It has become fashionable for physicians to enter executive education masters programs in business administration, public health, or medical management in hopes of attaining the needed business skills. In surveys of physicians conducted by Sermo, Inc, an online physicians' community, many respondents expressed disappointment in such programs.
6 I believe the reason for this disappointment is that unlike medical school, where societal necessity and board examinations dictate the creation of a fairly uniform product (ie, the physician), business school does not require such a product. Thus, there is a huge difference between top-tiered business schools and lower-ranked institutions. Unfortunately, many physician-oriented programs “dumb down” management classes to the level of psychology 101, and the requirements for accounting and finance classes are equivalent to a financial statement reading class.
In medicine, there are a limited number of conditions that have a given symptom or complaint. We proceed to create a differential diagnosis, given the patient's history, and we work our way through the algorithms until we hone in on a definitive diagnosis. However, good business skills require that we widen our field of view to find our focus. In order for physicians to be effective in leading quality healthcare, we need to take into account many changing factors, including—but not limited to—the political economy of medicine, health policy, the regulatory environment, the behavior of competitors (both domestic and foreign), and paradigm shifts in technology. We then need to apply our knowledge and understanding of those interrelating factors to solve problems at hand. The top schools do not merely teach facts, which may soon become obsolete, but they also teach students how to critically analyze; how to develop strategies that properly account for, weigh, and mitigate risk; and how to collaborate with colleagues to carry out the objectives set forth.
One area that physicians need to understand is how to approach entrepreneurship. Whether starting a practice, seeking venture capital to produce or commercialize a modification to a piece of equipment, or effectively lobbying the local hospital to purchase a new piece of expensive equipment, the same skills are required. These skills are related to analyzing market demographics, competition, payor mix, reimbursement levels, time frames for plan implementation and return on investment, opportunity costs, and continued sustainability.
As a profession, we must have the skills needed to address the systemic problems in healthcare, especially costs, rather than simply shift those responsibilities to someone else or to another place or time. As a former chief medical officer who has medically underwritten catastrophic care cases, I must vehemently disagree with Don Berwick MD,
7 the new administrator of the Centers for Medicare & Medicaid Services, who said the following:
I would like to point out that insurance by definition is risk-sharing, not wealth redistributing.
As a physician, economist, and health administrator, I felt an obligation during this past year to my profession and the American people to help see that healthcare is reformed in a responsible manner—saving money and improving quality and efficiency, rather than just shifting costs. As a starting point, I published a plan
8 and contacted three major physician organizations about assembling a team of leading physician administrators (including many DOs) from major employer groups, insurers, pharmaceutical companies, medical device manufacturers, hospitals, and government agencies to collaborate on developing a comprehensive physician-led reform proposal.
One of the physician organizations that I contacted replied that it had already decided in favor of the healthcare legislation then being considered by Congress, stating that the legislation wasn't perfect but it was better than nothing. Another organization said that it planned to wait to see the content of the final bill and then lobby for changes accordingly. The third organization said that it was afraid to get “political” for fear of losing its section 501(c)3 taxexempt status. I found this latter response to be especially perplexing. We all would like everyone to have the best healthcare available, and the best healthcare would get patients better in a faster and cheaper manner. Advocating that is not political; it is just logical and practical.
The responses I received were nothing short of astonishing. Perhaps an explanation for these attitudes lies in the following statement by Jean-Marc C. Haeusler, MD,
9 regarding medical leadership: