses in the Workplace. Newbury Park, CA: Sage Publications, 1992.
Curran, Connie R. "Systems of Health Care Delivery: Their Diversification and Decentralization." Perspectives in Nursing: The Impacts on the Nurse, the Consumer and Society. Eds. Clinton E. Lambert, Jr. and Vickie A. Lambert. Englewood Cliffs, NJ: Prentice Hall, 1989. 355-367.
Eastman, Jacqueline K., et al. "The Relationship Between Ethical Ideology and Ethical Behavior Intentions: An Exploratory Look at Physicians' Responses to Managed Care Dilemmas." Journal of Business Ethics June 2001: 209-224.
Havas, Eva. "Managed Care: Business as Usual." Humane Managed Care? Eds. Gerald Schamess and Anita Lightburn. Washington, D.C.: NASW, 1998. 75-83.
Johnson, Donald E.L. "Hospitalists May Relieve Nurse Shortage." Health Care Strategic Management May 2001: 2-3.
Leidner, Robin. "Meaning of Routinized Work: Authenticity, Identity and Gender." Fast Food, Fast Talk: Service Work and the Routinization of Everyday Life. Berkeley: U of California P, 1993. 178-213.
Leininger, Madeleine. "Humanism, Health and Cultural Values." Health Care Issues. Eds. Madeleine Leininger and Gary Buck. Philadelphia: F.A. Davis, 1974. 37-60.
Lopez, Steve. "The Single-Doctor HMO." Time 26 Feb. 2001: 8-9.
Pascual, Aixa and Sheridan Prasso. "The Doctor Will Really See You Now." Business Week 9 July 2001: 10.
Romano, Michael. "Charity Care Drops, Study Shows." Modern Healthcare 27 Aug. 2001: 12-13.