If Physicians Desire Leadership they Must Accept Some Uncomfortable Truths

Tuesday, December 22, 2015
Frustrated Physician

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If you have 30 minutes please check out the video "DIY Healthcare," accessible on Forbes. I enjoyed the video and it even inspired me to write this post. Why? Because of the 5 thought leaders on Forbes' stage only one was a physician. Despite the fact physicians are the most highly trained people in the business of medicine they remain largely sidelined when it comes to major decision making. And yes, I meant to write the word "business", as it leads me to Uncomfortable Truth #1: Medicine is a business. And a big one - try about 18% of GDP and rising.

Choices Matter

On a personal note I have been very busy lately - writing, doctoring, consulting and working towards a Master's degree at Dartmouth's Tuck School of Business. In order to do this (and do it well) I decided to make some radical career changes. I exited my "day job" as a medical director to focus on private practice, where placing quality over quantity keeps patients and others seeking my consultation. This dramatically increased my flexibility so I could excel in my business program. Oh - I also took a pay cut. Hopefully the latter is temporary; if not that's okay because I actually like what I am doing.

More Uncomfortable Truths for Physicians

One thing I've observed from business school is Uncomfortable Truth #2: It's an uphill battle for fully trained physicians to become physician executives. Let's face it - 40 is young for a doctor but ancient for someone getting started in the business world. Perhaps this age issue is one reason many business-minded physicians choose not to do a residency and go straight from medical to business school. They are not qualified to practice medicine but they do have MD at the end of their name, usually followed by MBA. Many of them are 30-somethings telling 50 and 60-somethings what to do. This does not sit well with most physicians.

Uncomfortable Truth #3 may not resonate with many of my non-physician business school classmates. That's okay - we can agree to disagree about UT #3: Health insurance companies play a large part in driving up prices. Annual double-digit inflation in health insurance premiums have become the norm; if you don't believe me do a simple Internet search and you will find articles such as this one from the Wall Street Journal. Why? Wasn't the ACA supposed to reign in health insurance costs? I do not have all the answers to this one, but I do know that for all of the "cost saving" initiatives insurers claim they are making they are hiking your premiums through the roof.

One thought on UT #3: health insurance companies are essentially glorified middle-men. They "buy" physician, hospital and ancillary services in bulk at discounted rates and then "sell" them to consumers (a.k.a. patients) or patients' employers. Guess what? A health insurance company's profits depend on buying low and selling high. As a free market champion I do not view the word "profit" as a bad one. But the ACA is forcing everyone to buy insurance, so their market has become one that is now completely rigged. UT #3 might not be fully appreciated until companies decide they will simply pay the ACA "penalty" rather than provide health coverage for their employees, funneling them towards the ACA-created health insurance "exchanges."

Uncomfortable Truth #1: Medicine is a business. Deal with it.

UT #2: It's an uphill battle for fully trained physicians to become physician executives. 
UT #3: Health insurance companies play a large part in driving up prices.

I believe that UT #3 is where my fellow physician executives can really make a difference. We are in a unique position in that we understand the system from the bottom up, not the top down. As such, I believe physician executives' unique perspectives will become increasingly valuable as insurance prices continue to skyrocket. If there aren't enough physician executives to make the hard decisions that need to be made these decisions will continue to be made by the status quo; i.e. non-physicians who tell doctors (and their patients) what to do.

So fellow physicians: Will you join me, make a sacrifice and get a high-end business degree? To quote my undergraduate alma mater, Wabash College, "It won't be easy. It will be worth it."

-Dr. Tim