Doctors and Managers-The Big Divide

doctors-and-managersThe big divide in a hospital between managers and administrators on one side and medical folks on the other  is something that no one really wants to talk about. 

A hospital is an immensely complex enterprise. The challenge is to manage an extremely diverse set of people with vastly differing education levels and skill sets but all contributing towards a unique patient experience. And than there is the uncertainty of the outcome, the human drama and the question of life and death. And than one has to churn a profit to keep the enterprise afloat. Not an easy task by any reckoning.

To expect a doctor not trained in management practices to deliver all this and more is unfair.

Here steps in the intrepid manager and the fight begins.  

The professional manager believes that while most doctors have an inherent knowledge of medicine, they know very little about managing people or running a business. Building teams, grooming and mentoring people, innovating, designing and implementing systems and processes, prudent financial management and investing in a brand are all alien concepts. Further the manager, to his horror realises that many doctors do not believe in some of this. For instance the big doctor himself is the brand, and that is good enough. Hospitals do not need advertising. Retaining and mentoring people is hardly required, there are always enough people willing to replace those who want to leave. 

On the other side of things the doctors look upon the managers as as an unnecessary encumbrance. After all, healthcare is supposed to be their domain, they are the ones who cure and heal and the manager is no more than an interloper on their terrain. He in any case knows as much about medicine as would fit on a pin head and has pretensions of running a hospital. To most doctors this looks and  sounds weird.

As if these divergent point of views were not enough, many a doctor have inflated egos and an inherent belief in their superiority. This stems largely from a system that encouraged the brightest and the best to choose medicine as a career. In the eighties, when I was in school it was an automatic belief that those who were at the top of the class in academic achievements, will inevitably head towards a career in medicine or engineering. I would reckon that this feeling of superiority would get amplified many times as one acquired God like skills in medicine. 

As times changed and management graduates proliferated, they refused to look upon doctors as any different than professionals like themselves and refused to treat them as demi Gods. As managers and doctors came together in a hospital the clash was but inevitable.

Mercifully things are now changing albeit gradually. Many a doctors now see professional managers as essential to running of the business. The managers also realise that their greatest challenge is in managing high performing and highly strung doctors. As a hospital manager I have always looked upon the doctors working with me as colleagues whom I support through my managerial initiatives. I may not agree with all their suggestions but I surely value them. My decisions however are driven by cold management logic, which I have been trained into and, which I would transparently share with all concerned.

A participatory approach involving all concerned usually works well, particularly when the reasons for decisions are clearly laid out. And I believe that is the only way forward for doctors and hospital managers to live and work together.

Pic courtesy www.flickr.com/Mossad Hussein

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