Some Reflections on Training Physicians, both as Caregivers and Leaders:

I initially trained as an obstetrician and then as a high-risk maternal fetal medicine specialist. I did that for a number of years and really got a lot of satisfaction out of improving the lives of patients. But early in my career I got an opportunity to also take a leadership role in not only providing direct patient care, but creating systems and policies and procedures and cultures that provided the best possible care for hundreds, if not thousands, of patients. What I learned in the process is that I’m just as happy to be one step removed and in the background making it all work seamlessly and improving the lives of many without necessarily being front and center and being the one who receives the thanks from the patient individually. So, I found that this can make an even bigger impact by putting some of the analytic skills and problem solving skills that I developed over time to really improving the lives of not only patients but also faculty and staff. I think that if I had to describe myself, it would be as somebody who makes sure things get done and things get done properly for the benefit of everybody, including the patient, but also the team because you have to take care of the team that provides the care so that they can provide the best care.

Most of us in academic medicine take great joy in sharing our “wisdom” with medical students.  I like to think the advice I give to those who have chosen to work with  the sick is a bit unusual, but extremely practical (click the link for video):

White Coat Advice

So, what to I tell physicians contemplating a leadership role?   First off, is that you’re never prepared for any job. At most, if you are really making a career leap, you will have about 65% of the skills required to be successful.  What you need  to do is  A) have confidence to rise to the challenge and  B) be willing to say “I don’t know” and be able to learn in real-time. That’s been the case every time that I’ve had a leadership role, from being the chief operating officer of the five hospital system to the chief operating officer of USF Health. You learn the role by  keeping your mouth closed and ears open, enforce upon yourself a period of observation, and  then you work to improve the environment you find yourself in. (click the link for video)

Advice When Considering Being a Physician Leader

 

Finally, no discussion on training leaders would be complete without a mention of change and change management.  Here, I learned quite a bit during my training in Six Sigma while at Yale, and the main thing I realized is that physicians usually just focus on half of the equation:

ge-change-managementcap-6-638     As scientists at heart, most physician leaders spend an awful lot of energy on the technical side of the equation.  They work hard until they have a Eureka! moment and the best  solution. They look at it from every angle to make sure it is as perfect as it can be.  Then what do they do next?  Younger leaders, yet to be burned, start rolling it out immediattely.  What happen as a result–usually not what was expected–sometimes things even get worse.  Why is that?  We tend not to focus enough on the acceptance or engagement of the solution.  For physicians especially, if they don’t have a voice in the change and hadn’t had a hand in crafting it, the solution becomes something done to them rather than something accomplished with them. It is therefore essential to have a deliberative and collaborative process mapped out all along, and don’t be afraid to have some nay-sayers on the team—you may be surprised at how quickly they come around when you meaningfully ask their opinion.  Once this is done, approach your implementation with care.  Socialize it well.  Change is scary for people, and for those firmly entrenched in a way of life or a way of doing things, change can be terrifying.   Though rare, some may go to great lengths to subvert your efforts, and personal attacks may be one of the weapons you will need to fend off.  Keep in mind though, that if you aspire to be a physician leader, this is the life you have chosen.

Is Academic Medicine Headed For Extinction?

 

The question for today is whether academic medicine is at risk for extinction. To answer that question, let’s take a deeper dive and look at how the average medical school funds itself.
 
The data from the AAMC shows that only about 4% of the medical school budget is covered by tuition — this may be surprising to many of you who are still paying off your student loans. The majority of the funding for a medical school is from clinical revenue, be it hospital contracts or faculty practice collections.
 
The real take-home message is that it’s the clinical practice that cross-subsidizes the research and education mission in academic medicine. So, when the clinical mission catches a cold, the rest of the academic medical center gets pneumonia. The big problem is we’re now in perennial flu season. And why is that? Well, let’s look at how much we spend as a nation on healthcare.
 
By 2018 or 2019, about 20 cents of every dollar in the U.S. economy is going to be spent on healthcare.  To put this in real-world terms, if you drink Starbucks coffee, you already shell out more for the cost of employee healthcare in each cup of coffee than you do for the cost of the coffee to brew it. If you drive a General Motors car, you pay more for the cost of employee healthcare than for the cost of the steel to make it.
 
The American people, and employers who shoulder the majority of healthcare costs, are saying, “Enough is enough; we want more value for our money.” And that is the shifting healthcare landscape we are all experiencing — whether you’re in academic medicine or not. It is a shift from fee-for-service to more emphasis on value. And the whole concept is about value. That is, improving outcomes while holding costs steady, or even reducing them.
 
So what does this mean for the average physician? First off, it means that we are going to get paid less for many things at baseline, and will only see a raise if we can prove outcomes are better. So, we’re going to be measured in ways that we never dreamed of before, and certainly in ways that we haven’t been exposed to in medical school and residency.
We’re going to get scorecards from our hospitals, or other partners, about how much our average hospital admission costs, what our average length of stay is, how much we consume in supplies, and how often our patients are readmitted.
 
And we’re going to be judged more on the total continuum of care, rather than quality in the acute hospitalization. It isn’t just enough to get our patients safely out of the hospital — they or their employers will judge us by how soon these patients get back to work and resume a normal quality of life.
Is academic medicine at risk for extinction?
 
Well, I think the answer to that question is largely in our hands.We’re going to have to change our behaviors, pay attention to what the American people expect of us, and be willing to change.
 
(This piece originally appeared in Opinion Makers, a new MedPage Today video exclusive weekly series, presenting leaders from all areas of medicine offering their views on current topics in clinical care, research, and policy.
In a video (https://www.medpagetoday.com/publichealthpolicy/healthpolicy/53928) , Edmund Funai, MD, chief operating officer of USF Health at the University of South Florida in Tampa, discusses the future of academic medicine. 
 

Time to Rethink Where We Are

 
Time to Rethink Where We Are
Many experts agree that the U.S. healthcare system is in the midst of its greatest period of uncertainty in a generation. We live in a dynamic health care delivery environment. Old paradigms focused almost exclusively on volume, driven by fee-for-service (FFS) reimbursement. New paradigms are evolving for health care delivery driven by value innovation – better outcomes for lower cost. Coincident with value-based care is a new emphasis on patient safety, evidence-based medicine and better coordination of care. The future is also likely to see new health care market segmentation with capitated populations co-existing with concierge-style care and traditional FFS payments.

 

Academic Health Centers (AHCs),  to which I have devoted my career thus far, are exceptionally vulnerable to these changes,  Having a tripartite mission:  clinical care, research, and the education of the next generation of physicians, introduces unique inefficiencies that community systems focused solely on clinical care do not face. It is challenging for an AHC to compete on price alone.  Society values the missions of the AHC, yet no entity wants to step up and pay the associated costs.

We need to find a sustainable way forward.