Employment Society

“Healthcare in the United States is in the midst of a massive wave of consolidation. For example, fifty years ago, virtually all non-academic, non-government U.S. physicians had an ownership interest in their practices. Today, approximately 70% of U.S. physicians are employed by hospitals or other corporate entities. Likewise, mergers and acquisitions have landed more than 70% of hospitals and 90% of hospital beds in multi-hospital health systems. As such, health care organizations have increased in size and their complexity has multiplied. For example, between 1975 and 2010, the number of U.S. physicians roughly doubled, but the number of healthcare administrators—employees of medical practices, hospitals, and health systems who do not directly care for patients—increased about thirty-six times.”

-Richard Gunderman, “Why Bigger Isn’t Necessarily Better: A Swiftian Perspective.” econlib.org. June 5, 2023.

This is an interesting essay. One direction that I would have preferred to explore is how does moving from an owner to an employee to a bureaucratic organization impact physicians? There is a move toward a different model, where people pay for a physicians services on a subscription model. How does the physician/patient relationship change when a family purchases a subscription? What happens when you strip out the bureaucracy of insurance, hospital systems, and so forth and cut down all the unnecessary documentation that comes with them? What happens when the physician knows the costs and has their name on the door? Does quality go up? I would imagine so.

The Employment Interview

I was reading this tweet, and it reminded me that I used to use an interview template when interviewing people for positions. Still strikes me as a decent tool. I find it useful to have a framework for evaluating people, so you can focus on what’s important to doing the job well and can make use of the same standard of evaluation.

The people making the hiring decisions tend not to like this style. This reason is clear. People tend to hire people they like. This template led me to recommend people regardless of whether I liked them personally or not. I tend to be more skeptical of people that are engaging the first time I meet them.

Most of the ideas came from a single book, which one I have forgotten. I think this could also be a useful tool for preparing for an interview.

Life Lesson: Notice & Exit Interviews

“After 14 years at Microsoft I turned in my resignation with 3.5 weeks of notice. No big deal. I was taught when I was younger it was classy. That it allows for a smooth transition and it’s the last thing people remember. I had some key turnovers I wanted to take care of. Again trying to do the right thing

I’m going to Amazon on Aug 1.

My manager naturally said here is your walking papers and out. I said that there are a few loose ends I should tie up. Nope. Ok. What I didn’t expect is that she changed my exit date without me knowing to two weeks earlier.

Why? Because she is sore. But what it did to me was mess up my healthcare coverage for two lousy weeks.

Can I do cobra. Yes. Is it a pain. Yes. Will I be fine? Yes. But it’s the last thing I remember now about what was a really good run.

Anyway here is a lesson I learned. For a brief moment I forgot that you do not matter to the company. Your achievements do not matter. What you did for your team did not matter and being classy with a handshake and well wishes is dead.

If you get a new job. Do what is right for you. Quit 1 day before your new role because it’s the safest thing for you. Especially today. I wish it wasn’t.”

-maddoc07, “Life lesson: give notice to your current employer at your own peril.teamblind.com. July 6, 2022.

I think the real life lesson here is to expect to be fired on the day you give notice. For healthcare, you want to make sure that it extends through the month, so you can have your benefits and not have a gap in coverage. Quitting with one day’s notice is a jackass move. Perfectly reasonable to give two weeks notice at the beginning of the month and keep your healthcare coverage.

Also, the exit interview is all about covering your employer from legal liability. There’s no reason for an employee to participate. If they wanted your opinion, they should have asked you before you gave notice.

Five Traps to Avoid When Working at Big Companies

https://mobile.twitter.com/arvanaghi/status/1504523654801022987

  1. Being someone’s lieutenant
  2. Developing expertise that only applies to that company
  3. Falling for perks
  4. Get raises, not readjustments (top end, 7% increase a year)
  5. Lack of recognition

h/t to Brandon Arvanaghi

I’d probably shorten this list to two items:

  1. Be good at doing something many companies and/or people need.
  2. Get recognized for being good by being paid for it, or do what you do for someone else.

You could reduce it further to the most important ability, at any job, is being able to walk out the door and easily find another. Any other situation is one based on exploitation, in one form or another.

A Boring Dystopia: Mouse Movers

““The pandemic has proved to be a catalyst to saying no to the ‘9-to-5’ schedule. The tables have turned in favor of the Worker,” Rodriguez told me. “They are in power today. They value work flexibility. They are ambitious. They value work-life balance and are not afraid of saying no to employers who don’t share those values. The Mouse Mover is a new tool in that shift—and we stand with the Knowledge Worker.” 

-Samantha Cole, “Workers Are Using ‘Mouse Movers’ So They Can Use the Bathroom in Peace.” Vice. December 8, 2021

Just to recap: the claim being made here is that being able to buy a mouse mover, which is a device that moves your mouse to simulate computer use, is a tool of worker empowerment. Maybe in a dystopia any resistance to digital Taylorism is empowerment. Needing a “mouse mover” isn’t empowerment. It’s a sign of your alienation.

