Healthcare is a complex machine. With each passing year, it appears to get even more complicated. There's an ever-increasing need to balance quality and cost between technology and humanity. These are competing needs, which are usually critical to healthcare delivery, as care professionals are faced with the often overwhelming paperwork and the need for hands-on patient-centered care.
There can be challenges in prioritizing one condition at the expense of the other. Tackling these challenges requires extraordinary leaders. We need to know how to strike a balance and understand what should be sacrificed of one to support another need.
As physicians, we were introduced to the language of medicine both in its crude and modern form. We spent our formative days getting used to its Latin and Greek roots, abbreviations, and acronyms, and today we communicate effectively with other physicians because of it. But during this time, most of us failed to learn the language used in the "business of healthcare" as this is hardly taught in our training. At that time, we didn’t realize that this was a potential problem because the systems we trained in didn't require us to learn it. Also, most of our curriculums didn't include it, and we didn't personally notice its absence, as we were busy learning other things.
Unfortunately, the healthcare landscape has since rapidly evolved, and more than ever, physicians need to be grounded in the "business of healthcare" and its language. Before things started growing at such a rapid pace, healthcare was different. Physicians primarily provided medical care to patients, business managers managed the physicians, and business executives and administrators ran the entire hospital. This separation of responsibilities initially made sense. Physicians - dentists, pediatricians, optometrists, surgeons, and all medical caregivers - needed to stick strictly to what they did best: offering medical care. The managers and the powers ran the hospitals and had fancy degrees in business economics, and needed to be in charge of everything else. However, this delineation created a silo effect in health care. Each party focused solely on its division and responsibilities within the system, often at the expense of efficiencies in other divisions. This usually led to several conflicts of interest and a great deal of mistrust in the system.
The system has evolved, and the language used in the business of healthcare has also evolved to now include administrative and managerial lexicons. The trends have changed, and it's not safe for a dichotomy to exist in the healthcare system. There's an even greater need for reconciliation between the role of caregiving and administration. There needs to be some form of a convergence of these roles. Unfortunately, just as most hospital administrators lack valuable insight on practical caregiving, most physicians are depressively deficient in the administrative skills needed to provide leadership in the business of healthcare.
Physicians generally possess the skills for clinical care, and managers primarily possess the skills for administering the business of health care. Multi-talented physicians— through natural talent or additional leadership training — are better positioned to lead health care organizations as physician executives. Physicians occupying managerial, administrative, or executive positions offer enormous rewards in personal, professional satisfaction and organizational success.
What Physicians Must Do
As physicians, we must take a stand. The status quo has not just become unfavorable to us as physicians but has also affected the core product of healthcare, i.e., the patient-physician relationship. Therefore, we must passionately advocate for our patients and our profession. Medicine is bound to stagnate and become devoid of innovation in clinical practice without caring, compassionate physicians being allowed to practice medicine and assume leadership roles. Physicians must wrestle back control of healthcare and limit the power of hospital administrators. The many challenges facing healthcare today call for robust and authentic leadership - and physicians are uniquely positioned to assume such leadership.
As healthcare professionals, we're in the middle of one of the most dynamic periods. The healthcare industry is moving at a pace few can keep up with. Unfortunately, the relationship between those who deliver medical care and those responsible for the administration of the entire healthcare machine has never been more fractured, tense, or challenged. It has never been more complicated because, at the primary level, physicians and administrators have traditionally not trusted each other.
If physicians must fix the problems, we must urgently learn the modern business of healthcare. Many physicians complete their training with little or no understanding of the administration, financing, or organization of healthcare. This is, unfortunately, a considerable limitation; it's no wonder there is sometimes deep suspicion between those administering healthcare and physicians. However, this doesn't necessarily mean that administrators are always on the right side but merely misunderstood. Administrators are a substantial part of the problem in the system, but as physicians who clamor for better healthcare, we must educate ourselves about the administration and financing of healthcare. Unfortunately, as noted earlier, physicians do not get a comprehensive education on healthcare policies, administration, finance, or organization during their entire premedical education, medical school, residency, or fellowship.
Physicians must educate themselves on these pertinent issues. Education opportunities abound for physicians who want to make a shift towards administration. There are also different opportunities for physicians to enter the administrative realm of healthcare. Consider, for example, the number of adverts for physician-executive positions in professional journals and the rapid increase in seminars/workshops specifically designed to train physician leaders.
Studies have shown that physician-run hospitals are more likely to score higher in general quality of care and patient-oriented health service delivery than manager-run hospitals. Of course, the results of these studies don't necessarily prove that doctors make better leaders, but they're certainly consistent with that claim. Support for the value of medically experienced administrators in healthcare can also be observed in other sectors. For instance, scholar-administrators have helped enhance research outputs in educational institutions. In sports, basketball teams with coaches who were former players themselves have been linked to improved chances of success. Similarly, in Formula One Racing, former drivers have particularly excelled as team leaders. Industry or domain experts have always been linked with better organizational performance.
It can be argued that when physicians are leaders in health care, they're armed with credible insights as to the requirements of their "fellow physicians" for better healthcare service delivery. They're better informed through a shared understanding of the motivations of healthcare providers. Since most physicians spend their careers looking at things with a patient-focused perspective, physicians moving into executive positions are better suited to balancing organization-focused and patient-focused strategies and policies.
Thanks to their wealth of practical experience, physicians usually know what's required to complete a job to the highest standard. Therefore, they’re more likely to "go beyond" to create the right working environment to achieve those required standards. They're better suited to set appropriate and feasible goals and accurately evaluate everyone's contributions. Fortunately, some healthcare and medical institutions quickly realize that the mix of knowledge and skills that physicians introduce to administration can spur enormous improvement and great organizational change.
Physician-administrators appear to be quite effective leaders precisely because they are physicians. Yet, healthcare leadership requires much more than just being a physician; it requires great leadership and social skills. All in all, physicians must get themselves accustomed to the fundamental principles of business, at least within the realms of healthcare delivery. They must strive for personal leadership development to be even better positioned for administration. They must clamor in the interest of future physicians and for the integration of administrative skills training into formal medical curricula.