Monday, April 7, 2014

Physician-Administration Tensions

The Affordable Care Act and development of Accountable Care Organizations increases the critical need for improving communications between physicians, clinic administrators, and hospital CEOs.

A tension has always been present between clinicians and bureaucrats.  When  you consider the physician mind-set is one of decision making autonomy, and dealing with new events. The concepts are not always congruent with the mind-set of the practice administrator.  In the operating room the surgeon is always thought to be ‘captain of the ship ‘.  The administrator is trained to focus on the complexity of coordinating multiple practice issues inside the office, or the hospital.  This coordination requires a set of skills not taught in undergraduate medical school curriculum.

MDs who desire non clinical responsibilities usually obtain a business degree such as an M.B.A. or M.P.H.  Some develop these skills on the job.

In the new environment of the ACO and ACA, he is just one of the key players. For some MDs this is anathema to  prior education and experience, especially for those who have been practicing for twenty years or more.  New graduates and young clinician are trained with the new paradigm and hierarchy in mind.

Add to this the necessity for change management in reimbursement, quality of outcomes and management of new reporting requirements the stage is set for increasing interaction between  clinician leaders and ‘management’. Without everyone’s cooperation in the practice change results can be compromised.

The principal characters (physicians) belong in several groups .
1. The champions for change who see the goals as beneficial.
2. Those who are neutral to changes, will ignore them and go on about their clinical work
without much thought to change, except to adapt quickly so they can continue their
clinical work with minimal disruption.
3. The saboteurs who will go beyond passivity or ‘foot dragging’ to slow down, delay, or
reverse the change.

In the recent past this third group would accomodate themselves by leaving an institution that was not compliant with their own preferred practice pattern. They would move to private practice either solo or in a group more compatible with their desires.   These opportunities have diminished drastically by the corporatization and more bureaucracy and support structures that are thought to be more efficient . The group mindset prevails since the financial rewards are mandated by the group and ‘political’ pressure on the individual clinician.  In the past clinicians might even leave their community to a region where patterns are different.  Today this is less possible because fewer small practices and the Affordable Care Act.

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