Doctors need to be the leaders of health care change

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In a time of crisis is when leaders step forward. If our nation faces one crisis, then it is that of the health care system which increasingly is unaffordable and trails other industrialized countries in quality and access. If there was a time leadership was needed then it would be now. As doctors, we should be providing this leadership. No longer can we let others dictate how health care should look. No longer can we simply abdicate responsibility to our patients by claiming that how much treatments or therapies cost are not our issue or our concern. As healers we need to do more than ever.

If there is optimism for our future, then it is due to the examples set by health care organizations that are actively solving the issues of cost, quality, and access and the commensurate rise of physician leadership, which is increasingly apparent through engagement with the media. All are signs that more doctors are willing to lead and make the changes needed to move the health care system forward.

When President Obama was fighting for health care reform, he spoke about how,

“[his] grandmother was generally very happy with her care, and if we could actually get our health-care system across the board to hit the efficiency levels of a Kaiser Permanente or a Cleveland Clinic or a Mayo or a Geisinger, we actually would have solved our problems.”

A common thread that ties Kaiser Permanente, Cleveland Clinic, and Mayo Clinic is physician leadership. Dr. Nicholas LaRusso, Medical Director of Mayo Clinic Center of Innovation notes that despite all of the amazing innovations of medical science over many decades, the one thing that has yet to be transformed is the delivery of medicine or health care. Specifically, the “integrated group practice” which relies on “salaried physicians, a physician led organization, a culture that is focused entirely on the needs of the patients, and an environment that expects teamwork” are now being adopted than in the past. At Mayo, doctors work side by side with business trained colleagues in making the changes needed to ensure that the environment doctors practice in is always focused around the doctor-patient relationship, the most critical relationship in health care. As authors of the book Management Lessons from Mayo Clinic note:

Mayo Clinic is a doctors’ organization. Physician-led, it provides a place where doctors can practice their profession in an environment that is as close to the ideal as they can make it. This means, however, that the doctors need professional administrators who are as bright and well-trained as they are to ensure that administrative operations achieve a level of excellence comparable to the clinical excellence that they pursue….Teaming physician leaders with administrative leaders brings both clinical acumen and business and management acumen to the leadership table. However, the physician perspective wins out when there is a tie vote—Mayo Clinic exists to deliver health care services, not accumulate wealth.

A focus on the doctor-patient relationship, a belief that health care exists not to make money, but to provide care has been tossed by the wayside over the past few years as insurers and employers shift more costs to employees via deductibles and copays, devalue physician decision making and autonomy with prior authorization, and disrupt the doctor-patient relationship. Ironically, it is increasing focus on the doctor-patient relationship which will save health care. Though the rise of the empowered patient will be important, it will be doctors working in roles they traditionally have not taken on in the past which will make fixing health care a reality. As Cleveland Clinic CEO Dr. Toby Cosgrove noted:

… most surgeons never know that the stitch costs $5 and the staple costs $400. Traditionally, knowing the costs of a stitch or a catheter or a bone screw — or any of the thousands of other supplies used during surgeries — hasn’t been part of many doctors’ medical consciousness… Conscientious medical providers have no choice but to confront cost issues or become guilty bystanders to the slow deterioration of America’s health care system…we challenged ourselves to save $100 million by focusing on how and what we buy to stock the hospital with needed equipment and supplies. The key was to meaningfully engage doctors. Now, as part of the purchasing process, dozens of doctors gather to discuss the merits of certain products: Which ones provide the best outcomes for patients? How many are needed? How much does it cost?

The key is having these difficult conversations, leading and engaging physician colleagues, and actively demonstrating that we can and must do better. This requires leadership. Unlike past attempts, having physician leaders, who also are active clinically, provides a level of credibility and understand which no doubt was sorely missing in the past if a business person suggested the same changes.

What is concerning is the rise of accountable care organizations and the increasing employment of doctors by insurers and hospitals. Are these physician led or physician run? Is it possible that the potential for true reform will fall short because these are lead by business people instead of a true collaboration with doctors? Time will tell.

Whether doctors should be special or different and that they need a leader with a medical degree rather than a MBA isn’t as relevant as the point that for change to occur, leadership is needed. If it takes a doctor to lead change, then so be it.

Which doctors in these leadership roles do you respect?

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.

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