Throw Money at It?

I often hear that one of the ways to solve the problem of staff shortages in healthcare is to throw money at the situation. I don't buy this for a number of reasons.

More Money Doesn't Always Mean More (or Better) Work

I know several people, who happen to be members of strong unions, who have good salaries (and one day will have good pensions). They self-report that they do as little work as possible, and spend time thinking of ways to beat the system. In addition to secure jobs, they move up on the salary grid each year, but they don't expend any more effort. If anything, they expend less effort.

How Much Money Would You Throw?

In throwing money at a problem, one also must determine how much to toss. How is different work valued? For example, explain to me why the person who is working to save your life is making – if s/he's lucky – $100K per year, while actors can make tens of millions of dollars for appearing in a bad movie that no one goes to see? Or what about the appalling amounts of money some CEOs make?

And even if we can all agree that competent, hardworking healthcare professionals who are saving lives should earn more than a bad actor – or even a competent CEO – how much should they earn? Every government, insurance company, and individual would be bankrupt if healthcare professionals were paid even close to the money such individuals are paid, even though they come closer to deserving it.

Job Satisfaction

What do healthcare professionals say that they like about their jobs? Helping people. Unfortunately, money destroys this motivation. An article published online on November 17, 2006 in Science essentially concluded that money makes individuals want to pick up their marbles and go home. In the experiment, even when people were simply reminded of money (e.g., shown play money, or shown a picture of real money), their helpfulness towards others was reduced.

Can Money Buy Loyalty, at Least?

But you ask, if we throw money at the situation, won't it at least buy loyalty, and allow us to keep the staff we have? Absolutely not! If anything, it guarantees that you're not buying loyalty. In a mercenary environment in which the only thing going for the job is a wad of cash, the whiff of an extra buck somewhere else will cause the person to hoist their lance and ride off to the enemy encampment, abandoning you.

Quality or a Warm Body?

Another reason to throw money at the problem, some say, is to ensure well-trained, well-qualified, competent people. But how can we guarantee that the healthcare professionals we throw money at are top quality goods? Having a license guarantees a certain level of quality, but what does this mean? For example, both the NCLEX and the CRNE (Canadian Registered Nurse Examination) issue only pass/fail grades. And people lose their licenses all the time. Also consider what "A Nurse" described in Outside Looking (Back) In, when she encountered several ward RNs with "a lack of knowledge in terms of basic treatments." Should they be paid as much as a nurse with who knows her/his basics, or one who knows a whole lot more than that? I'd say no. What if the extra cash doesn't buy you better staff, but those with more time on their hands, or those who are more financially desperate?

Additionally, while a hefty chunk of change may lead someone who faints at the sight of blood to enter the healthcare profession – should they?

Does Money Buy Happiness?

Assuming that well-paid workers would be happier in their jobs, let's evaluate the notion of whether or not money buys happiness. A February 13, 2006 report entitled Are We Happy Yet? by Pew Research Center, which was based on 3,014 telephone interviews, found that 49% of individuals with an annual family income of more than $100,000 said that they were very happy, while just 24% of those with an annual family income of less than $30,000 said that they were very happy. Significantly, the findings mean that 51% of those wallowing in cash are not very happy. (But I will admit that even if money doesn't buy happiness, at least it allows you to be unhappy in style.)

Or look at it this way: Norwegian writer Arne Garborg is quoted as saying, "It is said that [with] money you can have everything, but you cannot. You can buy food, but not appetite; medicine, but not health; knowledge, but not wisdom; glitter, but not beauty; fun, but not joy; acquaintances, but not friends; servants, but not faithfulness; leisure, but not peace. You can have the husk of everything for money, but not the kernel."

In Conclusion …

I love money. Almost everyone loves money! But it's not the answer – or at least not the only one – to healthcare shortages.

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