IT IS TIME FOR PHYSICIANS IN MASSACHUSETTS to take a critical leadership role in determining the fate of the health care delivery system. But as decision-makers gather around the table to chart the future course of health care delivery in our nation, will physicians have a seat? Will they, as guardians of our health, even be heard?
As the industry struggles to constrain costs, it is business expertise - accounting, operations and personnel management - that is being applied to streamline operations and improve efficiencies.
We risk becoming a nation in which health care is prescribed, not by physicians in lab coats, but by administrators in suit coats. Surely, failure to include the healer's perspective will be hazardous to our health.
It is true that physicians are represented on the senior management teams of many hospitals and managed care plans. Yet, their legions are not strong enough, large enough, or deep enough to adequately advocate for patients and protect quality, access to care, and appropriate utilization of services and technology.
To become viable participants, more physicians must learn to speak the language of business. This is a challenge, for most doctors prefer to analyze symptoms, not balance sheets. The very traits that make doctors such good providers of care -compassion, empathy, and conflict-avoidance - work against them in the corporate arena.
Physicians trained in the art of medicine must now become more skilled at practicing the business of management.
Four things need to happen to clear the way for physician involvement at the decision-making level:
Physician entrepreneurialism must be harnessed. In this tumultuous environment, managing health care organizations requires talent, vision, and more than a little assertiveness to initiate new ways of doing business. Many physicians have run highly successful, very profitable private practices. They have the entrepreneurial skills that our evolving health care system requires. These are, however, the very doctors who shun bureaucratic administration and
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institutional politics. Health care organizations must uncover these leaders and harness their innate business savvy.
Physician leaders must have mentors. Health care organizations have a responsibility to identify medical leadership talent. These organizations must train physicians and provide them with opportunities to test and hone their skills. Some institutions go so far as to hire consultants to mentor their doctors.
Physicians need management training. An increasing number of physicians are putting the initials "MBA" after their names. They have invested in improving their business skills by enduring the rigors of formal business school training. This training is crucial to ensure that physicians can respond to the economic challenges of care delivery.
Physician incentive systems must be modified. In academic medical setting, clinical competence, research performance, and publishing are rewarded with faculty appointments and peer recognition. In private and hospital-owed practices, the majority of compensation formulas reward productivity in the exam room - the more patients seen, the more revenue that accrues.
It's time to reward leadership. Managed care plans, hospitals and physician practices must cultivate, encourage, and reward physician participation in decisions concerning the financial and health ramifications of patient management. Then bright physicians with business acumen will apply their skills to this area.
The evidence is mounting: Organizations that recognize and reward leadership score higher on patient satisfaction, clinical outcomes, and profitability.
Our nation wastes a valuable resource when physicians are not included in the discussions about the future of health care. We also risk a health care delivery system that is too focused on profit and loss statements and less vested in ensuring that our citizens continue to receive the best health care in the world.
Jayne Oliva is a principal with The Croes Oliva Group, a team of practice management professionals in Burlington.
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