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Managing Physicians May Be Impossible

Philip Betbeze, for HealthLeaders Media, April 19, 2013

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.

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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.