Corporate Profit vs. Patient Safety: The reality of high clinician productivity
Despite spending more on healthcare than any other nation, the United States currently ranks a dismal 47th in global life expectancy. Let’s put this into perspective: A child born in Cuba is statistically expected to outlive a child born in the US, despite the fact that their healthcare system spends pennies on every one dollar in the US.
This, of course, begs the question… “Why is the US falling so far behind?” Part of the answer lies in the rapid financialization of the medical system.
Over the last few decades, profit maximization has become the key driver for the evolution of U.S. healthcare. Private equity firms and enormous insurance conglomerates are increasingly buying up hospitals, nursing homes, and physician practices.
Their goal? To improve the health in the communities they serve? Maybe. To maximize short-term financial returns for their investors? Definitely.
Don’t get me wrong. I am a big proponent of investing in our communities, especially when it is focused on healthcare. But this feels a bit different. Let’s take a look at the numbers…
When you look at the raw data, you might expect that the $41 billion in profits raked in by the top four health insurance companies in 2022 would be used to, I don’t know, say, expand patient coverage or lower premiums, right? But that is not what happened.
Instead, the largest companies took a staggering $26.2 billion of those funds and simply bought back their own stock to artificially inflate share prices. That’s $71 million dollars every single day. Seven executives rewarded themselves with $136.7 million for this strategy. This is all while patients are left to suffer the consequences of aggressive hospital cost-cutting.
And when I say patients are suffering the consequences, I mean this literally: Think about your grandparent, or an elderly family member, recovering in a hospital bed. You assume they are in the safest place possible. But research shows that if that hospital was recently acquired by a private equity firm, their personal risk of falling out of bed or catching a dangerous infection was just inflated by 25%.
A change in ownership literally increases your loved one's chances of getting hurt.
This macro-level corporate obsession with the bottom line trickles down to whatever facility you work in. This has morphed into the impossible productivity standards that are currently crushing many of us.
I recently learned from a clinician describing feeling torn every day between giving patients the time they deserved and keeping up with a schedule that barely left room to breathe. By the end of the day, she may have met her productivity and efficiency targets, but she felt like something human had been lost in the process.
I experienced this hyperfocus on financial incentives and productivity firsthand while working in a nursing home setting. The issue of strict productivity requirements is everywhere these days, but it seems to cut particularly deep in nursing homes.
That obsession with productivity followed me everywhere after my nursing home experience and even haunts me to this very day. I can still hear the clock ticking every time I take a short break to catch my breath, grab a drink of water, or use the bathroom. I’ll never forget the time my boss told me that the facility’s productivity numbers were significantly and negatively impacted by my… taking a vacation. She told me this the day I returned home from my honeymoon.
Are you a revenue generator or a healer? The more time you spend in this system, the harder that question becomes.
And it’s not all the fault of the facility’s management. In fact, directors and administrators are usually well-intentioned in my experience. It goes further up the chain… So, the next time you feel like you are fighting against a strict manager demanding you squeeze more billable minutes out of a frail patient, remember: you are actually fighting against a systemic, profit-first business model.
Feels a bit like David and Goliath, doesn’t it? But in case you forgot who wins in that fight… It was David. More on that later. First, let’s break down exactly what that looks like on the ground for the clinicians trying to survive it…
Imagine walking into a busy clinic at 8:00 AM, holding a steaming cup of hot coffee and carrying the weight of a dozen patients on your caseload. You are a highly educated healthcare provider, driven by a deep ethical commitment to patient care. But almost immediately, a stopwatch begins to tick in your mind. The productivity Gods are watching, they’re waiting, and they’re ready for you to start MOVING.
According to recent 2026 data, many clinicians are held to an astronomical 93% productivity standard by their management teams.
Let’s break down the mathematical reality of that number. In a national survey of inpatient rehabilitation professionals, practitioners widely agreed that current corporate productivity demands of 85% to 95% are simply too high and must be reduced. Instead, these frontline clinicians explicitly stated that a 75% productivity level is realistic and actually allows them to complete their essential job functions without the crushing burden of stress.
That 25% margin of non-billable time is exactly what we need to avoid rushing and skipping the steps required to keep our patients healthy and safe. It allows for critical clinical reasoning, careful and thorough documentation, and… breaks: For the bathroom, to eat, and to just take a breather. Yes, we are human, and we need to take breaks, despite what your employer and their spreadsheets might think.
But what are we supposed to do when our employer demands 90% productivity or higher?
The Math
At a 93% productivity requirement, a clinician is left with exactly 4 minutes per hour for everything considered non-billable. 4 minutes is a song on the radio. Think about that. You have 4 minutes to:
Chart review
Discuss the case with your interdisciplinary team
Write comprehensive medical documentation
Use the restroom.
Coordinate care with another specialist.
Speak with a weeping spouse who is confused and scared about their partner's stroke recovery.
… All in the time it takes Oasis to sing Wonderwall. Is that enough time?
It’s 10:15 AM, and Sarah has 9 minutes of “non-productive” time left
Take the example of Sarah, a clinician working in a high-volume Skilled Nursing Facility. Today she will see 12 patients. Because her facility demands a 92% productivity rate, Sarah has only 3.5 minutes between patients. In those few minutes, she must wash her hands, walk down the hall, read the next medical chart, and document her entire last session. And none of this accounts for breaks, family discussions, team meetings, or bathroom breaks.
Let’s look at how the math actually plays out in a realistic scenario:
9:00–9:15: Sarah arrives. In these first 15 minutes, she checks the charts for overnight nursing notes, tracks down a working wheelchair for her 9:00 AM patient, and waits for the one functioning elevator. She now has 29 minutes of non-billable time left.
9:15–10:00: She sees her first patient, but he’s had a rough night and needs to be changed by a CNA before therapy can begin. Being a good colleague and looking to move things along faster, Sarah jumps in to help the CNA. She now has 14 minutes left.
10:00–10:05: Sarah runs to the bathroom and grabs a quick cup of coffee. She now has exactly 9 minutes of non-billable time remaining.
It is only 10:15 AM. For the remainder of her 8-hour shift, Sarah has just 9 minutes left to document 12 complex clinical notes, speak with the MD about a new aspiration risk, call a worried daughter about a discharge plan, and attend the mandatory triple-check billing meeting.
This problem doesn’t end with the rehab department. I recently spoke with a CNA, and she said it’s not unusual for her to care for 20 patients during a shift. 20 patients! If she were trying to check on each patient every hour, that would give her only 3 minutes per patient. And that’s not even counting any breaks.
A fair, ethical, sustainable clinical practice is bumping up against unrealistic corporate expectations. And the result is a toxic environment where providing good, high-quality, genuine care feels like breaking the rules.
Next week we’re going to dive into this topic a little further. Many of us are feeling burnt out, and I want to know who started the fire. If you do too, stay tuned next week to learn more. Thanks for reading!
