Physician leaders who recently completed their master’s degrees in medical management through one of AAPL’s educational partners offer some ideas to allow them — and others — to fix what ails the system.
To our physician colleagues:
In March 2017, 24 physicians from varied backgrounds began a journey to learn and explore the business world through the Master of Medical Management program at the University of Southern California’s Marshall School of Business.
We were challenged as a class to address the shortcomings of today’s health care delivery model and suggest solutions. This is neither a simple nor singular task, and we believe progress hinges on physician leadership.
We came together from independent practices, small critical-access hospitals, and government-owned, for-profit and not-for-profit health care systems. We ranged from many years of clinical experience to relatively few. During our training, we developed a shared willingness to learn, to see things differently, and to better represent you, our physician colleagues, as we seek to improve our fragmented health care landscape.
It is evident there is no single solution to the crisis we currently face. However, incremental change can prove to be powerful when properly directed. We are willing to map the current state versus an envisioned, better future state, and be representatives for our physician colleagues as we work together to bridge the gaps.
Our health care system is far from ideal. Sometime during the past 30 years or so, our patients were demoted from being the primary focus of the system. We expect them to schedule appointments and wait for hours as we fall further behind in our work day. We shouldn't be surprised when they instead seek care in the emergency department or urgent care center — where they again wait. Consider the enormous costs of this type of reactive-care model: Soon, there will be little if any money left to educate our children, renew our infrastructure or compete in global markets.
This can’t be the best we're able to offer our patients and communities. We are better than this.
Complex, varying factors and attitudes have presented opportunities for nonphysicians to enter the health care space and “fix” the problems we were too busy to address. But the “solutions” often leave out the most important part: the patient’s health and well-being.
Those of us who attempted to address the issues often did not have adequate business training or strategic understanding — we were constrained by the lenses of our own personal, clinical worlds. To be successful agents for change, physician leaders must see beyond local priorities and understand the health care landscape from 20,000 feet. Value-based health care is the evolving (actually, rediscovered and historically patient-centered) reality; it is up to physicians to make that reality a meaningful, clinically relevant paradigm shift.
Physicians need to align around a common set of patient-centric values and goals and take the lead in health care reform. Our sense of self-worth has diminished as physicians, and we are increasingly commoditized by payer and delivery systems, contributing to alarming rates of depression and physician suicide. Crushing administrative and documentation burdens have diminished critical time with patients and fueled burnout. We seek positive change for both patients and clinicians: Through care model redesign, payment reform and unlocking technological potential, we can put the patient back at the center of the system.
We commit to work together to change health care delivery. We all have unique lives with individual careers and challenges. But we know we are stronger together, aligned around our core values and the belief that society needs physicians to be the impetus for positive change.
Today, our cohort raises its hand, volunteering to be leaders of change rather than victims of it. Who better to heal an ailing health care system than a group of dedicated physicians trained in business and leadership skills to support their clinical decisions? But we need something in return from you: The sacrifices we are making in personal time, income and experienced frustration in leading this change requires your support.
We ask these 10 things:
1. Don’t condemn us for limiting, or even eliminating, our clinical practice time. Our nonphysician leader counterparts fully dedicate their time and effort to leading. Physician leaders cannot be on equal footing with them if we view leadership as a part-time job or secondary concern. We promise to not forget what it means to be a doctor; we have walked in your shoes and understand the challenges you face. Rather than spending time practicing clinically in our own specialty, it can be more powerful and productive, and give us a more valuable perspective, to spend time alongside you in your practice environment to better understand your personal frustrations and concerns as well as your suggestions.
2. Join us when we need your expertise. Lend your time and knowledge to be a part of the solution and be rewarded with a step toward a better future.
3. Please don’t hold back your colleagues who want to be a part of this physician-led change effort. Those of us who pursue administrative roles sometimes find it ironic that our greatest critics are our physician colleagues.
4. Promote a medical education system that encourages and rewards those who want to learn more about management and leadership early in their training and practice experiences.
5. Assume positive intent when a physician leader does or says something that at first doesn’t seem to be right. Seek to understand, rather than reflexively condemn. Please ask how that “something” benefits patients, and offer your viewpoint of how it might affect physicians as well as patients. With constructive input, rather than obstructive criticism, you will play a key role in helping to craft a better solution.
6. Appreciate those around you who are providing exceptional leadership. Your opinion as a physician matters, and your positive feedback will build momentum behind physician-led change initiatives.
7. Embrace technology as a solution to many health care delivery challenges. However, speak up when you observe technology as a barrier to patient-centric care.
8. Maintain the view that we are all stewards of health care for our global society. This includes managing expenses and knowing when lower-cost options will offer equivalent outcomes to higher-cost treatments.
9. Actively pursue effective communication. Whether it’s patient handoffs, self-reporting of suboptimal outcomes or boardroom discussions, miscommunication is too often at the root of many issues.
10. Let failure be transformative. We are trained to avoid failure, yet it can be our greatest teacher. Health care delivery is complex on both individual and societal levels. Physicians, and physician leaders, are not perfect. However, a proactive approach to solving problems is much more powerful than a reactive, helpless or aggrieved position. Small steps do make a difference.
Mohammad Al Shabanah, MD, King Faisal Specialist Hospital & Research Center, Saudi Arabia
Waleed Altaweel, MD, King Faisal Specialist Hospital & Research Center, Saudi Arabia
Michelle Claudette Banks, MD, Martin Luther King Jr. Outpatient Center, California
Braden Batkoff, MD, Providence Spokane, Washington
Kimberly Bell, MD, TeamHealth West, Washington
Michelle Carter, MD, Howard University Hospital, Washington, D.C.
Daniela Carvalho, MD, Rady Children's Hospital of San Diego, California
Rahul Dhawan, DO, St. Francis Medical Center, California
Armand Dorian, MD, USC Verdugo Hills Hospital, California
Mahdy Flores, DO, Kaiser Permanente Riverside, California
Andrew Furman, MD, Accolade, Pennsylvania
Nancy Kung, MD, OptumCare, Nevada
James Lai, MD, Retina Consultants, Hawaii
James Lee, MD, The Everett Clinic, Washington
Nathan Levanger, DO, Teton Valley Health Care, Idaho
John Merson, MD, Muir Orthopedics, California
Moneeshindra Mittal, MD, Ascension Health, Kansas
Autumn Moser, MD, The Everett Clinic, Washington
John Neil, MD, HonorHealth, Arizona
Eugene Park, MD, Los Angeles County-USC Medical Center, California
Megha Shah, MD, Franciscan Health System, Washington
Deepjot Singh, MD, Torrance Memorial Medical Center, California
Jeffrey Tolstad, MD, Solheim Senior Community, California
Bryan Wong, MD, Ventura County Medical Center, California