Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What medicine can learn from Wells Fargo

Andrew Spector, MD
Physician
September 20, 2016
Share
Tweet
Share

In 1996, Jerry Maguire was fired for advocating a reduction in his sports management firm’s client base thereby risking the firm’s profits.  While writing his infamous memo (or as he would tell you, his mission statement), he recalled his mentor’s advice: “The key to this business is personal relationships.”

Tom Cruise’s voiceover continues: “Suddenly, it was all pretty clear. The answer was fewer clients. Less money. More attention. Caring for them, caring for ourselves and the games, too.” Spreading the idea that the firm should focus on service over profits cost him his job; then it cost him his friends and his fiancée. Lesson learned: more clients, more money. That’s the way to succeed in business.

On September 8, 2016, it was revealed that Wells Fargo employees fraudulently created 1.5 million accounts. Although we are likely to learn much more about how and why this occurred in time, early indications suggest that the employees were at risk of losing their jobs if they didn’t open enough accounts. This was not the act of a rogue teller. 5300 employees were fired. Those who are speaking out are pointing fingers at the managers who demanded higher volumes, no matter the methods used to attain them.

In August 2014, Ferguson, Missouri was the site of extensive protests following the shooting death of Michael Brown by a Ferguson police officer. In the aftermath of these events, the United States Department of Justice released a report describing the practices of the Ferguson Police Department (FPD). The report details how officers of the FPD were incentivized to issue more citations and scolded for failing to produce enough citations. Promotions were dangled in front of officers as rewards for writing the most citations. More citations meant more revenue for the city, so it really didn’t matter that escalating numbers of citations were handed out for infractions such as tall grass ($102) while enforcement of serious crime (assault, DWI, etc.) remained constant.

August 2015 was a low-water mark for academic publishing when Springer Publishers retracted 64 articles in 10 journals due to fraud in the peer-review process. Without any explanation provided by Springer as to why authors would fake their peer reviews, I suspect most readers fundamentally understand why researchers would jeopardize their careers to cheat in this manner. It’s because they would also jeopardize their careers if they didn’t publish enough. In many cases, it doesn’t matter if the publication will actually advance scientific knowledge in a meaningful way as long as it generates another line on a CV. From the FPD perspective, you could publish your tall grass paper or your DUI paper; it makes no difference.

I encountered this scenario myself when I sought a leadership position in education in my department. Coming from a background as a clinician educator, I was told my experience in education was adequate, but to enhance my candidacy, I should publish more. I was told that the leadership who make the final hiring decision would want to see that I’m “an academic.” To advance my career as a medical educator and get a job with no research requirement, I suddenly had to find something to publish. It was never suggested that I initiate a randomized controlled trial; any publications would suffice.

I’m not going to fake a peer review to improve my chance at a new job. Thankfully, I was looking only for a promotion, and my job was not on the line. But it’s not hard at all to understand why authors who felt their jobs were in jeopardy might cross that ethical line. These authors are certainly not unique, as we see similar actions across industries. When managers, lieutenants, and department chairs tie production volume to employee livelihoods and promotions, they must understand they are inviting fraud. They are exploiting human nature. People will do what is necessary to survive and maintain their incomes and careers.

Clinical medicine suffers from a similar problem. Often, contracts for physicians include RVU or financial targets. Physicians who fail to meet these goals risk salary reductions or being fired. Environments like this incentivize overutilization of medical resources and fraudulent billing practices.

In fiction and in real life, in sports management, in banking, and in policing, volume is used as the metric for promotion and advancement. Sadly, academic medicine is no different. It is highly concerning that our field behaves like these other industries with an excessive devotion to volume.

Without a manager demanding that he maintain a high volume of clients, Jerry Maguire doesn’t get lazy. He fights for his only client and succeeds at negotiating a high-dollar contract for Cuba Gooding, Jr.’s Rod Tidwell. Troy Aikman and Katarina Witt take notice. Jerry, it’s implied, will end up doing very well with his new approach. Success in his industry, he proves, can exist even with lower volumes.

Likewise, without departments insisting on high output, researchers will still be motivated to publish their work because that’s how science advances. Clinicians will still see patients because that’s our mission. When publications are currency, we create the environment most supportive of fraud. When higher patient volumes are mandated, we create the environment supportive of malpractice claims.

It’s time to end the obsession with volume. Demanding high volumes does not improve the quality of papers being published or the care being provided. It does, however, place academic medicine at risk of a crisis of confidence similar to what we see today with Wells Fargo. We need to abolish the concept of production for promotion before the public loses trust in us, too.

Andrew Spector is a neurologist.

ADVERTISEMENT

Image credit: Tupungato / Shutterstock.com

Prev

If doctors wanted to be wealthy, they would have become UPS truck drivers

September 19, 2016 Kevin 22
…
Next

Medical couples inadvertently sabotage their long-term happiness

September 20, 2016 Kevin 2
…

Tagged as: Primary Care

Post navigation

< Previous Post
If doctors wanted to be wealthy, they would have become UPS truck drivers
Next Post >
Medical couples inadvertently sabotage their long-term happiness

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Andrew Spector, MD

  • The unexpected truth about restless legs syndrome treatments

    Andrew Spector, MD
  • Fairness in medical publishing: Reforming the peer review process

    Andrew Spector, MD
  • Racially equitable decisions in the era of COVID-19

    Andrew Spector, MD

Related Posts

  • What medicine can learn from a poem

    Thomas L. Amburn
  • Residents need to learn medicine, not how to pass a test

    Eric W. Toth, DO
  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • Why academic medicine needs to value physician contributions to online platforms

    Ariela L. Marshall, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • KevinMD at the Richmond Academy of Medicine

    Kevin Pho, MD

More in Physician

  • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

    Anonymous
  • The man in seat 11A survived, but why don’t our patients?

    Dr. Vivek Podder
  • When did we start treating our lives like trauma?

    Maureen Gibbons, MD
  • Medicalizing burnout misses the real problem

    Jessie Mahoney, MD
  • Why some doctors age gracefully—and others grow bitter

    Patrick Hudson, MD
  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What medicine can learn from Wells Fargo
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...