But wouldnt these spreadsheets be tracking something like total revenue? If a doctor is spending time on admin tasks instead of revenue-generating procedures, obviously the hospital has accountants and analysts who will notice this, yes?

I'll contrast your experience with a well-run (from a profitability standpoint) dentist's office, they have tons of assistants and hygienists and the dentist just goes from room-to-room performing high-dollar procedures, and very little "patient care." If small dentist offices have this all figured out it seems a little strange that a massive hospital does not.

First of all, it's not unlikely that the dentist is the owner. And in any case, when you have a small system of less than 150 people, it's easy enough for a handful of people to see what's actually going on.

Once you get to something in the thousands or tens of thousands, you just have spreadsheets; and anything that doesn't show up in that spreadsheet might as well not exist. Furthermore, you have competing business units, each of which want to externalize their costs to other business units.

Very similar to what GP described -- when I was in a small start-up, we had an admin assistant who did most of the receipt entry and what-not for our expense reports; and we were allowed to tell the company travel agent our travel constrants and give us options for flights. When we were acquired by a larger company, we had to do our own expense reports, and do our own flight searches. That was almost certainly a false economy.

And then when we became a major conglomerate, at some point they merged a bunch of IT functions; so the folks in California would make a change and go home, and those of us in Europe or the UK would come in to find all the networks broken, with no way to fix it until the people in California started coming in at 4pm.

In all cases, the dollars saved is clearly visible in the spreadsheet, while the "development velocity" lost is noisy, diffuse, and hard to quantify or pin down to any particular cause.

I suppose one way to quantify that would be to have the Engineering function track time spent doing admin work and charge that to the Finance function; and time spent idle due to IT outages and charge that to the IT department. But that has its own pitfalls, no doubt.

> If a doctor is spending time on admin tasks instead of revenue-generating procedures, obviously the hospital has accountants and analysts who will notice this, yes?

I am going to assume that the Doctors are just working longer hours and/or aren't as attentive as they could be and so care quality declines but revenue doesn't. Overworking existing staff in order to make up for less staff is a tried and true play.

> I'll contrast your experience with a well-run (from a profitability standpoint) dentist's office, they have tons of assistants and hygienists and the dentist just goes from room-to-room performing high-dollar procedures, and very little "patient care." If small dentist offices have this all figured out it seems a little strange that a massive hospital does not.

By conflating 'Doctors' and 'Dentists' you are basically saying the equivalent of 'all Doctors' and 'Doctors of a certain specialty'. Dentists are 'Doctors for teeth' like a pediatrician is a 'Doctor for children' or an Ortho is a 'Doctor for bones'.

Teeth need maintenance, which is the time consuming part of most visits, and the Dentist has staff to do that part of it. That in itself makes the specialty not really that comparable to a lot of others.

Probably because dentists are more cash based and less battling with insurance for payments.

Customers are more price sensitive so the dentists have to be too.