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.