Leadership: Who’s in Charge of Medicare?

If you let them, physicians tell about the days when MDs lead healthcare.  They remember medical staff associations deciding whether to hire another surgeon, not administrators or bureaucrats.

After 40 years, most doctors know better.  They hold hat in hand, look at their feet, and speak only when spoken to.  Well, some do…

Even mentioning this topic requires courage.  It’s politically incorrect, dangerous.  Un-Canadian!

Medicare axiom: doctors are not in charge.

Sure, doctors write orders.  But everyone gets trained to double-check and question every order, and that’s generally a good thing.  A tiny step separates double-checking orders from questioning the relevance of physician opinion in everything.

Inside Medicare we hear, “Do we really need a doctor for this leadership position?  Patient care improves when doctors are not in charge!”

But what do people outside healthcare think?

What do patients and families believe?

Who do courts identify as being most responsible for outcomes?

Everyone outside of healthcare assumes doctors lead Medicare.

Health systems discover, over and over, that great outcomes require physician leadership (see comments here, here, here and here).

When things go bad, the boss takes the blame.  When companies flounder, CEOs get canned. When bad things happen from overcrowding or long waits, doctors get sued.

It’s well known that doctors have done a pitiful job of leading at times.  They have been arrogant and condescending.  We can be sure of this by watching TV and listening to our mothers tell stories about nursing in the 1970s. (#sarcasm)

Responsibility, not behaviour, determines authority.  Behaviour should not dictate that a whole class of providers remains in authority, or subservience.

Leaders who behave poorly should not lead.  They should lose their authority.  But you cannot remove authority and leave responsibility unchanged.

We need to teach physicians to lead well.  Then, we need to put physicians back in charge of healthcare.

Of course, we need diverse senior leadership teams in bureaucracy and hospitals, from varied clinical backgrounds.  But those teams must have 30-50% physician members.  Currently, doctors hold <10% of leadership positions in Medicare.

Until we figure out a way to give final responsibility for medical care to other providers, we need doctors playing a major role in all aspects of Medicare leadership.

(photo credit: spectator.co.uk)