Managing Physicians May Be Impossible

Philip Betbeze, for HealthLeaders Media , April 19, 2013

If you've been covering healthcare as long as I have, your notes and stories over the years are full of comments from and about hospital and health system leaders who tried to manage their physicians, and failed spectacularly. Speaking of tropes, managing physicians over the years has come to be seen as a "career-limiting event" among CEOs. Often, the last event in their tenure boiled down to a vote of no-confidence from the medical staff.

Whether or not they've been successful, or even correct in the way they've chosen to manage their physicians, senior leaders have the right idea: Physicians need to be managed like everyone else. Even leaders need management.

But many physicians are recognizing that their ability to influence healthcare, for the good of the patient, can be more fully realized by a management role of their own. I've had as many as a dozen CMOs tell me they had no idea what they were getting into when they were named CMO, which entails more and more these days, actually managing patient care, and by proxy, managing physician behavior.

Ditto for the burgeoning ranks of physician CEOs in hospitals and health systems. That doesn't mean they regret it. For the most part, they are exhilarated. They appreciate the scale on which they can influence patient care, which, after all, is why the vast majority of them got into medicine to begin with.

This month in HealthLeaders magazine, I write about several organizations that are putting their physician management skills to the test. Perhaps they'll succeed, perhaps not. Physicians have always been leaders in their organizations, whether or not they wanted the role. But that leadership role has been far from multidimensional.

That's changing rapidly. Physicians are leading the development of clinical protocols and managing their financial repercussions as never before.

But they can't do it alone.

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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5 comments on "Managing Physicians May Be Impossible"

EDUARDO MAHIQUES VICEDO (4/26/2013 at 5:07 AM)
Do do I do several questions: because doctors should manage?, managed work or the people?. Do as he is managed to a doctor?, this management can improve patient care?. Also must manage the patient?. I think that this trend of extensive and intensive management, will create many problems. People management, decreases your freedom and that is dangerous. Much more management, but dictatorship. Bad, very bad

Stephen Jacobs MD (4/25/2013 at 2:49 PM)
It's hard, but can be done. I'm a member of the Permanente Medical Group; over 7,00 physicians, exclusively associated with Kaiser Permanente Northern California. In our group the physician and non-physician managers are very successful. We're providing excellent care at a reasonable price and satisfying our patients in the process and being well compensated. However our group has had 75 years to hash things out, and it hasn't always been easy. We also have the advantage of having a health plan and hospital group that recognizes it needs to work with us (and vice versa). This is a very good model, but not one easily achieved. I think younger physicians are more managable then we old folks, but it takes a lot of work and a large perspective to get where Permanente has gotten so far.

Gus Geraci (4/22/2013 at 9:39 AM)
Define managing. If you mean telling them what to do to achieve goals you define, it's not impossible, merely difficult. Some physicians can be bought on way or another. If you mean joining them together with you to achieve common goals you can both agree with, and sometimes compromising your goals to find agreement, most physicians can be "managed" that way. It's a matter of trust, setting common goals, mutual respect, fact and opinion gathering, engaging all the stakeholders, and transparency. It's not very quick, nor very efficient, but it works. Amazingly, taking good care of patients is the same, but it does take time to achieve quality results, something not being reimbursed today. The same is true for "managing" physicians.




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