How Cronyism, Nepotism, and Unqualified Providers are depriving you of the best in Health Care


Currently, there is a bill before Congress called the Access to Quality Diabetes Education Act of 2015 (HR 1726, S 1345) which is to amend title XVIII (Medicare) of the Social Security Act to recognize only state-licensed or -registered certified diabetes educators or state-licensed or -registered healthcare professionals who specialize in teaching individuals with diabetes to develop the necessary skills and knowledge to manage the individual’s diabetic condition and are certified as a diabetes educator by a recognized certifying body. However, many currently working as diabetes or nutritional educators would not qualify for this license or registration as they lack both the educational background and the experiential training.

While many see this as simply more regulation, there is another way of examining the issue. Shouldn’t someone suffering from metabolic syndrome, type- two diabetes, or a similar metabolic condition expect that the person they are seeing has a minimal education and professional background? This certainly does not seem to be too much to ask. Unless of course, the person in this position lacks the education or training, or possibly both, to work in this capacity. This seems to be an issue with many, and that is because of nepotism or cronyism which has placed an unqualified provider in the position they are neither educated nor trained to fill.

Cronyism, hiring your friends or favorite staff to fulfill positions based on your liking of them rather than education or experience, and nepotism, the hiring of family members for the same reasons create unqualified providers that deprive people of the best health care possible. But don’t just take my word for it.

Jone L. Pearce, from the Paul Meringue School of Business at the University of California at Irvine, wrote that cronyism and nepotism are bad for everyone, and provides the research to back it up. According to the author, there is substantial quantitative research on nepotism and cronyism in the workplace as well as negative impacts on overall performance.

Max Weber (1864-1920) conducted observational research of German organizations, finding bureaucracies were nepotism and cronyism were constrained by minimal requirements provided superior functioning when compared with those organizations that were based upon, and allowed, nepotism and cronyism among other favorite leveraging. But this was nearly 100 years ago, so why hasn’t business learned the lesson?

While it probably does not surprise anyone that the owner of the local market employs his teenage son, and perhaps some of his friends, as bagboys or check out clerks, it should come as a surprise when persons in positions of authority that directly impact medical treatment, medical research, or healthcare, should have obtained those positions through a combination of higher education and experience. But even in the hallowed halls of medicine, we find nepotism and cronyism. The difference is that while you probably don’t care if your canned goods are placed in the same bag, you would probably be concerned that the person in charge of some aspects of your health care was placed in that position through means other than education and training. And you should.

For those of us who pay for our health care coverage, as well as those who have earned health care through a lifetime of work, when we go to a hospital, a clinic, or medical Center, we take it for granted that the people who sit in the offices that dictate our healthcare are qualified to perform the job. But this may not be accurate.

Favoritism, whether nepotism or cronyism not only diminishes our healthcare, it also decreases the performance of those healthcare professionals who have legitimately earned, through years of education and training, positions of leadership in hospitals and medical centers. When organizations place untrained in positions based on personal relationship or other favoritism, it not only decreases the effectiveness of that office and the staff but also negatively affects employee attitudes and perceptions. The last people we want distrustful of the medical establishment are those we rely on to deliver that medicine to us.

And rest assured, those working under these leaders who gained their position through means other than education and experience do not go unnoticed by their fellows or their staff. Realizing that the person you work for lacks both education and experience, and yet has control over your unit or department, is frustrating and undermining. Often the result is that coworkers, staff, and eventually employers are more just satisfied and less committed to supporting these supervisors and directors. And although the outcomes are frequently a reduction in employee satisfaction, a reduction in patient care and patient satisfaction, and an overall decrease in the personal appraisal of the hospital or clinic, I can point to more than a few situations in my state where this is a current issue.

In the end, cronyism and nepotism place loyalty and obligation not to the hospital, clinic or medical center itself, but instead to friends or family, those who secure the position. Cronyism is damaging to healthcare delivery because it supports the placement of unqualified people in positions of decisions regarding healthcare, medical research, or patient care. Decades of research in political science, economics, and even anthropology, have demonstrated that nepotism and cronyism are bad for organizational performance, and often spell disaster for both the manager as well as the staff.

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