Physician-administrator tug of war spills onto LinkedIn: A Hippocratic oath for administrators?

Healthcare reform has put particular emphasis on efficiency and cost control while trying to achieve good outcomes when treating patients.

That has put particular pressures on the relationship between hospital administrators and doctors who historically have been motivated and compensated differently. No where was that divide more apparent than in a vigorous discussion posted on the Healthcare Executives Network LinkedIn user group. A discussion started seven months ago garnered more than 600 comments and was still eliciting responses up until yesterday. One user suggested that a way to bridge the chasm between the two groups was to make hospital administrators take the Hippocratic oath to which all physicians are bound.

Seven months ago newcomer to the healthcare industry, Linkedin user Neil Pithadia posted this simple query on the Healthcare Executive Network LinkedIn user group: “I am a recent transplant into health care, but notice a a fundamental disparity between key stakeholders to decision-making in an organization, namely the Administrator and Physician. Why do you think there is such a large divide between the two and how do you bridge that gap?”

The first comment was simple enough. Ester Horowitz, who works in business development and compliance at South Shore Health Systems in Valley Stream, New York, posted like this:

Welcome to the real world of healthcare. Perspective is the answer. Physicians vs Adminstrators. While I’m able to bridge the faithful divide, it’s because I do it with the stakeholder’s perspective in mind and get what I want anyway.

And the flood gates opened. (The comments have been edited for clarity)

Major (Dr) Sachin Mane  wrote:

Sorry to be a spoiler. Twain has to meet in between these two divides. Doctors have their constraints being the provider of medical care to the patients under their care. The systems and processes required to be followed may not necessarily make sense to stakeholders in all cases. But doctors can be a real pain in the wrong place, especially in relation to saving themselves in situations that may give rise to the question , whether all the things that could be done, were (done) in patient care situations. This can give rise to unnecessary costs to stakeholdes without tangible benefits accruing to either patients or hospital.
One needs to take a situational approach and do the right thing for each specific situation. May be, since I am a doctor who has worked as an administrator, I can relate to it.

Then,  Jim Jim Sinnott  shot back:

I think you are missing the point of friction. Hospitals and doctors are (incentivized) differently. We are being required to provide more services in an environment of decreasing payments. The hospitals ask for more indigent coverage in some cases the hospitals are (paid) and we are not. More participation in hospital committees for the hospitals to continue with JCHA, and CMS. without any payment to the doctors serving. When is it enough. Now I am speaking about community hospitals. I blame this on doctors the average person in the street has no understanding of our plight and we have not done a good job of informing them.

Horowitz could not find much sympathy for Sinnott’s plight commenting:

While I agree with your statement relative to hospital expectations and reimbursement issues, OMG are you kidding me about your plight! You are the most highly paid people on this green earth and your peer group is more motivated by the $$$ than you should be. While your services are the product that not only churns the health industry engines, and your services are what keeps people healthy had they not had you, the majority of you live in tunnel vision as to who needs to be informed of reality.

As for Major Mane, I do believe we are speaking the same language when we say that we need to understand the perspectives of the stakeholders. We don’t have to agree with them, but we do have to understand them if we are going to be a bridge that moves the conversations forward to positive actions. It doesn’t matter if I have an MD set of credentials next to my name or not. What does matter is who is at the table. What the challenges are they face, and how we move forward. None of the answers are easy.

New user  Michele Rodriguez  chimed in by offering a tantalizing if slightly unrealistic suggestion to solve the problem:

Let’s not forget history. Physicians have been their own bosses in private practices, with hospital care and with insurers. I agree that reimbursement challenges put these entities at odds with one another. However, times have changed.

Hospitals and payers are increasingly taking over responsibility for outcomes and efficiencies. Care must now also be coordinated. This blurs the lines of responsibility for all parties. It is as if “we” (reform) are now saying, “hey, those of you who have dominated healthcare for years, are doing it wrong”. While this is truly the pot, calling the kettle black, it hurts, no matter how you put it. Pressures imposed by limited resources have changed the nature of the game to something that physicians hadn’t signed up for in the first place. When any game changes, the players are forced to reassess their involvement levels. Therefore, many physicians will look at the new playing field and decide the game is not one they wish to play in. Others, particularly newer players who have not participated in historical games, may be more attracted to the current game. Unfortunately, we may lose many valuable, experienced resources in the process. Administrators, must be sensitive to the reassessment process if they wish to retain irreplaceable key players in the game.

I believe that physicians, who must take the hippocratic oath, are keenly concerned about the welfare of patients. Those who keep that at the core, and are able to balance out the changes in the landscape, will weather the storm. Perhaps, administrators should also be bound by the same oath that physicians take. It would at the very least, begin put us on the same playing field.

Several doctors on the network appreciated this idea, and so did at least one healthcare executive.

But the conversation and each side accusing the other did also continue right up to the last 24 hours where Amanda Swaim lamented:

I was hoping I would be inspired by joining this group. Unfortunately this discussion has taken a turn for the worst. Try leading not accusing.

To which Dr. David Wishnew responded:

Amanda…You are exactly right. I know I am guilty of accusing, either directly or indirectly. BUT, it does indicate the underlying distress felt on both sides of the discussion. In every administrator/physician interchange, there is, it seems, a power struggle. Personally, I think that being the hospital employed Staff Medical Director would be the worst of all possible worlds.

One user,  Anthony Wunsh  tried to get the discussion to have a more constructive tone:

Group lets take a different approach and prove the bridge can be crossed.  If you would Administrators, please list your mission, job description and goal as you see them Physicians do the same, try to be as detailed as you can.

Once we have these views, perhaps we can appreciate the conflicts and the commonality and build off them.

We all know this divide exists and we all have opinions as to why, but I believe we all want to provide the patient with the best care possible at the lowest cost possible, therefore, the divide must come from the how to do this.

Alas, no one, so far, has taken up that offer.

You can read all 600-plus comments here.

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