More doctors should be hospital leaders

It may not be long before a hospital will be the least likely place to find a doctor. Pressures are mounting to replace physicians with computers, guidelines, nurse practitioners and even pharmacists. The assault on the patient-doctor relationship continues to mount.

Centers for Medicare & Medicaid Services recently made a final ruling that finds the regulation requiring a doctor sit on the governing board of a hospital to be “unnecessary, obsolete, and unduly burdensome on health care providers and suppliers.” Hospitals must now only “consult” with a physician “periodically throughout the fiscal or calendar year on matters related to the quality of care.”

Doctors have become the “problem child” of hospital administrators, government officials, insurance companies and the media. That is until their loved one becomes ill. But does CMS really believe that doctors are just an afterthought when it comes to patient management?

Hospitals would have you believe that that they are service centers. When was the last time you got “good” service”? In fact, hospitals are financial institutions that “sell” health care. They are large corporate entities designed to make a profit in an ever-increasing regulatory environment.

Doctors advocate working on behalf of patients. Does anyone really believe that hospitals should be making end-of-life decisions about patients without a doctor? Is it always about the money? Where will the line be drawn?

Amanda Goodall has led research into the question of “whether physicians can be efficient hospital managers.” Her hospital management study cites research suggesting leaders of sports teams are often better when they have “walked the walk” as a player and that the best universities are often led by scholars.

So why wouldn’t doctors be the best hospital managers? Her research concludes using the Index of Hospital Quality and establishes that in the fields of cancer, digestive disorders, heart and heart surgery doctors disproportionally lead the U.S. News and World Report’s list of Best Hospitals.

This is not conclusive evidence that a doctor should lead every hospital. But surely it is convincing evidence that CMS was not interested in patients when it made the ruling about governing boards.

It is about time Marilyn Tavenner, the head of CMS, takes a stroll into the workplace she represents.

Marcy Zwelling-Aamot is a physician and member, American Academy of Private Physicians.

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  • SteveCaley

    We are going through one of the most amazing periods of vanity that would put the people of Versailles to shame. A hospital is now to be run as a factory – by the same business leaders that eliminated US manufacturing from our shores. Perhaps they can outsource medicine.

    • Lisa

      I think medical tourism is a form of outsourcing. And If I remember correctly, there were discussions about insurance companies paying for joint replacements outside of the US (in India for example).

      • Patient Kit

        Also, didn’t I read that some radiology imaging is being sent to India to be read there more inexpensively? Anything that can be put on a computer and sent around the world in seconds, can be outsourced. Do we even know how much that is happening?

        • Lisa

          The term is teleradiology and it happens quite a lot.

        • Suzi Q 38

          If a lot of radiology is being done and is in India why do radiologist get paid an average of 300 cage and Apple year

          • Patient Kit

            Good question, Suzi. At least when we buy a T-shirt or a pair of UGGs boots, they are required by law to be labeled “Made in China” or wherever they were made. If radiology is being widely outsourced to countries where labor is cheaper, it’s not apparent to patients since it’s neither reflected as a cost savings for patients or identified on radiology reports with a “Read in India” label (as far as I know). And, as you pointed out, radiologists in the US are paid good salaries. So….wherever does the savings from outsourcing radiology go? And why aren’t healthcare providers required to inform patients when this kind of outsourcing is being done? Not to mention, does it have any impact on the quality of radiology?

            And while we’re on the subject of outsourcing, why is it that we seemly outsource everything made under the sun to be made by cheap labor in other countries, but pharmaceutical consumer prices in the US remain the highest in the world for necessary , sometimes life-saving drugs?

    • DeceasedMD1

      “Perhaps they can outsource medicine.”

      they already have….
      Scribes are being outsourced and silicon valley companies are creating the technology to outsource scribes. That will help the medical record. And of course telemedicine is outsourcing MD’s. But i think your point is it will only get worse…

  • Patient Kit

    If the official use of the word “obsolete” to describe doctors isn’t a call to arms for doctors, what will trigger docs into action? Regardless of what the powers that be want you to think, patients do not consider doctors obsolete any more than we consider pilots obsolete. We do not want to step onto jets with empty cockpits that will be “piloted” remotely by a computer on the ground.

    Until now, docs have gone along for the ride as healthcare in this country has become an enormous gigantic Big Business. Back when docs were still in a more powerful position in our healthcare system, they did nothing to stop the transition and escalation of healthcare into a Big Business. By doing nothing then, docs helped create the system we all currently have to live in. And continuing to do nothing is not going to magically turn things around. Docs are going to have to do something.

    Right now, you’re either a good company man or you’re a problem to Big Health. You can choose to either be a good company man or you can choose to actively join the resistance. What you cannot do anymore is fly under the radar.

    • TheresaWillett MDPhD

      Viva la resistance!

  • QQQ

    Read this good article.

