Propaganda: Poster illustrating growth in physicians versus administrators is flawed

Propaganda: Poster illustrating growth in physicians versus administrators is flawed

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This chart has made the rounds of social media for many years. It is designed to make it look like the reason health care is expensive is because of explosive growth in administrators at health care facilities.

This chart is 100% propaganda and makes use of many tricks to convey its propaganda message.

Growth of Physicians and Administrators 1970-2009.

Methods Used

  • The bright yellow color is designed to attract your attention to the steep curve, rising sharply to the right.
  • This is seemingly matched against a percentage growth in per capita health care spending. This is a random correlation.
  • This bright yellow segment is contrasted with the number of physicians, buried at bottom.
  • Seemingly authoritative sources are cited (Appeal to authority).

This item, on the surface, is convincing. Except it is almost entirely bull shit. It is true that there has been growth in non-care providers in health care. But not in the way this chart suggests.

  • The chart compares a percentage growth in one category to the percentage growth in another category. A large increase in a tiny number gets amplified into a large percentile increase. Comparing percentage growth rates like this is meaningless. These are not absolute numbers. We need to see a comparison of actual physician (and other health care providers) to actual administrators.
  • Many physicians are both health care providers and administrators at the same organization and may be double counted.
  • The numbers used appear to be inaccurate. See here and here.
  • The chart leaves out that physicians are not the only health care providers. Today there is a large increase in physician-assistants, nurse practitioners and host of other health care providers in these work places. These are not counted in this chart.
  • The chart fails to note that in the 1970s, many if not most physicians worked in private practices which did not have anyone designated as an “administrator”. The office receptionist/secretary/bookkeeper was the de facto office administrator. Fast forward to today and most physicians now work for corporate entities which – surprise – have management staff. This change occurred for many reasons, but including regulations and insurance company practices that made working as a self employed practitioner difficult.

Update

Another version of the chart adds a set of purported executive titles, seeming to explain the growth … but …

We will see these same titles in other non-health care businesses too – CIO, CTO, CQO, CSO, CDS, CDO, CRO – are all titles that exist in other businesses. It is quite possible that if we drew a similar chart for other organizations that we would see a similar curve – when comparing percentage growth to percentage growth, rather than absolute numbers.

Update – From Another Analysis

Some one founds some actual data for the number of administrators at the beginning of the chart, a period when the definition and the counting of administrators is the weakest. Based on this analysis, they find the chart over estimate the growth rate by a factor of 3. Then, the data is translated to a “percent of health care costs” trend line, which shows a far more muted growth in administration.

We can conclude that this widely shared poster is false – but has been very effective as a form of propaganda messaging. In fact, I first saw as it was shared by some physicians I follow on social media. They were not aware of the many ways this chart exaggerates the trend.

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