The Management of Medicine: Doctors Develop New Skills
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By Russ Willcutt and Avery Hurt From UAB Magazine, Spring 2000 (Volume 20, Number 1)
There was a time when doctors simply practiced medicine. Those days, however, are gone. Today’s physician must master not only the traditional tools of the trade, but also many skills usually associated with the business world. Beyond their central focus on medicine, doctors must now be astute managers—of people, of information systems, and of costs.
Financial Stewards
As chair of radiology at UAB for the past 18 years, Robert Stanley, M.D., is more than familiar with the inner workings of health-care systems. “But when I started noticing articles in The Wall Street Journal advertising business programs that were specifically designed for the medical profession, I was intrigued,” he says.
He also began to consider—and question—the manner in which many in the medical profession are appointed to administrative positions. “In the past, there has been the notion that, if you were brilliant in medicine and had achieved a certain recognition in your specialty, this automatically made you a good chairman of a department that had to be run like a business,” Stanley says. “That was a false notion in many instances.”
So he began researching existing programs on the Internet and testing the winds of professional opinion. “When I spoke with colleagues at Harvard, the University of Virginia, and the Mayo Clinic, I found that many of them had already gotten into business-related physician education programs,” he says.
Stanley became convinced that he needed to acquire the tools that would ensure he was being “a good steward of the department’s finances,” he says. “I felt that, with everything that’s coming down the road from the federal government and all of the changes that are happening in health care, I needed to know more about the world of business and management in order to function as an effective chairman.”
Learning to Lead
Luckily, he found a new program being formed in UAB’s School of Health Related Professions. The Executive Master of Science in Health Administration program is designed to bring physicians up to date on current management theory and strategies, according to John Sheridan, Ph.D., who is L.R. Jordan Professor of Health Services Administration.
“In any health system, physicians are the focal point for the delivery of health care, so people look to those people as leaders,” says Sheridan. “The executive program emphasizes the leadership and teamwork skills that will allow physicians to meet that expectation.”
In fact, Sheridan says that teamwork is probably the most important skill the program develops. “Any health system has an extraordinarily complex management system, but ultimately the breakdowns and also the great successes occur due to the lack or presence of what we refer to as ‘people skills.’ And that’s what business management is all about.”
It’s also about being able to look at the big picture, he stresses—and Stanley agrees. “One thing I can tell you is that it definitely got me out of my radiology box,” says Stanley, who graduated from the program in 1998. “The executive program exposed me to finance, management concepts, information systems, and biostatistics. I learned about whole areas that I was absolutely clueless on before, and I’m much more comfortable now when I sit down with a spreadsheet and a business plan that’s looking six or seven years down the road.”
Plenty of Payoffs
Although there’s a growing list of business management courses available through various health-related programs across the country, some physicians have chosen to take a more traditional route to acquiring managerial skills. John Cuckler, M.D., director of orthopaedic surgery at UAB, earned his MBA from the University of Pennsylvania’s Wharton School of Business several years ago.
“In this day and age, the business of medicine is far more demanding than ever before,” he says. “The margins are thinner, our patients’ expectations are higher, and physicians must now pay more attention to concepts such as efficiency and productivity.”
Cuckler points to the UAB Center for Joint Replacement as the perfect application of these basic principles of management. “This is a new clinical program, and we decided to address these very issues right from its inception. As a result, we’ve increased our efficiency and the quality of care we provide, and our patient satisfaction has absolutely gone through the roof. The benefits for the institution and for patients are immeasurable.”
Integrating Information
One aspect of health care that’s especially challenging to manage today is information—because there’s so much of it, and it can be tracked and shared in so many different ways. Physicians must therefore become conversant with new information systems technologies. To address this need, UAB’s School of Health Related Professions has launched a program in “health informatics”—a discipline that applies computer and information technologies to the singular needs of the health-care arena.
According to Helmuth Orthner, Ph.D., director of UAB’s Health Informatics Program and one of the founders of the discipline in the United States, there is a great need for health-care executives who understand both the clinical and information management aspects of the field. “Physicians and nurses have no hesitancy to use new technologies if they’re convinced that they really help,” he says. “And since anyone involved in the medical profession is working under tremendous time constraints, implementing newer, faster technologies is a natural fit.
“In the early days, computers were very labor intensive,” he says. “It took time to enter the data and maneuver through command-driven programs. As information systems have grown more transparent, however, they’ve become more useful and cost-effective in health-care situations. The industry needs leaders who can understand and make use of new technologies.”
Streamlining Systems
During the last few years, new information technologies have been rapidly incorporated into health-care management because of their power to integrate databases. In 1995, for example, UAB’s Division of General Internal Medicine formed a Section of Medical Informatics under the direction of Jerome Carter, M.D., in order to address the gap between patients’ medical records and billing information. Murat N. Tanju, Ph.D., professor of accounting in UAB’s School of Business, was asked to help develop the accounting side of the integrated system.
One of Tanju’s objectives was to analyze alternatives to the existing hospital accounting system. “Traditional cost accounting takes the total cost for a department and allocates funds across the number of patients it serves in order to come up with an average cost per department, which isn’t always accurate,” he says. “It’s better to conduct an activity-based cost analysis, which focuses on the actual patient services that are being provided.”
Tanju says that activity-based cost analysis could save both the hospital and the patient money. “But cost is just part of the picture,” he says. “We would also like to develop treatment pathways that allow physicians to know what alternatives are available so they can determine the most effective, efficient, and cost-effective approaches to patient care. If a patient has knee surgery, for instance, part of the treatment is rehabilitation. With an integrated system, the physician and therapist can work together to determine the optimum treatment pathway, which will also help to hold down costs.”
One of Tanju’s colleagues on the project was Warren Jones, Ph.D., professor and chair of the Department of Computer and Information Sciences in UAB’s School of Natural Sciences and Mathematics. “Medical informatics is the perfect example of the benefits of applying research to medical challenges,” he says, “because it can integrate patient records, diagnostic tools, even artificial-intelligence tools that can be used to diagnose disease. The computer field has so much to offer the medical field in terms of efficiency and productivity.”
Back to Business Basics
According to Cuckler, there is growing awareness among physicians that the practice of medicine is now inextricably intertwined with the realities of management and information systems. “The number of physicians who have gone back to school for additional training in business and technology has just ballooned in the last 10 years,” he says, “but I think it’s crucial for those planning to enter the field to go ahead and begin accumulating these tools far in advance of entering medical school.
“In fact, when high-school students come to me and ask what they should study to prepare themselves for a career in medicine, I tell them to study business,” he says. “And I say that in all sincerity because, whether you want to write poetry in the north woods of Maine or practice medicine in downtown Birmingham, you’ll need a grasp of basic management principles in order to meet your personal goals.”