A few months ago I wrote an article about a 28-year-old MBA who attempted to tell an experienced physician where to round first. The article was widely circulated and went a bit viral. Clearly, the scenario resonated with thousands of physicians across the country.
It was interesting that afterwards I received many messages from various people who had read it. The majority of these were messages of support and solidarity from fellow physicians, who had seen similar situations unfold themselves. But intriguingly I also received several emails from people on the corporate side of health care, who almost expressed apology for the scenario I described, and attempted to make me understand their perspective as administrators and MBAs. Seeing these types of messages from the very people physicians are so wary of, made me somewhat proud. I was proud because of the fact that medicine is still such a respected and relatively autonomous (and I use the word relatively) profession, that the business folk feel they need to reach out so quickly. Even if it's an attempt to defend the indefensible.
The last couple of decades have seen the rapid “corporatization” of health care. Instead of medicine being about the small private practice of Dr Smith around the corner, it is now all about mega multi-specialty groups, huge for-profit organizations, and multi-million dollar mergers. Don't get me wrong, I'm quite capitalist at heart, and definitely middle of the road when it comes to politics. Many of my close family and friends have gone the corporate route. But I just think healthcare is very different from every other industry—and not as amenable to pure business thinking. Healthcare has, and always will be, about humanity, compassion and real life emotions at its core. And thereby is the essential clash between those of us including physicians, and the business world that will always be driven primarily by profits. Of course, we need administrators in every industry, but I'm of the belief that only healthcare professionals—whether they are doctors or nurses—should be administrating in healthcare (with or without a business qualification). Not a non-clinical MBA.
It's very obvious, especially with our current political discourse and environment, that much of the middle class feels crushed and increasingly squeezed. There is so much raw anger out there against globalization, huge corporations, and massive administrator and CEO compensation. Large swathes of the country believe that it's these very factors that have brought Middle America to its knees over the last few decades.
So going back to those MBAs who reached out to me following my article. Most times and in most industries, criticism against their roles would be completely ignored and glossed over by those in the C-suite. After all, why would they care when they hold all of the power? Yet despite all the changes we've seen in healthcare, MBAs still appear to feel that they need to answer and defend themselves against what doctors are saying. They know that they have a case to answer—for now anyway. But let's not be under any illusions as to the trajectory of this path. Because when the day comes that they no longer feel like that, physicians would have joined the ranks of the other “coal-face workers” in the rest of America. Working and working, giving their corporate masters all the profits with little say as to how things are done.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.