Bureaucrats and nurses lead Medicare. Aside from a few CEOs, and a smattering of administrators, physicians do not lead Medicare. Most of the MDs in hospital admin positions do not have signing authority, cannot hire and fire, and have no budget.
If we include all paid leadership positions, non-physicians out-number physicians by at least 15:1, if not much more.
Physicians bear final responsibility for medical care. Until we figure out how to give other providers final responsibility, physicians should represent at least 30-50% of paid, senior leadership positions.
We need to train physician leaders and attract them to take leadership positions. Physicians won’t apply for leadership roles for a fraction of clinical earnings.
40 years ago, Medicare bureaucrats assumed leadership and fought physicians for control when necessary. This must change. Medicare will not run well without physicians holding many of the top positions. I said ‘many’, not ‘all’.
Once we create opportunity, physicians must not abrogate their responsibility to help run the system. Physicians need to value system involvement and not see it as ‘going to the dark side’.
Patients assume physicians run hospitals. They stare in disbelief when they hear physicians have almost no role in administrative hospital function.
Without a majority, or substantial portion, of physician members, leadership teams avoid decisions that might anger medical staff, or they make poor decisions for lack of physician leadership input.
Physicians do not lead Medicare; the myth has to change.
(photo credit: net.acpe.org)
Like many of the public I naievly assumed the ER inefficiencies, hours of waiting and, sadly, patients dying was because physicians just couldn’t get it right. I suspect the public is unaware of that fact. Hospital administrators would be well served to entice physicians to take administrative leadership roles. The pay at the top is usually more than a physician makes and the hours are predictable . How can a health care system operate without the docs being full participants in operational decisions. It’s been tried without the docs and hasn’t been a huge success for meeting patient expectations. Budgets are never balanced, services lacking…..time for physicians to be front and center. Collaboration is always preferred versus seperate agendas.
As always, your comments are welcome and insightful, Don. Thanks so much.
‘Engagement’ gets talked about quite a bit in hospitals. Engagement is not partnership. Partnership implies ‘full participat[ion]” as you said. I hope to write more on this in the next post.
Thanks again!
S
I 100% percent agree with this post and believe this a major issues that needs to be addressed. I myself was surprised when I graduated to learn how hospitals were run and who ran them – and how little influences physicians have. We are rarely consulted and I have few mechanisms to hav our comments heard on quality of care and patient safety.
Thanks Scott!
I, too, had the same surprise when I realized how the system ran, and who ran it. For some reason, all through training, I held the impression that very wise physicians with decades of experience held most leadership roles in the hospital.
Things have to change.
Thanks again!
Shawn