Is it a myth that physicians are poor man managers? Do we need to learn man management, store management, medical store management, and handling and maintenance of accounts? We need to compete with guys with MBAs and handle administrative issues as well as they do, if not better. We are not taught about administration in medical schools whereas they have a structured and well-defined course before they take over as Administrative heads of medical centers. A physician learns all the nuances of administration ‘on the job’. It is high time we made an extra effort to learn administration as it is incredibly important in today’s health services.
Fifty four percent of physicians in the USA have a burn out problem for which they blame leaders involved in health care, finance, policy and clinical administration [1-3]. Physicians often state “Why don’t these business people get us?”. “Why doesn’t the medical superintendent just back off and let me take care of my patients?” ” Why are there so many Administrators when there are few medical care providers?”
The healthcare industry is changing rapidly and so is medical science. Relations between those who administer health care and those who deliver healthcare are strained. There is often a lack of understanding and mutual trust between the two.
The Physician should be responsible for not only delivery of healthcare but improving healthcare delivery and redesigning healthcare as well. The Physician should be educated about healthcare policy, administration, finance and organizational behavior. Conversely, the Administrator should understand the clinician’s perspective. Both should be able to speak the same language and build meaningful bridges.
The mean salary per annum of an administrator with more than 10 years of experience in the USA is 600,000 USD whereas a physician with similar seniority and experience is paid about 280,000 USD. Financial management and credit control are major administrative problems in the USA, and it is the Administrator who sorts these problems out.
This is what the Physician thinks: A hospital is not a hotel and patients should not expect to be pampered. This is what an Administrator thinks: Learn from the hospitality industry and treat patients like guests at a four-star hotel. So who is right? The Physician who practices tough love, or the Administrator who tries to emulate flight attendants and provide business class comfort to the patient.
Some interesting studies have revealed that there is an inverse correlation between patient satisfaction and clinical outcome [4-7]. Patients can be very satisfied and dead an hour later. Interestingly, the Administrator tries to improve the patient satisfaction level whereas the Physician tries to improve the clinical outcome. So are they pulling in different directions?
Advise an MRI which was recommended by the patient’s brother-in-law who practices medicine in the UAE or prescribe antibiotics which the patient just browsed on the internet and watch the patient satisfaction reaching new heights. Giving patients what they exactly want will score satisfaction points but is costly to the system and detrimental to the individual and public health.
Quality healthcare is “the degree to which healthcare services
for individuals and populations increase the likelihood of
desired health outcomes and are consistent with professional
knowledge”. When the patients are dissatisfied, their real message
is that their emotional needs are not being met. They may
feel disrespected, confined, vulnerable, fearful and lonely. They
expect the healthcare provider to treat these emotional needs
too. To improve clinical outcome, we need to address these issues
Between 1990-2012, the US healthcare force grew by 75%,
out of which 5% growth was contributed by physicians and the
remaining 70% by administrative staff in the healthcare industry.
The ratio of doctors to healthcare workers has gone from 1: 14
to 1: 16. Out of these 16 healthcare workers, six are involved
in patient care and the remaining 10 provide administrative
support helping with documentation and meeting the regulatory
Doctors have become worker bees in the factory of administrative
estates. In the past, the Physician was responsible for
both business and practice of medicine and administrative personnel
had complimentary roles to play. Today the Administrator
has evolved into a kind of instruction manual dictating how,
when and where the Physician should work. The Administrator
has become the modern-day healthcare entrepreneur. In the USA
the number of physicians has risen 150% over the last 30 years
whereas the number of administrators has risen 3000%. According
to the New York Times, Hospital Administrator salaries are
responsible for a higher percentage of medical costs8 According
to the Times, health care administrative costs make up nearly
30% of the total U.S. health care bill.
A smart administrator will lay off clerks, make the Physician
maintain electronic health records of patients and take the calls
of insurance companies thereby saving man power. He will try to
automate the art of medicine through protocols and algorithms
and will suggest cheaper and less trained alternatives in an
attempt to cut costs. He will try to provide healthcare with the
help of an army of IBM computers at the click of a button Table 1.
I was carrying a cup of coffee down a hospital corridor. I was
grabbed by my shoulders and physically shaken up by a junior
administrator. I was a 25-year-old intern coming off a 36-hour
shift. He was 25 too, coming for his eight-hour working day.
Patients need primary care but not necessarily a physician.
Corporations undervalue physicians and consider them replaceable.
They lay greater emphasis on employment of nursing practitioners
and physician assistants.
In the future, physicians will not be judged by their clinical
skills, but by how much money they saved for insurance companies
and will be paid based on clinical outcomes. Everything will be
target oriented: there will be a target cholesterol level, a target
blood sugar level and even a target blood pressure reading which
would determine the pay package of the Physician.
Medicine cannot survive and innovate without committed
and compassionate physicians who should retake control of
healthcare and practice as administrators. The physician in
addition to looking after his patients, should take keen interest
and learn about health policies, man management, procurement
and purchase of medicines and accounting procedures. He
should step out of his comfort zone of his department and
actively involve himself in administration otherwise, as Arnold
Schwarzenegger says, it will be “Hasta la vista, Docs”.