A post by Andrew Barna.

A few days ago, Tony asked for a topic that doesn't get much air time; something that really impacts hospitals, but that doesn't get talked about. Well I've got one that many people in the industry are positively scared to discuss. Even I admit that this was a touchy subject when I worked for a hospital. It is the role physicians play in hospitals and within the healthcare industry. I think there are two critical issues here.

The first is the relationship between physicians and hospitals. In many cases across the country, this is not a marriage made in heaven and it is easy to see why. The relationship between hospitals and physicians is not only fraught with legal peril, it is a relationship between parties with differing interests and financial incentives. It takes exceptional leadership, patience, and business savvy on the hospital side to make these relationship work. And even then, changes in the market and/or physician behavior can break the relationship (that is not to say that hospitals are never at fault). The main issue here is that the relationship between physicians and the hospital can make or break a hospital and my guess is that the overall state of hospital/physician relations is not good. I don't mean to stir the pot, but I haven't seen any indicators that the case is otherwise. The challenge for hospitals is how to build a mutually beneficial relationship that, in the end, serves the best interest of the patient as well.

The second key issue is the role that physicians play in the transformation of our healthcare system. There is no doubt that our healthcare system is undergoing tremendous change, and yet, physicians, as a group, seem to be the most resistant to the change that needs to occur. Indeed, I would claim that the transformation would occur faster if physicians were more unified in their support for change. But it is in their very nature (or at least how our medical system has evolved) that this is the case. Physicians are "independent" and licensed to practice on their own with only their peers to answer to. The most common metaphor for managing physicians is herding cats. The peer review process, in many cases, is not effective. If we have to convince one physician at a time that healthcare delivery in this country needs to change and then get that physician to subscribe to any particular change initiative or philosophy, it is no wonder that we can't seem to get the ship turned around.

All that said, I don't mean to disparage physicians. There are individual physicians that are showing tremendous leadership in our healthcare system, and I believe that physicians, as a whole, will continue to play a key role in healthcare delivery (even if that role will change). Further, I think hospitals and hospital administrators have alot to learn about dealing constructively with physicians. But there is alot of ground that needs to be covered here. We haven't gotten the relationship between physicians and hospitals right yet, and there hasn't been a uniting force or movement that has brought the collective consciousness of physicians together yet either.

If we are going to fix healthcare, we have to mend this relationship.