Digital Pathology Blog

How Many Doctors Does It Take To Change a Light Bulb?

Why would we want to do that?
In 1993, George Halvorsan, Chairman and CEO of Kaiser Permanente from 2002-2013, wrote in his book Strong Medicine:
"Rather than taking an overall leadership role in the continuous improvement of the health care delivery system, too many medical professionals either ignore the problems of the system in order to concentrate in their own specific practices or focus their energies and talents on protecting the status quo."
 Today - more than 20 years later! - health leaders still say physicians shun leadership and resist change.
What's the basic problem? I think it is predominately the conservative physician culture. This culture reluctantly shares decision-making and managerial power with colleagues, administrators and outsiders. For independent physicians, there are simply too few incentives, too little personal satisfactions, and not enough spare time and extra money to induce change.
Health industry leaders have repeatedly told doctors they must consolidate into larger groups or integrate with hospitals to survive; achieve greater size, critical mass, and scale; cultivate managerial care expertise; work in multidisciplinary teams; seek capital offered by large companies; follow evidence-based or standardized guidelines to practice good medicine; practice preventive medicine; develop systems approaches to managing chronic disease; install information technologies in their offices; offload business functions to the Internet; communicate with patients through the Internet and by e-mail; convert to paperless offices, prescribe electronically, and standardize codes and transactions.
Many physicians have not bought into the argument that bigger is better, or that managed care and corporate models for achieving quality are in their best interests or their patients’.
The changes are disruptive, although ultimately I think they will better serve patients with more integrated and connected healthcare delivery systems. The transition is hard.
The way many physicians think can be illustrated by a few key points:
  1. We became physicians to serve patients, not hospitals or business corporations.
  2. Our customers are “patients,” sick individuals who need our help, even when that help is expensive and experimental.
  3. We are supposed to be patient advocates, protectors and guides through systems with many obstacles to care.
  4. We see patients one at a time, and you don't measure success on “population health”.
  5. We distrust group activities. Our success has always largely been by individual effort, medical school, residency… and starting out in practice was not a team sport. 
  6. Rewards have come through working hard, mastering our specialty and impressing colleagues, not through participating in “meeting a target” or completing a checklist to qualify an investment or meeting a deliverable.
  7. We dislike organizational politics and policies. We are professionals, not “providers" to be ordered about.

These beliefs can rub against the changing healthcare eco-system. Yet in the end, re-organizations happen, practices adopt and adapt and technology wins. Hospital mergers, acquisitions, consolidated group practices, standardized treatment plans, larger and larger integrated healthcare delivery networks, centralized testing and electronic order entry, all together are changing the landscape of the traditional hospital-physician-patient model.
Change is inevitable and changes around you require you to change or be changed. Advances in imaging technologies, personalized medicine, hospital networks and reimbursements will require us to dismiss old notions and adopt new ones about how to serve our patients, ourselves and our practice environments. 
Jack Welch perhaps said it best when he quipped, “Change before you have to.”
I call on all of us to embrace the opportunities and distinguish ourselves as change agents, champions and leaders.


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Posted by Keith Kaplan, MD, Chief Medical Officer on Tue, Dec 02, 2014 @ 12:21 PM