PCMS Member Corner: Parkinson’s Law

As a physician, I spend a lot of time trying to figure out why things happen.  Usually, I think about why the patient has their problem, but other times my mind goes to why we physicians have so much busywork.   Since I graduated from medical school in ’01, it seems the amount of inane bureaucratic tasks we are required to fulfill has grown exponentially.   It seems we have an army of bureaucrats standing behind us, directing us to do disruptive tasks that make our job harder, then patting themselves on the back thinking they are helping to save lives.

Much of this can be explained by Parkinson’s Law.  The law, which was published in the Economist in 1955, applied the observation that work expands to fill the time available for its completion to any administrative body.   It explains, using human nature, why a bureaucracy is destined to expand, even while the amount of actual work it accomplishes is stagnant.

Instead of me trying to summarize the paper, please read it for yourself here.

Although C. Northcote Parkinson used the British Navy as an example, we see the same effect in health care.

This graph from Health Care Costs, A Primer; The Henry J Kaiser Family Foundation shows the steep rise that has occurred in just the years from 1970 to 2009.

Recently, it was estimated that more than a third of US healthcare costs go to bureaucracy.  And according to a Harvard Business Review article by Kenneth Segel,“Bureaucracy is destroying value in innumerable ways, including slowing problem solving, discouraging innovation and diverting huge amounts of time into politicking and “working the system.’”  I am sure this is something everyone in medicine has experienced.

What can we do about it?  There are several “lean daily management systems” approaches that have been found to be helpful.  But as Upton Sinclair said, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”  I am pessimistic the necessary changes could come from administrators themselves, which leaves the solution to politicians.  How can we physicians – who understand the problems – make things better?  Joining organizations like PCMS and the Arizona Medical Association helps (thank you very much), but we can do more.  Getting politically involved and financially supporting great organizations like the Arizona Medical Association Political Action Committee (ArMPAC) are ways everyone can help make a difference.

Written by Dr. Roy Loewenstein, PCMS Board President
February 2023