Would you expect the chef at a restaurant to be told that they are not only required to prepare the food in the kitchen but also deliver it to each of the tables and manage the billing as well? What about sorting out the finances of the restaurant or understanding the number of patrons that need to flow through per night to optimize income.
If the answer to the above is no, then why do we expect the same job cross over from physicians today?
Being a great physician traditionally involves applying knowledge, and communicating with healthcare teams, patients, and families with compassion. Why change it?
By the time a physician graduates from medical school, they are taught about the importance of helping their patients, and their primary role of serving them. They are trained to treat and manage the patient’s health complaints and form an empathetic yet professional relationship with their patient.
The demands from a physician today are not the same as they were in the past. To add to clinical work, physicians are also expected to be experts in leadership, quality, conflict management, hospital operations, patient flow, project management, quality and innovation, health information and equity, diversity, and inclusion, to name just a few.
The rising pressure to deliver high-quality medical care while also adopting parallel roles in the health care setups have been a source of distress for many physicians. Some promote that medical schools should take a step to introduce hospital management skills and administrative workshops to train the medical students from the very start, leading to more well-rounded physicians. However, is this the answer?
Additional demands on physicians, without adequate training, add stress on the physician leading to conflict, burnout, deteriorating physical and mental health, and eventual consideration of vacating the profession that they worked so hard to enter. So why do we place these demands on our doctors? There are other opportunities to integrate physicians’ knowledge into these areas of healthcare that need to be considered.
The evolution of the physician leader
The foundation of a physician is laid down during their time in medical school. This is where they learn all that they know, whether through theoretical lectures, practical ward or clinic experiences, or direct teaching from physicians in practice. Despite being taught within medical schools, the transition from medical school to a healthcare setup has been challenging for many.
When physicians decide that they want to be in formal leadership roles, they typically move into these roles without training, or they seek training on their own when they recognize gaps in knowledge. More organizations are offering leadership training, but unlike other professions, this training is up to the physician to attend. They must give up clinical time, income, and/or personal time to do so, without remuneration.
In addition to having little leadership training, physicians also have little training on leading teams. The lack of administrative training at medical schools and lack of recognition and rewards in the healthcare setup is found to be the two leading causes of distress and burnout in most physicians today. Physicians are put into an environment that they are not used to, given roles that they are not trained for, and must carry out extra tasks for which they are not paid.
Over time, the lack of preparation leads physicians to feel unprepared, disrespected, and they look for alternative ways for validation. Some pursue alternate career paths; others retire or take on new opportunities within healthcare. In addition to this, it is easy to become disgruntled which can lead to becoming less sensitive to the hospital and patient demands – whether it is with respect to time, extra effort, or management of resources.
What Needs to Change?
Expecting physicians to be experts in so many areas of health care is a misguided approach. Significant time away from patient care is spent in these activities, in a time when clinicians are scarce. Patients need their doctors, and they need highly trained doctors who have focused on their clinical skills, knowledge, and ability to get clinical work done.
I propose that it makes the most sense to allow practitioners to further their clinical knowledge, gain experience in the front lines and skills, focus on keeping updated on the vast amount of clinical information that is now available, and to master relationships, team management, leadership, and communication skills. This focus would allow practitioners to contribute by the way of clinical and leadership capacities to all areas of the organization. Organizations and health systems would be responsible to provide the experts in the other areas of healthcare that are needed to optimize strategic plans, operations, and patient care. Experts in areas such as quality, innovation, patient flow, health system operations, and health information can then integrate with the physicians, and all expectations can be clear.
The Bottom Line
Over the years, the increased burdens and tasks imposed on physicians has added enormous stress and expectations that they find difficult to achieve. We can continue to build on training offered to engage physicians in other aspects of medicine, other than clinical work and education. Formal roles for those physicians who have become proficient in additional areas of medicine, such as leadership, quality work, wellness, health information, conflict management and other HR issues, innovation, healthcare system operations and utilization, need to be created. Providing recognition for practitioners who have furthered their skills to contribute to the system is critical, and this involves creating paid positions for these physicians within our teams. This strategy will ensure that the front-line voice will continue to be integrated in the highest capacity.
I hypothesize that careful thought into this type of physician integration will decrease conflict, retain practitioners, decrease burnout, and allow practitioners to get back to medicine. They will have renewed sense of accomplishment, respect, and this will be apparent to patients under their care. It is time for physicians, healthcare organizations and institutions, and medical schools to come up with a collective effort to create a framework with more specified opportunities in which physicians can contribute to the optimization of healthcare operations, support a focus on higher quality healthcare, and integrate the physician voice into all aspects of the rapidly changing health system.