Managing Physicians May Be Impossible

If physicians can't be managed, we're all in for trouble, because healthcare is bankrupting us. Everyone needs to be managed, whether they're the President of the United States or a country doctor.

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.
Jeff, MD (4/19/2013 at 11:56 PM)

Demonization of the physicians in this country is ignorant. Its simply a case of more pathology than resources. We provide services. Just because 90% of patients respond to one treatment doesnt mean the other 10% shouldnt receive it. You oversimplify the problems of costs as an over-treating problem when simple actuaries/ math will tell a different story. How idiotic to blame a group that works 80-100 hour shifts, neglects family, neglects self-health to help practice medicine. Its amazing how good doctors do gheir jobs!!!! Come hang with me fir 4-5 days, I bet you will #1[INVALID]-not want the job,#2[INVALID]- have a different opinion about [INVALID]-"they are doing it all wrong". Its a cloak and mirrors game by shufting ficys on waste and overutilization.....when real problem is need to rationalize a limited amount if resources....why dont you work in trenches fir a while.... And quit demonizing a profession that holds this country together... Literally Good grief.....hospitals, nurses, consultants will do a lot better job at saving costs, treating patients, and accepting liability if patient cannot wait to see this...again, ignorance is a bad thing.... Costs, we think about it on every case[INVALID]-you idiot!!!! Protocols/evidence? Surgeons do a great job!!! You think we are hard to manage? Its because we are a lot smarter as a group yhan the poorly trained people with no real experience who try to tell us to do 20 things and write 15 things to do our job, when 2things is better, more efficient and less costly!!!!!! Government , nurses, protocols, etc increase duplication, cists, etc What a kniw it... Its an inside joke to us
John Jaffe MD (4/19/2013 at 9:37 PM)

Agree in general with the author's observations about the notorious difficulty in managing physicians and physician groups. I can personally attest to these challenges, having served as Medical Director for a large (over 3000 network physicians) PHO. However i would suggest that the main reason(s) for physicians resenting any kind of management aren't chiefly financial, accumulated debt, etc. as suggested in this article. Truth of the matter is that physicians are both selected and trained to be independent-minded[INVALID]e.g., "think for yourself", "the physician-patient relationship should be your main priority", "do your own investigation", "read your own X-rays", etc. etc. So to take people who have these independence goals and training and place them in an environment which is exactly the opposite of what they've been accustomed to (i.e. employment) is guaranteed to be dislocating for the doctors and problematic for those trying to fit them within the management structure of any organization.


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