These are turbulent times. The system of health care in this country has experienced radical change with the advent of managed care and the involvement of Wall Street. It seems that the profit motive has supplanted the values of meeting the needs of individual patients, especially those of vulnerable and disenfranchised populations. Physicians, in particular, are feeling a loss of control of the systems within which they work. Why is this the case?
As a physician, I believe the present state of affairs is primarily our own fault. For too many years we have been saying, “Just leave me alone and let me practice medicine.” We have abdicated control of the health care system to the entrepreneurs, bean counters, investment bankers and lawyers. There are too few physicians in the true leadership positions of health care organizations. This must change. Physicians and other health care providers must retake control of the health care system in America. It is those with personal experience in providing direct patient care who are most likely to have the “reality perspective” necessary to protect the interests of our patients.
The question then before us is “how can this be accomplished?” It is true that, as health care providers, we lack the training needed to support the business and organizational decisions necessary to navigate the complex world of health care systems. Consequently, at least some of us need to go out and get that training, and “pay our dues” by working in administrative positions to gain the experience and credibility necessary to rise to positions of leadership within health care organizations. Only then will we be able to materially impact the decisions that affect the health care system as a whole.
So what kind of a physician is best suited to the role of a business leader? Several personal characteristics come to mind:
The physician leader must have a broad perspective on health care, including population-based and preventive health care strategies.
The physician leader must have a high tolerance for ambiguity and be comfortable making decisions based on incomplete information.
The physician leader needs excellent communication skills and a broad training background in human behavior.
The physician leader must be equally skilled at dealing with individuals and with groups, and know both how to lead and how to be part of a team.
The physician leader must have excellent skills in locating and managing resources, as well as the creativity to develop resources not yet available.
The physician leader must be particularly comfortable with delayed gratification and long-term planning for the future.
The physician leader must have the intellectual honesty to know when he or she is in uncomfortably deep water and in need of the advice and counsel of others with more specific knowledge and skills.
If it is not yet obvious, I believe the personal characteristics that select for those physicians who choose family medicine as a career are the same qualities that make for an effective physician leader. Consequently, I feel that, as family physicians, we have an obligation to step forward and accept leadership roles as the opportunities to do so present themselves. We need to take advantage of opportunities for advanced training in business skills, either in the form of formal graduate education or training programs oriented toward preparing physicians for leadership settings.
That said, being a physician executive is not for everyone. The article by Steve Thomason, MD, in this issue of Family Practice Management addresses well the considerations associated with a career shift toward administrative medicine and discusses the characteristics of a physician executive that are predictive of success in that role [see “Becoming a Physician Executive: Where to Look Before Making the Leap”]. He also provides an excellent list of some of the major resources for physicians hoping to build their executive skills. To quote Dr. Thomason, if you feel that the physician executive role might be a good fit with your temperament and personality, then “it's worth a look.”
We need to work together, collaborate with our other specialty colleagues, learn from our administrative colleagues and support those physicians taking the “road less traveled” into leadership positions. Family practice, the specialty that has established a leadership role in the education of physicians, should now take a similar role in the evolution of the American health care system.