December 18, 2006
Student Scene
The Education of a Physician-manager
Photo by Rachel Eastwood Jason Sanders |
In early December, Harvard Business School held its fourth annual Healthcare Club Conference. Several MD–MBAs attended, as well as students from the MD–MPH program in health care management and from MIT. Topics included emerging revolutions in bioscience, the life cycle of a biotech company, medical-device innovation, and trends in health care delivery. This latter panel was particularly close to my interests as a future clinician. Representatives included a senior internist at Massachusetts General Hospital, a VP from Blue Cross/Blue Shield, an executive director promoting coverage of the uninsured in Massachusetts, an IT entrepreneur, and a health care consultant. Through experiences as a medical student, I had perceived the roles played by government and academic medical centers, but this discussion highlighted the influential approaches by players in the private sector.
Private Sector with a View
The aspiring physician, of course, recognizes that he is part of a multidisciplinary care team, from the nurse, to the case manager, to the respiratory therapist. But recognition of the broader reality is much less immediate–that all of these team members make up part of an enormous, seemingly external economic sector: medical school applicants don’t usually write about joining a profession with 17 percent GDP and good growth opportunities. Yet despite its special place in human society, many individuals do approach health care from the macroeconomic viewpoint as just another sector (like packaged goods or manufacturing). Entrepreneurs scan for market opportunities, and health care’s inefficiencies enable them to implement creative ideas as well as some frank cherry-picking.
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The aspiring physician, of course, recognizes that he is part of a multidisciplinary care team.... But recognition of the broader reality is much less immediate–that all of these team members make up part of an enormous, seemingly external economic sector. |
The challenges facing today’s student doctors are to communicate with these myriad stakeholders outside the academic medical centers, to assume leadership roles among providers, and to focus on equitable and sustainable solutions. Flash-in-the-pan ventures are good for a quick buck, but rarely provide broad patient benefits.
Flavor of the Month
Some of the hot topics now on the table include on-site employee health services, retail-affiliated nurse practitioner clinics (e.g., Minute Clinic at CVS or RediClinic at Wal-Mart), and medical tourism. Each of these ideas offers tangible benefits to patients, providers, and payors, but I am concerned overall that they might just be transient solutions to failures of the existing delivery system. The impact of the express, “low-cost” clinics will be minimal or even disruptive without painstaking engagement of the broad-based hospital and group practice system. Disturbing the status quo certainly can be helpful in measured doses, but I don’t see an overarching vision that is leading these changes. However difficult, collaboration must be the guiding strategy for improving our fragmented delivery system.
Taking Back the Reins
Recent New York Times profiles of physicians entering other careers, such as consulting and finance, have stirred dialogue within the medical community about its roles and responsibilities in confronting old challenges dressed in new clothing. While doctors have a storied tradition of being multifunctional professionals—from writers, to Nobel laureates, to community activists—forays into business have been less common. The pendulum of debate about trade-offs between equity stakes in delivery organizations and their potential for conflicts of interest (e.g., the Stark Law) has swung toward the latter, such that physicians lack the access to capital for innovation that their peers possess in other sectors. But now there are striking opportunities for health care managers not only to keep ailing hospitals in the black, but also to forge regional, integrated systems for maximizing public health.
It is my hope that MD–MBAs, along with others, will apply their training to tackle such difficult tasks: using finance alongside moral philosophy to craft equitable coverage and incentives, or using process design alongside evidence-based science to create intelligent decision-support systems. Physicians must regain their strong leadership position in health care, prevailing against the push and pull of external parties. Doctors who venture outside the world of clinical care—whether in business or politics—can be valuable members of a team that makes leadership vision a reality.
—Jason Sanders is a fourth-year medical student at HMS.
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
Copyright 2006 by the President and Fellows of Harvard College