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In the ever-challenging field of medicine, the image of physicians putting their knowledge and resources to the patient’s use often summarizes the way we understand the medical industry mechanics. Under this picturesque description lay thousands of ever-turning wheels in a complex mechanism whose leadership is constantly responsible for the life and death of millions of patients.

However, are physicians responsible for the medical industry mechanism, and, if not, who bears the responsibility? Quite surprisingly, recent data disclosed a number of 14,8% physicians who manage their own practice. Less than a quarter of the nation’s physicians reign their medical destinies. What about the other physicians? Most frequently, they find employment in hospitals under the leadership of healthcare administrators, whose sole goal is to bring a „business” touch to the medical field. As such, actual physicians, who were the backbone of the medical administrative side last century, are currently outnumbered (3200% growth between 1975 and 2010) by healthcare administrators, whose understanding or willingness to understand how physicians save our lives is frequently deficient.

Putting Physicians and Healthcare Administrators at Loggerheads

Such an arrangement, in which physicians work around the clock to save lives while hospital administrators focus on policy, administration, finance, and organizational behavior, is not meant to last. The two sides are at loggerheads, and the resulting enmity is already claiming casualties. In 2014, 54% of physicians reported a loss of enthusiasm, cynicism, and a reduced sense of accomplishment due to this tense relationship. Instead of pursuing ways to improve health and patient care, physicians are gradually abandoning this “culture of engagement.”

Being a Boss in the Medical Industry

Taking One’s Destiny into Their Own Hands

With this in mind, we are entitled to ask, “Where does the fault lie?” ”It’s the other party’s fault,” one might respond. Since hospital administrators have a poor understanding of the physician’s life-saving capabilities, and physicians have the same poor understanding of business and management, distrust was sure to spring in a place where it is least needed – where we save lives. As such, physicians are entitled to take their destinies into their own hands and found private practices. However, what does a private practice entail, especially during pandemic times?

The Perks of a Private Practice

The decision to start a private practice employs multiple variables, from choosing the perfect site to finding the appropriate moment to begin in the first place. A physician must treat this path with extensive care and for serious reasons – the road is extremely arduous, especially for young physicians, whose business administration knowledge might not suffice. However, the following perks draw physicians who choose the private practice path:

#1: Being your own boss – in a private practice universe, being your own boss translate into free choice concerning employment and a healthier working environment. The physician can build their team while choosing staff members whose personalities do not clash with their own (a common issue within public hospitals).

#2: Private practices are more lucrative – this advantage does not strictly refer to revenue but to how physicians can distribute the revenue at will. Physicians with a knack for business development can aim for opportunities that elude hospital administrators and, therefore, could cause friction between the two parties. As such, physicians can enjoy complete control of their finances, negotiate salaries, etc., while acknowledging the business world’s ever-present risks. Frequently physicians go through an MBA (Masters of Business Administration) to sediment their business skills before embarking on this endeavor.

#3: Providing superior patient care – the physicians’ “culture of engagement” requires constant nurturing to improve patient care at a holistic level. For numerous physicians, the drive towards progress through uncharted medical territories prompts them to abandon administrator-run hospitals and pursue their own ways.

What Could Deter Physicians from Private Practices?

Chasing one’s dreams without constraints sure sounds appealing for all, not just physicians. However fulfilling it might sound, starting and running a private practice is a consuming endeavor, for which not all are adequately prepared. For starters, physicians must face the following deterrents:

#1: Busier schedule – unless they hire a locum tenens physician to cover, physicians will always be on call, day or night. They can expect some jam-packed days ahead, which translates into less time amongst family and friends.

#2: Private practices are not one-size-fits-all – while some medical fields enjoy a certain level of autonomy that prompts them towards private practices, others depend upon hospitals, such as Pediatric Infectious Diseases and some surgical specialties.

#3: It could be exhausting  together with private practices come great responsibilities; financial decisions, employment, marketing, and management are but a drop of a private practice’s daily requirements, on top of the physician’s actual medical activity! Such a mountainous workload could translate into an intimidating task for some physicians.

Reconciling Physicians and Hospital Administrators

Instead of increasing the divide between physicians and hospital administrators even further, the two parties would immensely benefit from a joint effort towards bridging this divide and understanding each other’s role in the medical community accordingly. The time has come to dispel the “culture of mistrust between those who deliver care and those who administrate it” and build a sturdier, well-founded bridge between the two worlds. While the first step is always the most difficult, the following propositions are sure to bring the two sides closer together:

#1: Restarting the culture of physician engagement – assessing and valuing every physician’s insight on patient care is critical towards healthier patients, happier physicians, and a brighter future for the medical field.

#2: Learning about each other – such a requisite goes both ways – hospital administrators will benefit from learning about disease diagnosis and treatment while physicians can reap the fruit from healthcare policy, administration, finance, or organizational behavior training. Essentially, hospital administrators will learn how their colleagues save lives while physicians will ascertain how healthcare is paid for.

#3: Remembering to put the patient first – what both physicians and hospital administrators must remember is that they share a common vision, a vision that renders their work fruitful and meaningful, and that is saving patients. For that reason, physicians and hospital administrators need to rekindle their trust in one another and act together towards a solid patient-centered culture.

Conclusion

When guilt is shared, the guilty parties have but one course of action – to forgive each other’s mistakes, rekindle their mutual trust, and strive towards a more hopeful future. Such is the hope that physicians and hospital administrators will put aside their differences and abandon the “Who bosses whom in the medical industry?” question in favor of “How can we better serve our patients?”

BIBLIOGRAPHY:
1) https://www.sgu.edu/blog/medical/private-practice-doctors-discuss-self-employment/

2) https://www.kevinmd.com/blog/2015/08/so-doctor-whos-your-boss.html

3) https://www.healthcare-administration-degree.net/top-healthcare-administrator-the-hospital-ceo/

4) https://www.forbes.com/sites/sachinjain/2016/06/29/physicians-and-health-care-administrators-friend-or-foe/?sh=602238751a95

5) https://scholar.harvard.edu/files/poojachandrashekar/files/mar_apr_2019_264-268.pdf

Ionut Raicea
Ionut Raicea