Collaborative Musing: The Passing of the Guard?

A friend and colleague who is an orthopedic surgeon surprised me with a 2-page response to my article on surgeon frustration. I wrote that physicians’ mastering process skills not taught in medical school or residency, like communication, win-win negotiation, and conflict resolution are key ways that they can improve their leadership skills, practice environment, and patient care. I was so impressed with the thoughtfulness of his reply that I asked his permission to reprint parts of his note in my blog. He wrote:

• I think that the medical community as you and I knew it is probably changing forever…. I fear the only way for hospitals to be successful and efficient is with a salaried (owned) medical staff. I don’t like this idea much- that’s not why I went into medicine… It seems that we are stuck with doing much of the work of medical care, but the profits go more toward the hospital (who of course cannot pass on profit because of Stark implications).
• Page 79 suggests that we MDs will need to learn to change as in learning consensus-building vs. traditional command-and-control mechanisms. I have difficulty seeing how MDs are going to buy-in to choosing teamwork over primary responsibility for medical care. Perhaps this MD mindset will change with the new generation … coming into the… marketplace.
• I think that as a surgeon, a leap of faith is required to buy into the new system. Unfortunately, my years of dealing with a divergent … administration makes it difficult at times for me to do so.

If he and I were sitting by a pool, where our last conversation took place after an Estes Park Institute conference, here is what I would say after I thanked him for sharing his thoughts with me:

• I do not know of any salaried physicians who are “owned” by their employers; physicians, like university professors, feel more of a sense of allegiance to their specialty and their colleagues than to their workplace, regardless of their year of birth
• We all rely on teamwork- in the office, the OR, and on the floor; teamwork does not need to compromise responsibility; in fact, it can enhance responsibility for clinical outcomes if we use clear communication and promptly acknowledge and learn from mistakes
• It is only possible to be passionate about the role of communication and collaboration in improving clinical outcomes if one has seen evidence of it working. As I have said before, the old separation of leaving clinical care to doctors and nurses and finance and operations to administrators does not work any longer, especially regarding never events like falls, catheter-acquired infections, and hospital-acquired bed sores that the Center for Medicare and Medicaid services will not pay for.

My friend and colleague views medicine as a calling; he has won the Distinguished Physician Award, as voted by physicians at his hospital. When he retires, it will take more than one physician to fill his shoes. The purpose of this blog post is to stimulate discussion, not to decide who is right or wrong. What do you think:

• Are hospital-salaried physicians hospital-owned?
• Is teamwork antithetical to primary physician responsibility for patient care?
• If personal change must accompany cultural change, what administrative pre-conceptions about physicians and what physician preconceptions of administrators must give way?

As always, I welcome your thoughts.

Kenneth H. Cohn

Posted in Physician Engagement

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