by Dr. Kenneth H. Cohn

I heartily recommend Abigail Zuger’s provocative article on Dissatisfaction with Medical Practice (Zuger A. 2004. "Dissatisfaction with Medical Practice."New Engl J Med 350(1):69-75). I learn more each time I reread it.

In the article, Dr. Zuger points out that the golden age of health care, which lasted approximately two decades after the passage of Medicare in 1965, was an anomaly. For example, she mentions that in 1913, the American Medical Association estimated that no more than 10 percent of physicians were able to earn a comfortable living.

She also quoted Dr. Kenneth Ludmerer from Washington University as saying, "One of the virtues of medicine...is its self-critical nature...Intrinsic dissatisfaction can lead to significant social good." As a nurse executive counseled me, "It's the sand in the oyster that creates the pearl."

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by Nick Jacobs

The fundamental charge of a hospital administrator is, and always should be, patient care. All too often, however, we immerse ourselves in the daily tedium of trivia that deals with mundane issues that can only be described as the fundamentally messy drivers of day-to-day life among human beings. We deal with those issues that cause our in-baskets to bulge, our voicemails to fill, and our Blackberries to show memory overload; but, for the most part, they are not essential issues that contribute directly to patient care.

The vast majority of these problems are very similar to those that were part of my daily challenges as a teacher some 30 years ago. They often deal with egos, with jealousy, or with seeking ways for the individual employees to save face after engaging in confrontational behavior. There is also one very true description as well that states that "the problem is never really the problem." If you look under the surface, you will find the reality of every situation.

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by Tony Chen

2006 was the year of consumer-driven health care. Two years ago was the year of retail clinics. Last year was the year of health IT (with Google and Microsoft making big splash entries). So, what will 2009 bring? Here are some predictions sure to go wrong:

1. The number of uninsured and underinsured will increase dramatically.

Think about it: Unemployment was once close to 5 percent. At some point in 2009, it could get up to 10 percent. Add to that the many businesses that will be cutting healthcare coverage for the sake of business survival, as well as the folks who will decide to forego buying individual health insurance to make ends meet.

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by Christopher Cornue

As part of an ongoing series reviewing my first 100 days as a CEO, I spent the first 45 to 60 days assessing the current culture, operations, strategy and environment at my new hospital. My initial (and lasting) assessment: I'm working for a wonderful group of individuals--the employees, physicians, board, community, etc.--everyone has been so welcoming and positive!

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