Get a different job, if you can. If you can’t, don’t pretend to yourself that using tools like this are empowering. They aren’t. It’s a symptom you should seek some kind of real empowerment, such as the ability to decide to use the toilet whenever you want without someone wondering why you aren’t working. Or, to engage in true utopian thinking, find work where you have control over how and why you spend your time because making those kinds of decisions are valuable in the environment you work rather than merely being present to respond at a moment’s notice to your boss.

Communities vs. Transactions

My wife and I have different ways of looking at the world. It occurs to me today that the ambiguity of these two ways of looking at relationships is often exploited.

I think my wife’s understanding is typical. In her view, people do things for one another because they care about one another. Unless it is some extraordinary request, you don’t count the cost. If someone doesn’t care about you, or you them, then you are not obligated to do anything for them. In fact, it’s likely you won’t help them because you don’t have the feeling of reciprocity from them.

However, one problem with looking at the world in this way is that beyond a certain threshold, the community model moves into a transactional model. Someone asks for something beyond the normal level of reciprocity of the commons, and then you owe them something extraordinary in return. But, it’s tacit. This is never actually said because the transactional model is a different model of interaction, and it undermines the community model.

There are also some cases where there will never be anything in return. But, sometimes the obligation is created across generations, such as taking care of elderly parents with the hope that, one day, your children might take care of you in a similiar manner. These kinds of commitments gives community longevity, so they last beyond the current participants. But, again, there’s quite a bit of ambiguity, and in many cases, expectations won’t get met.

I start from a different place. I assume every interaction is transactional, and I try, to the degree possible, to be autonomous and self-sufficient. The last part is key.

In the transactional model, you’re in the world of commodities and commerce. While there are relationships built on commerce, they are not relationships of regard or community, they are relationships of convenience. The advantage of being autonomous and self-sufficent is you can live in a world of commerce and not have to count the cost, the same way that you live when you live in the community model, except it doesn’t matter whether people care about you or not.

Except, obviously, it does matter whether people care about you. The difference is that I don’t need that to be the basis for my day-to-day interactions with everyone. There is a small group of people that I interact with the expectations of community. But, outside of that small group, it’s the transactional model.

And, here’s why that’s important. When you go to a subreddit, like antiwork, and you see that a boss asks someone to come in on short notice and be a “team” player. That’s a community argument. But, does the boss care about you? Not at all. The relationship is transactional. Working this kind of ambiguity, given how many people subscribe to the community model, is a path for exploitation. It’s really that simple.

Four Hours of Work

“The real lesson – or one of them – is that it pays to use whatever freedom you do have over your schedule not to “maximise your time” or “optimise your day”, in some vague way, but specifically to ringfence three or four hours of undisturbed focus (ideally when your energy levels are highest). Stop assuming that the way to make progress on your most important projects is to work for longer…

…The other, arguably more important lesson isn’t so much a time management tactic as an internal psychological move: to give up demanding more of yourself than three or four hours of daily high-quality mental work. That’s an emphasis that gets missed, I think, in the current conversation about overwork and post-pandemic burnout. Yes, it’s true we live in a system that demands too much of us, leaves no time for rest, and makes many feel as though their survival depends on working impossible hours. But it’s also true that we’re increasingly the kind of people who don’t want to rest – who get antsy and anxious if we don’t feel we’re being productive. The usual result is that we push ourselves beyond the sane limits of daily activity, when doing less would have been more productive in the long run. “

-Oliver Burkeman, “The three-or-four-hours rule for getting creative work done.” OliverBurkeman.com. April 3, 2021.

Policy of Poverty

“The American economy runs on poverty, or at least the constant threat of it. Americans like their goods cheap and their services plentiful and the two of them, together, require a sprawling labor force willing to work tough jobs at crummy wages. On the right, the barest glimmer of worker power is treated as a policy emergency, and the whip of poverty, not the lure of higher wages, is the appropriate response…

…I suspect the real political problem for a guaranteed income isn’t the costs, but the benefits. A policy like this would give workers the power to make real choices. They could say no to a job they didn’t want, or quit one that exploited them. They could, and would, demand better wages, or take time off to attend school or simply to rest…But those in the economy with the power to do the dictating profit from the desperation of low-wage workers. One man’s misery is another man’s quick and affordable at-home lunch delivery.” 

-Ezra Klein, “What the Rich Don’t Want to Admit About the Poor.” The New York Times. June 13, 2021.

Play Your Own Game

1. Judge less.

At least half the people doing things with money that you disagree with are playing a different game than you are. You probably look just as crazy in their eyes.

2. Figure out what game you’re playing, then play it (and only it).

So few investors do this. Maybe they have a vague idea of their game, but they haven’t clearly defined it. And when they don’t know what game they’re playing, they’re at risk of taking their cues and advice from people playing different games, which can lead to risks they didn’t intend and outcomes they didn’t imagine.

-Morgan Housel, “Play Your Own Game.” Collaborative Fund. May 13, 2021