Raising the Physician Voice by Randy Cook, MD

Written by Dr. Randy Cook

Sometimes I have to pinch myself when I think about all the things that I have seen over 44 years of medical practice and the number of things that have changed in healthcare. When I think about something as simple as the way we do operations, back in the beginning of my time as a surgeon, if we wanted to repair an abdominal aortic aneurysm, it would be through a massive abdominal incision, sometimes with two additional incisions in the groin. Nowadays, that operation is done through little more than a needle stick.

Indeed, the entire nature of healthcare delivery has changed dramatically over the years of my active practice and will continue to do so, likely at an ever-increasing pace. Many, in fact most, of these changes will be for the better. Who would want to return to the days of “exploratory” surgery, now that imaging techniques and directed tissue sampling can give us much more useful information than a dangerous and debilitating operation could provide just a few decades ago? On the other hand, some of these changes will be disturbing and disruptive. The intrusive oversight of payors and utilization police are only a couple of examples. These are the things we’ve already seen, and we can be certain there will be disruptive forces that we never anticipated.

I can now see retrospectively that physicians began to buy into the false assumption that they were not properly equipped to understand business and therefore they should just step aside when there was a business decision to be made. The second big change is the ridiculous amounts of money that came into play and the healthcare landscape as a whole really got out of hand. If you look at the history of healthcare in America, many hospitals, particularly in the early to mid-20th century were operated by religious or other charitable groups. They were constructed for the benefit of the community. That was their sole purpose.

When did the shift start? Well, in the early 1970s, there began a divergence of priorities in healthcare where physicians tended to follow the path of quality of care, while ceding responsibility for revenue management to what was thought to be a more appropriate expert culture, i.e., the business school graduates. What we see now are hospital CEOs demanding salaries in the high six and even seven figure range, while nurses and other “round the clock” personnel are forced to work with too few staff and too few resources for too many hours and too little pay.

Nowadays, a lot of hospitals, are considered to be profit centers. If you want to make some money you can buy some stock. The financial pressure has caused a tremen - dous change in the way hospitals and healthcare in general is administered. It has created quite a different feel, I think, to be a physician in the 21st century as opposed to when I started.

What has to be done? Well, three things.

Speak Up

First, physicians have to step up and say we are capable of and deserving of a voice in how medicine is delivered. Physicians are smart, intuitive, compassionate individuals. The business side of healthcare is in desperate need of their individual voices. The instant the physician goes to work for someone other than the patient, the patient loses. Which is why it is paramount that physicians speak up and claim their rightful place at the business table. In my opinion, it is critically important for physicians to become more engaged in hospital management. To do so effectively, they will need to acquire some skills that were not taught in medical school. One place to look for help with such skills might be with either classroom or online business education courses. But more importantly, it’s crucial for physicians to question management and demand that institutions put patient welfare at the top level of priority.

Ultimately, the good news is, we’re beginning to have a real conversation about how to elevate our system of healthcare to a level that we deserve, both as patients and practitioners. These conversations need to continue on a much larger scale.

Band Together

When I first got into practice, many of the things I expected turned out to be entirely accurate. But the one thing that blew me out of the water was how much time physicians in the 1970’s and 1980’s spent battling with one another and fighting over turf instead of working together for a common purpose. For physicians to have a credible voice in the business of healthcare, they must stop fighting with each other. I don’t see quite the level of turf battling that I did 45 years ago, but part of the reason for that might be that so many physicians are now employed by hospitals or hospital systems. This is a serious problem that I believe is exacerbated by suffocating educational debt. If physicians must be employees, it is critical that they put forth a unified message with respect to patient advocacy.

Invest in Coaching and Mentors

Finally, physicians may need help finding their voice. When you’re battling debt, burnout, and bureaucratic processes, it can be easy to lose your voice and even your desire to stay in medicine. I’ve seen it happen time and again. The good news is that there are some relatively simple, easily accessible steps to deal with or, even better, head off these issues before they become bigger problems.

Professional coaching has been a highly popular and demonstrably effective method of dealing with the realities of the business world for years. In much the same way that being a good student of business doesn’t guarantee being successful at business, the same is true of medicine. The challenges and realities of the practice environment are entirely different from the learning environment. Coaching affords a completely objective and unbiased advocate to help identify your strengths and weaknesses and to give you the space and the tools and the encouragement to perform at your best.

All of this puts me in mind of a favorite poet of mine. This one is from a much more recent era:

For the loser now Will be later to win

For the times they are a-changin’ Bob Dylan - 1964

It’s up to us to take control of the change. ☤

To learn more about Dr. Randy Cook, go to https://mymdcoaches.com/our-podcast-host