Last year, at a late stage in my career, I had the opportunity to
partake in the inaugural Surgical Leadership Program, offered by
Harvard Medical School.
In this unique one-year course, through a combination of in-person
workshops, virtual learning, and small group projects, I, along with 130
surgeons, with varied backgrounds and specialties, from over 30
countries worldwide, learned the “A-to-Z” (and then some) of thebusiness of medicine, and in particular as it
relates to surgical practice.
Whether it was thought-provoking leadership discussions with the Dean of
Harvard Medical School, challenging business case studies with the Dean
of Harvard Business School, or the numerous other engaging interactions
with world-renowned faculty, professors, CEOs, innovators, scientists
and entrepreneurs, we literally were exposed and had direct access to
the world’s best and brightest. And it was through these interactions
that we, surgeons, learned how to write business plans, negotiate
skillfully, market our strengths (& weaknesses), balance hospital
budgets, hire and fire effectively, manage complex teams; resolve
conflicts, brand our images as both physicians and leaders, and so much
more.
As the course came to an end, last September, I thanked the Director,
Dr. Sayeed Malek, for the opportunity to have attended this course and
expressed my gratitude for the profound learning I had gained.
I then went on to say, to his astonishment, that there were also two
things that I did not like about the course!
Firstly, I relayed my unhappiness that the course ending meant a missed
opportunity for continued formal learning in such relevant and importantnonclinical subjects. Secondly, I shared my wishes that the
course had been offered twenty years earlier, at a time when I needed
these skills the most. .
Now as the Covid Pandemic has caused a disastrous upheaval to our
professions, business, families, educations, and essentially to all
aspects of our lives, I realize more than ever before that when it comes
to navigating myself in a Pandemic such as this, mastering the skills I
learned in my recent course – i.e. the business and politics of
medicine – are equally as important as the highly technical and complex
cardiac surgery skills that I acquired long ago.
The bottom line is that working as a physician, on the frontlines of the
COVID-19 Pandemic, requires knowledge and know-how in dealing with the
financial, administrative, and political sides of medicine in addition
to the clinical skills needed to treat the disease. And, the issues of
budgets, negotiation, hard financial choices, team management,
reallocation of workforces, etc. have proven to be as important as the
diagnoses and treatment of such a complex disease.
Our lack of training and knowledge in the business and politics of
healthcare [1, 2, 3], has marginalized physicians’ roles in
healthcare leadership and often even excluded us from important
leadership roles in our profession. The systemic absence of such
education and acumen may be due to the taxing demands of current medical
educational models or to an erroneously peripheral categorization of
nonclinical subjects [4].
Moreover, our disengagement form the business aspects of Medicine has
kept many physicians out of leadership roles in our own hospitals, and
consequently, many of the “C-Suite positions” have ended up being held
by non-physicians. And to be fair, many have served our profession with
honor and distinction and deserve our full gratitude and appreciation.
Now, as we witness the magnitude of the problems resulting from the
current pandemic, one cannot help to wonder how much of the current
chaos is due to the disease itself versus the “disconnect” between the
ethical and clinical responsibilities of the providers and the authority
and policy regulation by the politicians and business leaders in
medicine. We, as physicians, are responsible for the health of the
nation, but, unfortunately, we have little-to-no authority to make any
truly influential policy decisions.
As this pandemic struck our Nation and the rest of the world, we,
physicians, along with our nursing and other healthcare colleagues,
found ourselves with an unprecedented need to rise to the occasion and
take full responsibility for caring for the sickest patients, assaulted
by a disease, that we knew very little about. Then, to further
complicate an already complex situation, we as an entire nation,
witnessed firsthand how collectively ill-prepared our divergent
healthcare systems, hospitals, public health departments, medical
suppliers, and local, state and federal governments in fact were to
handle the literally hundreds of thousands confronted with this new
disease. As healthcare workers, we were rightfully tasked to do our jobs
of caring for these sick patients, struck by a highly infectious
disease; however, we were soon confronted with severe shortages of
essential medical supplies, medications, and personal protective
equipment (PPE). Sadly, we, the frontline healthcare workers, have had
to face the tragic reality that this grave unpreparedness has costed
many of our colleagues the ultimate price – their own lives.
