As the federal and state governments continue to implement the provisions of the Affordable Care Act, experts express concerns about the lack of physicians to care for the expanded pool of patients. “The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.” (The New York Times, July 29, 2012.)
Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans.
The shortage has been described as an invisible problem; that is, patients still get care, but the process is often slow and difficult. An additional concern is the lack of experienced physician leaders to manage the implications of the shortage over both the short and long term.
We asked Brian Wong, M.D., CEO of The Bedside Trust and iProtean expert, to provide his insight on the anticipated physician shortage and the importance of physician leaders.
iProtean: There is a lot of talk about boosting physician leadership programs to help hospitals leverage existing physician resources in a smarter way. What are some practical actions administrators and physician executives can do to prepare for the anticipated physician shortage?
Brian Wong, M.D.: My solution for this impending crisis is quite similar to the treatment plan that I have put into practice to prevent related symptoms such as poor physician relations, poor retention, disengagement, lack of physician collaboration, poor staff relations, etc. Not only are these symptoms directly related to the shortage crisis, they carry substantial costs and impact care on a daily basis.
Allow me to rephrase your question in a more patient centered way: ”How can physicians contribute as leaders so that we have a greater impact on care without adding more to our workload?” The answer to this “ultimate” question positions your physicians to stop these recurring symptoms in your hospital community, while also addressing the root causes of physician shortage in our industry that led to diminished capacity: a deadly combination of early retirements, practice restrictions (closed panels), shortened hours, and non-direct patient care career changes.
To be successful at expanding physician capacity without increasing workload, we must design a physician’s role so that it aligns with what matters most to patients, while creating the conditions for the team-oriented approach required as this shortage advances. Organizations must be intentional when it comes to physician role design. Many of the hospitals that come to us for assistance seek improved physician involvement and higher levels of accountability to improve patient experience and care, but they lack the ability to clearly define and communicate the specific role physicians need to play.
iProtean: Please clarify what implications physician role design has on physician leadership development and the specific issues it addresses for organizations.
Brian Wong, M.D.: Having spent over 30 years of my career as a physician and physician executive, my point of view on physician leadership may surprise you. Most physicians did not get into medicine to become leaders and have a less than enthusiastic response to leadership training. Role design is a practical and concrete solution for organizations that need more physician involvement but realize the constraints of leadership programs that require a year’s worth of soft skill development and a binder full of initiatives. Getting physicians to show up as leaders is possible when you connect their role with patient needs and what physicians are naturally good at. It’s a simple business case: every physician has a coaching role.
Most of the physicians with whom I work are natural coaches. Unfortunately for the patient, coaching is not often treated as an organizational practice and a part of the culture as it is in medical school. So why did it stop? Once outside the academic setting, nobody reminded us of this important role, and our collective coaching acumen deteriorated into what physicians themselves might call “disuse atrophy.” When physicians understand their primary focus includes fulfilling their organizational role as coaches, team performance improves dramatically and patients benefit.
One medical director I’m working with noted “When I ask my physicians to start thinking like a head coach of a team it gives them a specific role to play and the opportunity to set new standards for how we work as a team to benefit the patient.”
Role design is not a new business concept, nor a complex solution to these common challenges. The most innovative consumer-facing businesses outside of healthcare leverage cooperative infrastructure models (role design), as opposed to using our current institutional carrot and sticks approach for improved physician collaboration and capacity. In the healthcare industry, we have not taken the requisite steps to design a cooperative infrastructure with our medical staff. Instead, we have resorted to an array of initiatives that target only the symptoms resulting in overburdened, disengaged physicians; higher operational costs; and inferior patient experience and quality.
iProtean: What advice would you give to a leadership team looking to begin addressing physician role design-related issues?
Brian Wong M.D.: Take time to help your team gain clarity on your current state, the costs your current state has on patient care, productivity, etc., and the results you require. It’s important to guide conversations based on what matters most to your patients rather than the “do more of this and less of this” approach I’ve seen all too often. Consider these three patient-driven points as your discussion guide:
- Patients expect us to work as teams.
- Patient-centered teams need a coach.
- Every physician has a coaching role.
These three tenets will provide the structure and focus for an initial discussion that will begin to better define the role physicians must play within your organization.
The first step in building a more cooperative infrastructure with your physicians begins with a few conversations. As the conversations build, consider a few of these road-tested questions that generate greater clarity and direction:
- When it comes to designing collaborative relationships with physicians, is our institution an enabler or an obstacle?
- Have we taken the steps to collaborate with our physician executives to develop a clear organizational definition of physician leadership?
- Has this definition been accepted, well communicated and appropriately vetted by the medical staff leadership?
- Do our physicians have an organizational role description that guides the type of physician involvement and teamwork we’d like to see in our community?
- How might a more clearly defined role description affect job satisfaction and fulfillment for current and future physicians?
- As we invest resources in physician leadership related activities, what are the expected outcomes; i.e., improved teamwork, improved staff relations, accountability to quality goals, etc.?
- How might a culture based on physician coaching affect your goal of better care, better experience and lower cost?
- What primary coaching capabilities and actions (formal and informal) can our physicians fulfill to have a greater impact on care daily?
Questions like these will help your organization begin to define role clarity for your physicians. If you are going to improve the capacity and contribution of your physicians you must create a coaching culture. Being intentional about role design will retain and attract physicians, create a more collaborative environment and, most importantly, improve the patient experience and quality of care.
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Brian Wong, M.D. appears in the iProtean courses Introduction to Quality, The Medical Staff, Improving Quality, New Delivery/Payment Systems and Hospital-Physician Alignment. You can contact Dr. Wong for more information about collaborative coaching models and Coach+Leader tips at www.bedsidetrust.com.
For a complete list of iProtean courses, click here.
iProtean Symposium & Workshop
Mark the Date!! October 10 – 12, 2012 at The Lodge at Torrey Pines, La Jolla, CA. Faculty: Barry Bader, Monte Dube, Esq., Lisa Goldstein, Dan Grauman, Marian Jennings and Brian Wong, M.D. For more information, click here.
For more information about iProtean, click here.