Gift Gone Bad

            Over the summer, I worked in a medical practice office and this was my first work experience with no peers of my age. I made lots of observations about the organization in this office, but it wasn’t until I started this class when those observations made sense.

            The medical practice has four surgeons who specialize in general and bariatric surgery. This organization is made up of the following: four surgeons (three of which are partners and own the practice), an office manager, physician assistants, medical assistants, front desk staff, scanning staff, and the bariatric department. In the bariatric department, there is: a supervisor, surgery schedulers, insurance advocates, and patient advocates.

            I was hired as a paid summer intern and I was the only intern for the summer. I was being paid the same amount as the scanning staff, front desk staff, insurance and patient advocates. I was assigned to work with a patient advocate in the bariatric department, who reported to the supervisor, who reported to the office manager. The supervisor and office manager had their own offices and the rest of the bariatric staff working in a large room, except for me and the patient advocate I was working under. My job description was preparing for seminars, working/hosting these seminars, communicating with potential and new patients, end of the month reports, ACS (accreditation of the practice), and referrals to the practice.

I came to my first observation quickly: the supervisor is not a leader and does not have manager characteristics. This created a break down between the other bariatric department staff. Since the supervisor was not acting as a manager, extra work and responsibilities (that should have been dealt with by the supervisor) were put onto the office manager and then delegated to other workers. This created resentment between the staff because some people with doing more work and working longer days than others, but still being paid the same amount of money. In addition, the workers who wanted to take on more work and responsibility to better the practice did not get along with the workers who did the bare minimum. The different work ethics among the workers created a divide and each group looked to a different person for leadership and approval over decisions. The workers who had a strong work ethic and high productivity saw the office manager as their superior, and in contrast, the workers who had a low productivity saw the supervisor of the department as their superior. Overall, I would argue that the high productive workers in the practice, not just the bariatric department, were the individuals who had intrinsic motivation.

The patient advocate I worked with had intrinsic motivation and received a lot of self-gratification from preforming at a high productivity level. As an individual, who at the beginning of the summer internship had no previous experience in a medical office, I benefited greatly from having a mentor who acted more like a leader than a coworker. She possessed the qualities of a leader and I always thought she was the stand out individual for the supervisor position. The women I worked with had a transaction cost when deciding who to value more. Frequently, she would be given tasks by both the office manager and supervisor. She would have to determine which task was the most pressing and important to be completed first.

As the summer continued, I observed that many of the bariatric staff would look to my mentor, as opposed to the supervisor, for guidance. Both the intrinsic and extrinsic workers came to her for advice, knowledge, and feedback. The extrinsic workers would attempt to put their work on to her and consequently me. I would complete the task faster and with less complaining, so often we did not argue with them about who should be doing the work.

I believe that this practice implanted the gift exchange model. The office manager recognized that the women I was working with was picking up the slack of the other workers and valued her employment in the firm. To keep her happy, the office manager moved us to a separate office. This increased her happiness because we could work separately from the department workers and increase productivity. However, I feel that the gift exchange model was not fully realized because there was no reciprocation among the workers. This was due to a few different reasons. One, because there was no cross training between workers and individuals only knew and wanted to do their job. There was no willingness or possibility for workers to pick up the work of missing coworkers. In addition, because the workers were completing different amounts of work, this created a divide amongst the bariatric department.

           Since the summer ended, I have kept in contact with patient advocate I worked under and she has updated me on the firm. Two insurance verification workers have quit and the office manager is currently looking to replace them. These two workers were not high preforming individuals and had extrinsic motivation. I would argue that the practice will be better off without them slowing the progression of the practice.