    “3 Reasons Doctors Make Poor Leaders and What You Can Do About It”

    http://healthworkscollective.com/dikedrummond/33956/physician-leadership-3-reasons-doctors-make-poor-leaders-and-what-you-can-do-abou

  • buzzkillerjsmith

    20ll article showing that docs run hospitals better than business types:

    http://www.sciencedaily.com/releases/2011/07/110706104808.htm

  • QQQ

    Interesting! Does he come on regularly? How is his comments and with fellow members here on KMD?

    • PoliticallyIncorrectMD

      Those who can – do, those who can’t – teach ; )

      • QQQ

        So he teaches?

        • PoliticallyIncorrectMD

          He teaches physicians how to be happy but himself chose to get out of seeing patients ?!

          • buzzkillerjsmith

            I’m not sure if Dike pulled the plug 100%. If he has not, I apologize to him.

          • PoliticallyIncorrectMD

            I did not mean to be personal (this time). My broader point is that people who entered the field of Medicine for right reasons feel happy and content regardless of the extrinsic factors. Those who do it because of lifestyle, compensation, status, etc. are likely to find themselves easily discouraged by economic and political changes.

          • Bradford Lacy

            That may be one of the most insightful comments that I have read. The same is also true for every occupation.

          • TheresaWillett MDPhD

            I have to disagree with that, although I am sure it applies to some. I never went into pediatrics for money, fame, or the hours (boogers happen 24/7). I am frustrated because of the interference with my time with patients and my ability to truly help rather than lecture and send along with a prescription. I am a scientist who focuses on the CARE in healthcare, and that is not supported in the current environment of health business.

          • PoliticallyIncorrectMD

            What prevents you from spending more time with patients ?

          • TheresaWillett MDPhD

            Benchmarks. ‘They’ gather data from somewhere, say that we need to see x patients per hour, and limit our staffing based on more benchmarks, which may or may not actually pertain to our specialty. I was told in no uncertain terms that I should not book patients for 45 min, and I am not allowed to plan 60 min for a complex mental health teen visit. Even in private practice without the above interference, pediatricians see 20-40 patients a day because they cannot afford to see fewer- payment is so poor for care of children due to the status quo that we have allowed to come into being. Very frustrating.

    • buzzkillerjsmith

      Dike was around here a fair amount but not lately. He has a website that is worth a look.

  • TheresaWillett MDPhD

    “We often anoint someone a medical director without providing the appropriate training and support that should accompany that role” YES! Leadership is not the same as controlling the people ‘beneath’ you and telling the higher ups what they want to hear, but that is what is rewarded in my experience. We ‘little’ people so need proper, invested, transparent and inspiring leaders to make it through this change intact, but those who try to step up are squashed mercilessly in the interest of the status quo.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I think hospitals should be run by nuns, or a modern version thereof, vows of poverty included.
    http://www.nytimes.com/2011/08/21/us/21nuns.html?pagewanted=all

  • DeceasedMD1

    good luck with MD’s being leaders. hospitals are buying up MD practoces to now where 75 % are hospital employees.

  • Joe

    Are there that many physicians who want to be leaders? Most new physicians I’m seeing seem to eschew any duties not associated with direct patient care. This includes committee assignments, medical staff functions, and any other administrative/quasi-administrative roles. On top of the “work/life balance” concerns that feed this mentality, residency appears to be hardwiring into them such an intense hate and animosity for hospital administration that they want nothing to do with the job or the people holding the job. Older physicians really just want to retire, so leadership roles there are out as well. Physicians stuck in the middle are looking for security. Administrative duties are not seen as a good path to that goal.
    I could be wrong, but that’s what it looks like from here.

    • buzzkillerjsmith

      Looks the same from here for docs out of residency.

      Please tell us about the intense hate for admin for docs in training. I didn’t realize that was going on in residency.

      • Patient Kit

        Maybe that’s a good thing. Maybe there is hope that they will organize themselves.

      • Joe

        Again, anecdotes aren’t data, but the new docs seem to have a very developed paranoia regarding administration and they all attribute it to messaging in residency. “You can’t trust those guys,” “Stay away from the suits,” “Just ignore them and hope they go away.” Now that they’re out, they don’t even bother to look into leadership roles. The only thing they feel comfortable with is treating the next patient in front of them. Possibly being a change agent is out of the question. What’s worse is that it colors their opinions of any colleague who DOES try to engage on a higher level, even when they are at odds with administration. On one end, they are “sell outs.” On the other, they are criticized for “going on a power trip.”

        • buzzkillerjsmith

          Another group of sheep to the slaughter.

        • Patient Kit

          “Just ignore them and hope they go away” is exactly what got us all to where we are today in the US healthcare system.. News flash!!! They didn’t go away. They got more powerful because doctors ignored them and hoped they’d go away. Another news flash!!! Nobody is flying under the radar. You’re under something. But it isn’t the radar.

  • buzzkillerjsmith

    Almost every bit of revenue that went to Russia’s elite was generated by the serfs.

    The weak produce, the strong enjoy what the weak produce.

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