There’s a growing disconnect between what hospitals expect from physicians and what physicians want and need – for their own success and well-being. It’s creating a tension that’s unhealthy and counter-productive.
Brief History Lesson – The Relationship Fractures
For decades, physicians and the independent medical staff had a, generally, symbiotic relationship. With the implementation of new payment methodologies, in the early 1980’s, hospitals began pushing physicians to control costs. Physicians had no real incentive to control costs and didn’t respond well to the pressure. Then physicians started opening businesses that competed directly with hospitals – imaging facilities, labs, surgery centers, and specialty hospitals.
Hospital leaders started looking for ways to keep independent physicians, even those who might have competing business interests, engaged – to keep their business at the hospital. This meant creative joint ventures, clinical integration models, and co-management agreements. Sometimes, the hospital’s preferred strategy was to either buy local practices or build their own employed group.
Employment Does NOT Ensure Alignment
At the time, we told hospital leaders “employment does NOT ensure alignment.” Employed physicians don’t, necessarily, share you goals or motivations. More importantly, rather than thinking about gaining control, administrators should have been partnering with their employed physicians for their mutual success. Successful, satisfied physicians who feel valued and supported will stay, be more productive, more collaborative, and more willing to take on leadership roles.
Most systems didn’t take that advice. “If we can just employ them, the “alignment” problem goes away!” was the mindset. Physicians didn’t immediately embrace this trend but the number of independent practices continues to decline.
Today’s Growing Disconnect
Where are we today? Health systems have, to a large degree, solved the problem of competing with their physicians. They have varying degrees of “control” over them, but there is a growing disconnect between physicians and the organization – a disconnect that is causing a whole host of problems.
What Hospitals Want from Physicians:
- Compliance – Leadership needs physicians to adopt, adapt to, and comply with ever-changing policies and procedures.
- Engagement – Administrators want survey results indicating that physicians are, generally, satisfied. Moreover, “engaged” often means “on-board” and cooperative.
- Productivity – Hospitals have to consider the cost of a physician
compared to the revenue he produces. Interestingly,
the private practice of medicine was, generally, profitable but when
hospitals take over practices, they expect to lose money.
- Retention – Physicians are a valuable workforce. Physician turnover is increasing and it’s expensive. The loss of a primary care physician might cost $250,000, a surgeon – maybe $1M. But, while systems commit extensive resources to reduce nursing turnover, what are they doing to keep their best physicians?
- Outcomes – Systems push physicians to improve quality metrics but how many really partner with them on the endeavor?
- Cost Containment – In theory, a hospital can impose cost-containment efforts on their employed physicians.
- Referrals – Although we continue to talk about new payment methodologies, the vast majority of revenue is still tied to volume.
- Disruptive Behavior and “Wellness” –
Hospitals see physicians as useful, but somewhat fungible commodities. Physicians who don’t behave are not as valuable. They are deemed “disruptive” and enrolled in a disruptive physician program. Some physicians have real behavioral issues – but how many are just expressing reasonable frustration? Similarly, the system continues to ask more of physicians, without providing sufficient support. When the demand out-paces the capacity, they are deemed “burned-out” and, again, sent to a program intended to make them more resilient – so they can increase their capacity.
- Leadership – Hospitals want physicians to take on leadership roles, but are their goals aligned and are we giving physicians the tools to lead, effectively?
Compare this to What Physicians Want:
- The Opportunity for Rewarding Work
– Beyond the inherent rewards, most physicians have specific interests the kind of work they really enjoy. Physicians would also prefer
that the administrative, EHR and the other “business” functions of
medicine, don’t overwhelm the joy they can get from their practice.
- Career Success – Whether it’s academic accomplishments, leadership roles, or financial security, every physician wants to see a path to career success.
- Emotional Wellness – Every person is seeking emotional wellness. Work demands that exceed one’s capacity negatively impact work performance and quality of life. Are the demands unreasonable? Is the capacity limited? Often both are contributing to the problem.
- Organizational Support – People are incredibly resilient and can tolerate a great deal when they
know they are valued and supported. Any professional should expect
that his or her organization demonstrates a sincere interest in their
- Opportunities for Growth and Development –Like any professional, a physician wants the organization to understand
his or her goals, find opportunities for growth and commit resources to that growth. This might mean a mentoring program, a formal
development plan, helping to create a new program, or leadership training and opportunities.
What to do About the Disconnect?
These lists are substantially different. The disconnect contributes to
increasing turnover, burn-out at epidemic proportions, and declining physician career satisfaction. Moreover, the situation negatively impacts a hospital’s ability to achieve its goals and fulfill its mission.
The Organization – It’s the organization’s job to reconcile
this disconnect. Physicians are valuable assets – a unique workforce.
They are not fungible commodities. Talent acquisition and talent management departments are laser focused on attracting, retaining and developing nurses. Where are these functions and resources for physicians? Who’s working to re-engineer the practice of medicine and integrate the processes and technologies that make the work less stressful and more productive and rewarding?
The Physicians – This situation is not going to be
resolved any time soon. We need to equip physicians to better manage it,
to influence it, to take control over their careers and pro-actively attend to
their emotional well-being. They need to develop effective communication and leadership skills. They need to create a professional culture of support and lead their own teams with empathy. Unfortunately, a physician’s training and early career completely ignore development of the necessary self-awareness, communication, collaboration and leadership skills.