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Manager Bites Physician, Physician Bites Back

Posted Aug 26 2008 4:08pm
One of the things that spurred me on to management was trying to resolve complaints about doctors. My first taste was dealing with complaints from the front desk staff and the nurses about residents. Over time, I learned some of the principles that I explored more fully in my management degree. Funnily enough, working where I do with fully adult grown-up doctors, you would think there are fewer complaints.


This week I am being asked to deal with a physician who is refusing to see patients from a county program and is refusing to file prescriptions electronically.

Sure, we have the prima donnas, who harbor childhood memories of the respect that physicians used to command. I have very little tolerance for the rose-colored view of a fantasy golden age which probably never existed. They expect everything to go their way, as though they were in private practice. Sorry but you took a job in an employed situation and, although I will do the best to represent you, you are now in an environment where everone else has a say in how things run.

Of course there are those doctors who occasionally get frustrated enough to throw scalpels, verbal or otherwise. Temper tantrums are not acceptable anywhere, especially in my eyes. This behavior makes my job of representing the physicians to management all that much harder. Making my job harder is usually bad when it comes to evaluation time, that should be easy enough to understand.

But these types of doctors are few and far between, although they seem to have a disproportionate impact in shaping management's perceptions of physicians.

So what accounts for the perception by management that physicians are chronic, terrible, whiny complainers? Physicians are 'difficult' and thorny to manage.

Things have certainly changed since physicians have exited private practice, where they could run things as they pleased. Now they are very likely to find themselves in an employed situation and find themselves answering to people whom they regard as less educated, fewer skills, less influence and whose only authority is titular. Everybody has a boss and even the Chairman of the Board answers to a higher power, be it the Code of Federal Regulation or the God of Abraham.

People with busines degrees are acculturated in the context of a complex system with multiple stakeholders where teamwork is important. It's like being a little brother in a family of 10. Physicians are acculturated to write orders and see that they are carried out. It's like being the big brother keeping everyone else in line. Maybe a better analogy is like being the only child, who never had to worry about other brothers and sisters at all.

It turns out my physician got dumped on by a social worker who left a non-verbal child with little documentation for a complete assessment which took over an hour. Moreover the computers have been running slow as molasses so it was impossible to write electronic prescriptions.

In other words, my doc was in the right, but nobody bothered to listen enough to understand the situation. Maybe the problem had not been articulated in a way the manager could hear. This seems like an awful way to treat physicians, but I see it all the time. This is worse when you consider that physicians are the primary source of revenue since they are the only ones at our enterprise that can provide a service and bill for it.

My experience is that, whatever the complaint, the physicians are coming from a very valid point of view, but do not express what they want in sufficiently diplomatic terms. Maybe it is true that physicians are not sufficiently savvy at articulating their needs and demonstrating their importance to the organization, but who is the professional manager here? If management does not pay attention to some of the smartest people in their organizations, they do themselves a disservice. Physicians become disgruntled, disaffected and ultimately disengaged. A disengaged physician does not care any more.

Personally, I'd rather deal with people who are complaining, because it means they still care about their patients and the quality of care they are delivering. Moreover, why would a physician manager want to get caught between physicians who are getting slammed in clinic and managers who are unwilling or incapable of improving their production environment?
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