Anemia in Academia: Part 2 - Bureaucracy (#534)

Force #2: Administrative drag.

Not many years ago, I tried to hire a young neurologist.

Bright. Capable. Thoughtful with students.

The sort of clinician you recognize immediately.

The type who listens carefully before speaking and whose patients seem calmer simply because she is in the room.

She wanted to teach.

She wanted to build a program.

She wanted an academic life.

We lost her.

Not to salary.

Not to a competing offer.

We lost her to time.

By the time the position description wound its way through committees, approvals, revisions, equity reviews, budget signoffs, and human resources checkpoints, nearly four months had passed.

Four months!

By then she had accepted a private practice position and moved on.

No drama. No anger. Just life continuing forward.

Meanwhile, the university was still filling out forms.

When people talk about why academia feels thin, they often talk about money first.

But if money is the first force, bureaucracy is the second.

And in many ways, it is more exhausting.

Because you can justify lower pay in exchange for meaningful work.

It’s much harder to justify wasting your life in meetings.

Bureaucracy rarely announces itself as the villain.

It arrives dressed as good intentions.

Accountability.

Transparency.

Compliance.

Risk management.

Process improvement.

Each step sounds reasonable on its own.

Together, they become quicksand.

A simple hire becomes twelve signatures.

A new piece of equipment becomes three months of procurement.

A curriculum change becomes a year of committees.

A travel request becomes an obstacle course.

Nothing is forbidden.

It’s just slow.

Relentlessly slow.

When I first entered academic medicine, most of my day was spent in three places:

The clinic.

The classroom.

The research lab.

Now, when I look at many junior faculty schedules, I see something different:

Email.

Zoom.

Meetings.

Compliance training.

More emails.

Medicine has been squeezed into the margins.

I sometimes ask young colleagues:

“How much uninterrupted time did you have this week to think deeply about a case or a paper?”

They laugh.

Not because it’s funny.

Because it feels impossible.

Paperwork is the silent thief of academic energy.

It steals ten minutes here.

Twenty minutes there.

An hour after dinner.

Not enough to protest.

Just enough to exhaust you.

By Friday, you haven’t done anything you imagined you would do when you chose this career.

You haven’t mentored the student who needed you.

You haven’t refined that lecture.

You haven’t read the literature that keeps you sharp.

But you did complete five online modules and attend four meetings about meetings.

It is hard to feel like a healer or a teacher in that environment.

You begin to feel like a clerk.

Private practice has its own pressures - productivity targets, client expectations, long days.

But when I talk to colleagues who have left academia, they often say the same thing:

“I’m tired, but at least I’m tired from medicine.”

That sentence stays with me.

Tired from medicine.

Not tired from process.

Not tired from navigating systems designed decades ago for problems no one remembers.

Just tired from doing the thing they trained to do.

There’s an honesty to that kind of fatigue.

Bureaucracy also carries a subtler cost: autonomy.

In small, older academic departments, decisions once happened down the hall.

You talked to the chair.

You solved the problem.

You moved on.

Now decisions drift upward and outward.

To offices far removed from the clinic floor.

To people who have never met your students or patients.

To people who determine how you document your time, how you hire, how you spend, how you teach.

The further the decision moves from the work, the less humane it becomes.

Policies replace judgment.

Forms replace trust.

And slowly, faculty begin to feel like employees rather than professionals.

That shift - from trusted craftsman to managed unit - is corrosive.

None of this is dramatic enough to make headlines.

There is no single moment when someone storms out and says:

“I quit because of paperwork.”

Instead, it’s quieter.

A slow accumulation.

A thousand small frustrations.

Until one day a private practice calls and says:

“We just want you to see patients and teach our interns.”

And suddenly the choice feels obvious.

Not because of money.

Because of oxygen.

Universities, of course, need structure.

Universities are stewards of public trust and donor funds.

Universities need fairness and oversight.

But somewhere along the way universities have confused necessary governance with perpetual administration.

One protects the mission.

The other smothers it.

If we want to restore vitality to academic medicine, we must do something radical:

Give time back.

Fewer committees.

Shorter approval chains.

Protected clinical and teaching hours.

Trust professionals to act like professionals.

Not everything needs a form.

Some things simply need judgment.

Money may determine whether someone considers leaving.

Bureaucracy often determines when they finally do.

Because anemia isn’t only about blood loss.

Sometimes it’s about suffocation.

In Part 3, I want to talk about another quiet force.

The one that follows naturally when time disappears.

The steady, human cost of trying to do four full-time jobs at once.

Burnout.

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