Are there too many administrators in healthcare, compared to the number of clinicians? Have the technology and regulatory changes forced physicians to spend too much time at their computers, and not enough with patients, or undermined the relationship between physicians and administrators?
I explore some of these issues and more in a Q and A with top health officials in athenaInsight that says:
“Here’s some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.”
“Yes, that’s 3,200 percent in 35 years, a statistic derived by Physicians for a National Health Program using data from the Bureau of Labor Statistics, the National Center for Health Statistics, and the United States Census Bureau’s Current Population Survey. Physicians for a National Health Program.
Healthcare Is So Much More Complex – More Administrators Needed?
Decades ago, “the hospital was seen as an open workshop where doctors brought their patients and worked largely independent of the hospital,” says Ben Bache-Wiig, MD, executive vice president and clinic clinical officer at Allina Health Group in Minneapolis, Minn. “Now, more than 50 percent of physicians are employed by hospitals and work in largely speciality groups. They’re being asked to follow protocols within a hospital system and report to administrators.”
The level of complexity has “grown exponentially and the degree of complexity has grown exponentially and the degree of external requirements has also skyrocketed,” says Marilu Bintz, MD, a senior vice president of population health and strategy at Gundersen Health System in La Crosse, Wis. “Since the early 1980s, there has been a consolidation and aggregation of larger and larger physician groups in our health system, some affiliated with one or more hospitals. Then there’s the trend of hospitals merging into larger networks. If we’re saying the sheer number of administrators is compromising relations between physicians and patients, I disagree. I don’t believe the number itself is a key factor. The key is for (physicians and administrators) to come together and deal with that complexity.”
“The challenge,” she adds, “is for physician leaders and non-physician administrators to find the common ground that, if approached with the best interests of patients and community in mind, leads to the success of the health system and physicians. That starts with an understanding of one another’s role.”
All those technological changes – impact on doctors. No time for patient care!
“When we talk about the practicing physician, the way the system is structured, there is a shorter and shorter window of time when a patient sees a doctor,” says Louis J. Goodman,PhD, executive vice president and CEO of the Texas Medical Association and board member of The Physicians Foundation, where he previously served as president. “Based on Physician Foundation surveys we have conducted over the past six years, that’s the No. 1 reason why doctors enjoy medicine and their practice, and that is the time with patients. Yet we see that time is diminished when they have to consider unnecessary box checking on electronic record forms to meet regulatory requirements.:
“Our 2016 Physicians Foundation survey shows that physicians spend 21 percent of their time on non-clinical paperwork. There is a significant increase in the number of administrators, at a much more rapid rate than we are producing physicians,” says Goodman. “With the growth of administrators, we naturally are going to see an increase in rules, regulations and management procedures to that ‘triple aim’ that hospitals like to talk about (improved patient experience, overall population health and reduced cost in healthcare).”
Physicians becoming administrators.
“More and more we’re seeing an enhanced push toward physician-administrators, with more physicians going into administration through MHA and other degrees. Doctors have a greater sense that an administrator understands their concerns and is focused on the clinical side of patient care than if that person is a physician-administrator rather than a lay administrator,” Goodman says.
“There’s been a conscious effort in our health system to encourage physicians to take a leading role in the organization,” says Bache-Wiig. “ I myself am a physician who had the opportunity to cross over and become successful as an administrator with excellent professional support throughout the system. That formula has been pretty successful for our four healthcare systems.”
“We have an open dialogue and have helped physicians maintain autonomy and innovative spirit,” Bache-Wiig says. “There is the challenge of standardization versus individualization, which can lead to physician burnout and disengagement, and we are not immune to that.” “
Hospitals Should Open-the-Door For Physicians To Become Administrators
“Health systems have to be more welcoming to physicians who want to be involved in administrative medicine,” says Bintz. “There needs to be a common understanding that the term physician-administrator does not require that a physician stop caring for patients. Physicians have to have the opportunity to be involved in caring for patients. Physicians (also) have to have the opportunity to be involved in administrative roles and continue to practice if that is their desire.”
Bintz adds: “Here at Gundersen Health System we have spent 125 years fostering a culture where we attract both administrators and physicians who believe the patient comes first, that we exist to serve our communities, and that it’s important for physicians and administrators to work together to demonstrate how we do those things.”
Training Physicians to Be Administrators
Goodman: The Physicians Foundation has sponsored the Physicians Leadership Academy since 2010 and what we’ve tried to play a role in helping physicians undertake leadership roles. We have partnered with different, highly seemed university and medical programs, such as Northwestern and Duke. And we use seminar and small group formats focused on areas such as leading organizational transformation, executive decision-making and negotiating productive agreements. Physicians can take back to their hospital or practice and give them the tools administrators need. Without understanding the technical or financials, that puts physicians at a disadvantage to being administrators. We are giving them the tools at the baseline for a practice so they can do the best they can, going forward for their patients.
Nick A. Fabrizio, PHD, FACMPE, FACHE, a principal consultant with the MGMA Health Care Consulting Group in Washington DC, observes:
“There are definitely gaps with lack of business training (for physicians). That’s where the MGMA and other groups, graduate programs and trade associations provide needed additional training. Working in a health system is difficult and very different from a physician group practice. There are multiple stakeholders. And behind every physician leader, there is always a great non-physician administrator, whether a CFO or a CEO, someone with the knowledge of running a hospital for 20 years or more, having that knowledge especially being able to survive politically in this climate, is invaluable.
Docs: Don’t Be Loners — Be Part of a Team
The need for teamwork: “If we’re saying the sheer number of administrators is compromising relations between physicians and patients, I disagree. I don’t believe the number itself is a key factor. The key is for (physicians and administrators) to come together and deal with that complexity.” Says Bintz: “Beyond that, the best way to improve the quality of care that patients receive is to have a strong partnership between physicians and administrators so that both understand the complexity of how ‘quality is defined and reported, and both understand the real-life details of high-quality care at the bedside. The relationship is far more important than the numbers.”
Bache-Wiig: “In many ways we across the country have trained physicians to come out and think of themselves as individual businesses. There will be an increasing need for physicians to function within complex systems, and understanding that role in complex systems.”
What’s the shouting about?
“I don’t’ see what the data sees – big discrepancies in the numbers of administrators to physicians,” Fabrizio says. “ In fact I have seen hospitals taking away administrative operations people through mergers and combined joint ventures. I see that happening as positions are absorbed into the larger structures.” – Joe Cantlupe, HealthDataBuzz