He couched his answer in the context of how hospital and health system CEOs should see the physician-administration relationship. In his view, the idea of hospitals and health systems treating the physician as a customer is exactly what's gotten healthcare in trouble financially. Because in the end, treatment orders, in most cases, are written exclusively by doctors. He suggests CEOs develop structures where the hospital or health system is sharing risk with physicians as partners and not as customers to whom you pander.
Lest physicians reading this column think this is a case of "blame the doctor" for all of healthcare's woes; it's not. Physicians want to be treated as adults anyway, he says. But any way you cut it, for both physicians and administrators, you have to "go big or get out."
Consolidation is already progressing steadily. In every community of 500,000 people, he predicts we'll see healthcare owned and controlled by a couple of $2.5 or $3 billion (revenue) enterprises instead of six hospitals and 1,500 independent practices.
That means managing physicians. But managing physicians takes far more skill than managing, say, a factory shop floor. Or maybe it doesn't, but that's another story.
In this narrative, physicians have lots more education, and lots more power, than that. The question is how to do it well.
Many physicians, being prior victims of management failures, could probably tell you, if you let them. If management's about taking better care of patients (and critically nowadays, taking better care of populations), physicians are for the most part a ready audience. If it's about money and costs, they tune out. Yet it's all linked.