It is a well-known phenomenon that MDs and MBAs approach healthcare from very different perspectives, yet their respective roles and objectives are becoming dependent upon successful collaboration more quickly than they recognize.
As an MBA in a senior management position of a large national physician group for eight years, I have had the opportunity and privilege of working closely with hundreds of physicians in support of their mission to provide high quality and effective care to their patients. Taken as a whole, the experience was a deeply insightful view into the challenges — and the opportunities — faced by the entire U.S. healthcare system in a microcosm. Based on that experience, the following are some insights and observations that might be of some use when contending with the challenge of how to bridge the gap in communications that are often present when MBAs and MDs try to collaborate.
1. Consensus-building. By training and inclination MBAs tend to be "group thinkers" and are trained to view successful outcomes as dependent upon building consensus. This often leads them down a time-consuming path of seeking permission from various stakeholders to compromise and engage in bargaining in the decision-making process. As the ultimate holder of accountability for what might be dozens of patient encounters each day, the MD naturally views their clinical judgment as the key driver in decision-making: With MDs "the buck stops here." The practice of medicine is not a democracy.
2. Scalability. As a rule, MBAs tend to seek solutions to problems in a way that they perceive to be scalable and replicable, trained in the belief that the capacity to perform repetitively and consistently leads to better efficiency and quality. One-off situations are by definition outliers, and as such their importance tends to be downplayed. MDs have no such luxury and must seek out the unusual. Every case has the potential to be unique in some way. MDs welcome the "interesting case" which can summon all their expertise and break up the dulling effects of routine. The MBA mindset is to view the unusual case as an unwelcome break in the routine, adding cost while slowing down the efficient care of other patients.
3. Centralization. MDs are most comfortable with decision-making that takes place locally and in their own immediacy. The more that decisions require centralized control, the less autonomy and control remains with the MD. The often-repeated expression "all healthcare is local" is rooted in an axiomatic faith in physician autonomy as a cornerstone of the medical culture. MBAs, on the other hand, tend to seek centralized approaches to decision-making, often appearing in the guise of policies, programs and processes. MBAs often quietly harbor the view that the MDs insistence on autonomy is somewhat overdone, and may not be as indispensable an ingredient to effective patient care as they might think.
4. Leadership. MBAs like to think of themselves as either nascent or actual leaders. It is understood that their intention is to build a career trajectory that will move them up in their organization (or in another organization) into positions of increasing authority and control. After all, this is an important reason why they become MBAs in the first place. MDs tend not to harbor this kind of ambition in the same way, though there are plenty of exceptions. In any event, the MD follows a very different career path, and there are usually fewer steps on a career ladder available for the MD to climb. The result of this is a dearth of opportunities for MDs to practice leadership skills on a routine basis. This is a systemic weakness which needs to be addressed, because from the MBA's viewpoint the lack of trained physician leaders creates a "leadership vacuum" in many healthcare organizations that need to be filled; MBAs are happy to fill them.
5. Performance. One of the healthcare MBA's favorite analytical tools is performance rankings of the MDs. Quantifying "results" based on pre-determined metrics, assigning them a weight for averaging purposes and reducing performance down to a number is, to the MBA, how MDs and indeed all workers should be measured. "You manage what you measure" is the MBA's mantra. This does not always sit well with MDs, who may viscerally react to this uniform approach to performance assessment as inappropriate and even fundamentally at odds with the practice of medicine. Too much context is lost in the numbers, and too many factors beyond their personal control bear upon the performance "data."
6. Productivity. MBAs look at MDs' productivity statistics (another performance measure) and wonder why so many MDs claim they are overworked. Looking at work hour statistics supplied by the Medical Group Management Association, one would not come away convinced that most MDs are logging more hours than, say, the typical healthcare MBA or indeed any high-caliber professional service provider. MDs are quick to point out that much of their work is not captured by the numbers crunchers since doctors often work after (or before) their shift, complete administrative tasks at home, take night call, or otherwise work in halted sessions without advance notice. MBAs tend to gloss this over; the unspoken retort is that "it comes with the job, just like my job."
7. Stress. Frequently conveying an attitude of benign neglect, MBAs remain attentive to, but not highly concerned about, MD claims that their work involves a level of stress that the non-physician cannot fully understand or appreciate. Sensitivity to work stress is generally not high on the priority list for most MBAs (much to their own detriment), and they often have too little regard for the effects that MD stress may have on patient care and safety. Lack of empathy by MBAs for MD job stress is very common, creating distance and interfering with efforts for deeper collaboration.
8. Language. MDs and MBAs usually work for some type of business entity, whether that entity is for-profit, nonprofit, academic, government or sole proprietorship. To the MBA, however, it is all too apparent that with few exceptions MDs have little training in the language of business that all entities speak — the language of finance and accounting. MDs are very aware and sensitive to this fact, though it does not often deter them from contributing their views on how their entity can improve its performance. This is a significant disconnect and a root cause of why MDs and MBAs often find themselves talking past each other on even the most basic business issues.
9. Growth. MBAs are trained to look for ways to grow the organization's revenues and profits to the long-term benefit of the owners or stewards of that organization. Improvements to quality, efficiency, profits, revenues, technology and the like are generally viewed as a means to that end of growing, as they say, "the top and bottom line." MDs, however, don't always relate to a strong growth imperative. Indeed, the MDs sometimes wonder what all the growth talk may be costing their own priorities, including their compensation. This issue can become rather sensitive when it implies that the MD is less concerned with the long-term health of the organization than the MBA, and can devolve into finger-wagging about lack of engagement or weak physician-hospital alignment.
While acknowledging the different lenses through which MDs and MBAs view their work, there is much cause for optimism in finding solutions. Many healthcare organizations contend with these issues squarely and openly, tackling them with varying degrees of success. The emergence of MD-MBA programs, where the "dual perspective" is built into the training, is a welcome development with a promising future but with less than one thousand joint degree holders, their numbers are still too small to make a significant impact on a national scale. There are now over 1 million Americans with MBA degrees, and thousands are entering into service each year into the healthcare industry. They share the same overarching goals with MDs — effective healthcare delivery — even as they search for the best ways to get it done. Meaningful and lasting solutions to bridging the gap between MDs and MBAs are under development in hundreds of healthcare organizations today. MDs and MBAs alike would benefit from an accelerated transfer of this knowledge throughout the healthcare system.
Todd Kislak is a healthcare consultant. He has spent more than 20 years as a healthcare executive, most recently as vice president at IPC The Hospitalist Company. He holds an MBA from Harvard Business School. He can be reached at tkislak@gmail.com.