Are Doctors Reluctant Leaders ?

[u/SudhakarJay]

Seems to me that Doctors have ceded a lot of space to management and administration for far too long. I can appreciate that clinical duties are paramount. However, several decisions that directly and indirectly impact patient care plans, safety, and performance get taken many a time without the doctors being adequately involved or designing them. It seems to me that hospital administrators prefer keeping their doctors at the periphery, especially when it comes to economics.

Most Doctors, privately and in smaller groups, continue to rue and helplessly grumble over their almost complete loss of franchise and agency within the hospital system. Unlike in the past, when it was just the doctor and the patient in a “parent-child” relationship, healthcare systems are now incredibly complex. Hospitals are heavily indebted to banks, shareholders, PE, increasingly powerful regulators, and litigious “consumerist” patients.

There is also a growing trend towards privatization of healthcare in emerging economies. In markets like India, almost 70% of all care is in the private sector. Even in countries like China, where the state is pervasive, over the last decade, the share of private hospitals has increased from 10-12% to about 40-45%. The USA has a strong network of private hospitals. Fee-for-service payment mechanisms continue to be dominant and contribute close to 70% of the healthcare provided in the USA. In a largely private system, economics will always be front and center. 

But the balance between economics and medicine is a gentle and delicate one. A balance that can only be maintained with alignment and mutual coordination. The risk to doctors is when “good medicine” cedes too much space to “good economics.”

Doctors have no choice but to “grab the bull by the horns” to find the sweet spot where “good compromises” between good medicine and good economics can peacefully co-exist. The Covid pandemic demonstrated to us that doctors must be at the forefront of designing and delivering care. There is nothing that is non-medical about a hospital enterprise.

We need our Doctors in the Boardrooms as much as in the Procedure/Operating Rooms. 

Views ?

[u/bd2999]

Some posters are being pretty darn hard on doctors here. Doctors are people, so you are going to get a wide range of people whose common trait is qualification to practice medicine. Some make great leaders and others not so much. And many of them are worked very hard and are lucky to make it with the debt and everything else.

I do agree that the administrative end has more power than they should on many issues but you are always going to need a system like that to make a hospital work, let alone a health care system as a whole.

Yes, decisions on best medical treatments should be led by scientists and doctors and science based medicine. No question. And doctors should have flexibility in how they practice medicine not based on contracts as total binding on them.

The problem is that the US has decided money is more important in general or is weighed against health. That is a major problem but I am not sure it is simply because doctors dropped the ball along the way. There are alot of things that doctors are not good at or do not understand in the administration of care, at least the parts outside of the actual medicine.

Doctors should take the lead in pandemics but not every doctor needs to be a leader as such. That is for qualified ones in special positions but doctors at ground level should be trying to help stop the spread of misinformation, provide vaccines, treatments and advice to their patients. Some abdicate that to one degree or another and that is a problem but on the whole most doctors are not these super heroes people want them to be. They are people that have an important and stressful job that entire groups of people hate as being part of a money alone system.

[u/LakeSpecialist7633]

They are increasingly absent or incapable leaders.

[u/Tibreaven]

Medicine is a career where you study all day every day, for like 10 years straight, only to then generally work most of the day, then be on call frequently.

Healthcare has become incredibly administrative and economically bloated. Unfortunately, asking your overworked professionals to be at the forefront of changing this is increasingly difficult. Very few people became doctors to then never see patients and spend their time being a political figure. The rest could boycott work, which the public overwhelmingly hates because of the perceived duty for doctors to always be seeing patients.

You bet they're reluctant leaders.

[u/jokesgalore]

There is nothing that is non-medical about a hospital enterprise.

This right here. I wish more people understood this.

[u/lochnessrunner]

Doctors are tired! They are overwhelmed and/or overworked.

Between patients and administrative burden they lose passion to put their next on the line. I have noticed with many, not all, that being a doctor just becomes a job.

Example, my husband came home from work today swearing and saying he wants to be a welder or an engineer instead of a doctor. Reason he had to deal with a drug seeking patient who made his day hell. Next up is cold and flu season, where patients come in all the time NEEDING antibiotics when they have had a cold for 1-2 days. If doctors don’t provide it, then they have to deal with patient satisfaction and negative reviews.

All of that to say, I get that people think doctors are the easy access point, and they would appear to be, but they’re not really. Either you need to figure out a way to change the system so they can help. Or you need to figure out a way to get the information directly to the population versus going through a median.

[u/hisglasses66]

They're terrible leaders. Because if they were good leaders we wouldn't have the system we have today. The AMA is directly responsible.

If they want to lead and be good advocates they need to do double the work. Take care of patients and advocate. But too many excuses about burnout and system issues.

Skill issue. They're not cut out for it.

[u/perpetually_puzzeled]

Leading is like dancing. Some are born with an innate talent, some learn and do reasonably well and some are just embarrassing. Doctors and nurses and any clinician can make great leaders just like anyone else. Perhaps few choose it because as others have said, after years of study and dedication to something that is both a science and an art, it is just less likely.

[u/she-wantsthe-phd03]

Don’t doctors become doctors to idk heal people? It’s like asking why we don’t see more psychiatrists leading or sociologists.

Plus you have to be willing to lay your entire life bare for the media circus to exploit every mistake you’ve ever made and take it out of context like it’s entertainment if you show any kind of chance of succeeding. I haven’t done anything horrible like idk a Kennedy, but I’ve done things I wouldn’t want the entire country discussing because they’re my business.