There have been countless articles about the relationship between physicians and hospital executives ("white coats versus blue suits"). During the best of times, it's often a frictional relationship. During the worst of times, it can become downright adversarial. Dr. Diane Shannon writes (see "Bridging the Divide for Leaders and Physicians" from the American Association of Physician Leadership), "The gap between administrators and physicians manifests as lack of understanding, lack of cooperation, lack of engagement, anger, frustration and, sometimes, disrespectful behavior. These slights, both real and perceived, between managers and providers are a source of underlying tension in many health care organizations."
One of the most commonly cited reasons for why hospital administrators and physicians are often at odds is the complexity of our health care delivery system. J. Deane Waldman and Kenneth H. Cohn suggested an alternative viewpoint in The Business of Healthcare writing, "...the real enemy is our dysfunctional health care system." Regardless of the reasons, there can still be an contentious relationship there, and one way that health care organizations have attempted to solve this issue is by promoting physicians into executive leadership positions.
Speaking from my own personal experience, I have often found that working as both a physician and health care administrator can be difficult at times - for example, the physicians will say things like, "You've gone over to the dark side" or "You've become a suit". You're never quite fully accepted by either group ("You are one of them" - and being a "them" is not meant to be a compliment). Finally, you frequently have to shift both your mindset and the language that you use, depending on which "hat" you are wearing at a specific point in time. However, I will also say that the positives have outweighed the negatives, and my career so far as a physician executive has been extremely rewarding.
With all of this in mind, I found a recent article by Sachin Jain appearing in Harvard Business Review to be quite interesting - it's called "Tips for Physicians Transitioning to the Business Side of Health Care". Here are Dr. Jain's four recommendations:
1. Don't expect others to do your job
Importantly, Dr. Jain is currently an adjunct Professor of Medicine at Stanford University School of Medicine. He basically states that physicians are paid to think, not necessarily do - and while that may be true for some physicians, it's not necessarily true for all physicians (I am thinking specifically of my surgical colleagues, who are expected to think and do). He uses the example when a physician at the bedside will enter an order for a medication into the electronic health record (or write a prescription), which is then transcribed by a pharmacist, at which time a nurse will administer the medication to the patient. Conversely, when a physician becomes an administrator, he or she may expect a similar infrastructure, which is not necessarily the case. Physician executives are often asked to not only develop ideas, but also to build and execute a plan to implement them. He writes, "The best physicians who work in organizations roll up their sleeves and make things happen, owning both vision and execution - being close to every detail and shaping and doing the work."
2. Be thoughtful and curious, not reflexive and defensive
Dr. Jain emphasizes that practicing clinicians often have to make quick decisions under uncertain and ambiguous conditions. For example, if a patient is having a heart attack, the physician has to be able to quickly recognize the clinical presentation and administer treatment as quickly as possible. In contrast, he suggests that physician administrators are often faced with complex situations where careful deliberation and making informed (based upon data) decisions are imperative. Again, I do not completely agree with him here. In my experience, I've often found that administrators have to make difficult decisions with imperfect information - we live in a VUCAT world after all! It would be great to wait for perfect information, but I've found that perfect information is a rare exception and not the norm (whether I am wearing a "physician hat" or "administrator hat").
3. Focus on outcomes, not politics
Dr. Jain argues that health care organizations are political organizations, and while I have found that to be true, managing an organization as complex and as heavily matrixed as an academic medical center (as an example) can't be one that depends solely upon consensus. As Dr. Martin Luther King, Jr once said, "A genuine leader is not a searcher for consensus but a molder of consensus."
4. Learn the new language
Here, I completely agree with Dr. Jain. I have found that the language used in the C suite to be quite different than that which is commonly used on the hospital wards. For example, a Chief Financial Officer once asked me why physicians don't ever write business plans. I responded that there is very little difference between a business plan and a research grant proposal (to that end, I recently compared the two at the Leadership, Empowerment, and Development Program provided by the Society of Critical Care Medicine at its annual meeting a few weeks ago. Importantly, because different terms are used, if someone spends all of their time on the business and administration side, they may not fully appreciate that things are more similar than they are different. Regardless, learning the language is important!
Overall, I found Dr. Jain's recommendations to be interesting and worthwhile to consider. However, perhaps the most important advice that I can provide for any physician considering a change in career paths towards health care administration is to find a group of colleagues and mentors to help you along the way. Over the years, I have often discussed problems that I have encountered with my peers as well as my mentors, and I usually have found that they have experienced something similar at some point in their career.
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