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Managing Physicians May Be Impossible

Philip Betbeze, for HealthLeaders Media, April 19, 2013

I realize the headline above is provocative.

In fact, most physicians I know probably don't even appreciate the insinuation that anyone could even ask the question, never mind whether it's possible or not. And I get that. No one who learns and trains as long and hard and goes into debt as much as physicians do is much in the mood to be told how, when, or where to practice medicine once they're past that personal finance nightmare.

You read that headline, and all the tropes about managing physicians come to mind—that it's like herding cats, it's a thankless job, and, best of all, that it's impossible.

If it is, 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 (managed, at least in theory, by the voters, and checked by Congress and the courts) or a country doctor. If not, we get what we have now in some cases, which is management without data; management without evidence (incidentally, that's probably one reason physicians have historically so hated to be "managed").

I doubt if he would appreciate me attributing this quote to him—so I won't—but as a good source told me in a recent conversation, "the era of the "M-Deity" is over," referencing the abbreviation for the term medical doctor.

Strong words. I asked him what he meant.

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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.