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The Doctor As Physician-Manager
by Rufus Green, MD, EMBA '96
 An evolution in our health-care system is shifting it from the traditional fee for service to managed care. Public concern about affordable care and rising costs are the principal drivers of this process. The process of reform, no matter what its eventual outcome, is accelerating the ascendancy of management in health care. It appears now that future health care in this country will be under the umbrella of "managed competition."
What exactly is managed competition? It has been described by some as the structured or regulated competition of managed-care plans with the ultimate goal of achieving universal access to quality health care at reasonable cost.
Another good definition comes from Dr. Fay Raymond.
In her 1977 monograph, "Managed Care 2002," Dr. Raymond wrote that managed competition is the process of applying "standard business practices to the delivery of health care in the traditions of the American free enterprise system."
Most physicians are enculturated in the Old World order, that is, the paradigm that gave them the feeling of control, prestige, specialness, and clinical autonomy. This is being lost to the evolving paradigm of a different medicine with a new belief system, what I refer to as Twenty-first Century Medicine.
Twenty-first Century Medicine is creating a new role for doctors
that will be of critical importance in the present and future of our nation's health-care delivery system, that of the physician-manager.
Previously, health-care management existed on an individual basis: within a physician's office, within an individual hospital, within an individual nursing home, pharmaceutical firm, ambulatory surgery center, hospice. Never before has management systematically evaluated the health-care production process of choosing the right level of these individual elements to achieve desired health outcomes at a reasonable cost.
Given the critical management processes that must be undertaken to achieve the highest quality and the lowest cost, the primacy of the physician-manager emerges. The physician-manager is the one individual who, by virtue of both professional training as a caregiver and management education and experience, can adequately assess the trade-offs to achieve a new equilibrium where maximum quality will be available at the least possible cost.
Combining clinical and management training effectively in the physician-manager creates a new medical career at a critical time in the history of American health care. Attention needs to be given to cost and quality as interrelated phenomena. A well-trained physician-manager not only could accept the social challenge occasioned by the ascendancy of management in health care but also could satisfy society's needs for effective decision making in health care. Some of our most successful health-care organizations have physician-managers as their CEOs. Physician-managers will help orchestrate and design the health-care delivery system for the twenty-first century.
Continuing change in the delivery of health care in this country is the reason that physicians should obtain management training. Lack of academic preparation for management is a clear shortcoming of most physician executive candidates. Our present medical education system does not adequately prepare us with formal training in management disciplines and for most of us, the management knowledge we do have is learned while on the job. Recognizing this deficiency, a number of physician and hospital organizations have offered some formal, albeit abbreviated, training in management for physicians. These training programs have come in the form of seminars, self-study series, mentoring, and short courses primarily focused on four areas: identifying the physician's management style and how best to apply it; instruction in business interaction techniques; understanding providers' expectations of the physician administrator; and developing contracting and negotiating skills.
In my opinion, the most effective type of training program is the Master of Business Administration degree offered at various universities. Some of these institutions, including The University of Texas at Dallas, offer flexible course schedules that enable physicians to continue working while completing their degrees.
In 1996, I became the first physician to graduate from The University of Texas at Dallas' Executive MBA (EMBA) program. After I recognized and acknowledged that health care is evolving from a cottage industry to a free-market business-competitive industry, I set a goal of formalizing my business and management training.
The EMBA program has provided me with excellent training in organizational behavior and design, economics, financial and managerial accounting, statistical analysis, management science, corporate finance, entrepreneuership, government relations, global economies and international business, communication skills, and best of all, the analytical skills necessary for good problem solving and creativity.
Some of the unique characteristics I found in the UTD program were:
repeated opportunities to learn from my classmates who were experienced managers in major global companies in different industries around the world, friendships developed over the two-year program period, the international trip, and the professionalism, expertise and resourcefulness of the teaching staff.
Dr. Green serves as the medical director
of the Urology Network of Texas and the
Urology Institute. He is a Board Certified
Urologist and Fellow, the American
College of Surgeons.
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