As physicians, many of us particularly those working in non-academic
institutions, have been relegated to simply become providers of
healthcare under the control of non-clinical business and corporate
decision makers whose interest may not have always been in line with
that of the medical professionals [5]. At this time of crisis, it
has become readily apparent that there is a pressing need to address
such inequities in healthcare management with a mindset that Medicine
has become a business [7,8]. To accomplish this, we need to create a
continuing education system to enable physicians to learn what medical
schools do not teach. Physicians should be both familiar with and
competent in becoming leaders, negotiators, skilled business managers,
and principals capable of creating their own brand. Moreover, it is
imperative that we master essential nonclinical skills like balancing
budgets, effective hiring practices, and negotiating contracts in order
to truly succeed in today’s medical world. Overall, I am convinced that
in order to be an excellent physician, you must also become an effective
leader, who is versed in politics, finances, and the business of
medicine.
As I reflect on the important idea of expanding our knowledge and skill
sets beyond the clinical scope of medicine, I am reminded that cardiac
surgeons historically have been pioneering, innovative, and often have
led the way in establishing evidenced-based standards for the medical
profession. One important example was the launching of the STS Adult
Cardiac Surgery Database (ACSD), in 1989; which to this day remains the
world’s premier clinical outcomes registry for adult cardiac surgery and
contains more than 6.5 million cardiac surgery procedure records.
In summary, the ultimate question is: Has the time come for us to learn
and teach one another what medical schools did not teach us about the
business of medicine and what it takes to be fully active and engaged in
political and administrative decision make that directly affect our
healthcare environments?
As you reflect on your own unique experience, as a physician or
healthcare worker dealing with this Covid Pandemic, I encourage you to
explore this very important question. In the meantime, I, too, shall
answer the question.
Let the Learning Begin.
References
[1] Wang, J. V., Albornoz, C. A., Hazan, E., Keller, M., & Saedi,
N. (2019). Business administration training for dermatology residents:
preparing for the business of medicine. Clinics in Dermatology, 37(1),
78-79. doi:https://doi.org/10.1016/j.clindermatol.2018.09.001
[2] Ovadia, S. A., Gishen, K., Desai, U., Garcia, A. M., & Thaller,
S. R. (2018). Education on the Business of Plastic Surgery During
Training: A Survey of Plastic Surgery Residents. Aesthetic Plastic
Surgery, 42(3), 886-890. doi:10.1007/s00266-018-1096-z
[3] Satiani, B. (2004). Business knowledge in surgeons. The American
Journal of Surgery, 188(1), 13-16.
doi:https://doi.org/10.1016/j.amjsurg.2003.12.056
[4] Abbas, M. R., Quince, T. A., Wood, D. F., & Benson, J. A.
(2011). Attitudes of medical students to medical leadership and
management: a systematic review to inform curriculum development. BMC
medical education, 11, 93-93. doi:10.1186/1472-6920-11-93
[5] Daugird, A., & Spencer, D. (1996). Physician reactions to the
health care revolution. A grief model approach. Archives of family
medicine, 5(9), 497-500; discussion 501.
http://triggered.edina.clockss.org/ServeContent?url=http%3A%2F%2Farchfami.ama-assn.org%2Fcgi%2Freprint%2F5%2F9%2F497.pdf
[7] Athwal, P., & Stock, H. (2014). The Business of
Radiology…. Journal of the American College of Radiology, 11(2),
215. doi:https://doi.org/10.1016/j.jacr.2013.11.018
[8] Ladouceur, R. (2016). Extra fees for uninsured services.
Canadian family physician Medecin de famille canadien, 62(5), 373-373.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865330/
[9]
https://www.sts.org/registries-research-center/sts-national-database/adult-cardiac-surgery-database
The author acknowledges and appreciates edits made by Noah Newman,
Michael Johns MD and Deepa Soni MD