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I have spent nearly half a century in the world of health care leadership, first in management and later as a consultant. Throughout my career, one of my most consistent observations has been that most health care organizations do not treat physicians very well.
I knew it because I saw it nearly every day in the hospitals I worked with. But it wasn’t until this year that I experienced firsthand how poor treatment of physicians can impact patients.
Last summer, I was diagnosed with cancer, which began my exceedingly difficult journey navigating a treatment plan.
My first visit with a surgeon at a nationally recognized hospital lasted about five minutes. He walked into the exam room and said, “You are not a candidate for surgery, and I am referring you to radiation therapy. You will not have a good outcome.”
My follow-up appointment with the radiation oncologist at the same hospital lasted maybe four minutes. “You are young and healthy,” he said. “You should have surgery and not get radiation, but I would not have surgery here.”
Neither physician asked me about my treatment goals nor seemed to want to get a sense of who I am. Neither had any awareness of my medical knowledge, nor did they offer me any comfort.
Six second opinions later (but who’s counting?), I found myself in an exam room with a surgeon and a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City.
The two physicians had reviewed my studies together before meeting with me, so they were prepared to guide me as a team. They went over my history, and they spent time talking to me to find out my goals for treatment. Ultimately, they helped me make a care plan based on my diagnosis, my individual situation, and my personal goals and preferences.
It was a huge change from what I had gone through repeatedly over the previous weeks — and the entire experience has made me take a fresh look at the concept of world-class health care.
For starters, it made me realize that the fundamentals of patient preference have not changed. What was true 45 years ago when I began working in health care is still true today: Patients choose to get health care where they trust their physicians and feel that their physicians understand and care about them.
Unfortunately, the current approach to managing a physician enterprise works directly against that reality.
Productivity-based compensation makes it very hard for physicians to give patients the individual attention they need. In addition, the rise of physician employment has led many organizations to view physicians as interchangeable workers. In this environment, physicians feel abused and underappreciated. In many cases, patients end up bearing the brunt of their caregivers’ frustration.
What can be done? I have two suggestions.
First, we need to recognize that the way hospitals treat their physicians will eventually be reflected in the way physicians treat their patients.
At Memorial Sloan Kettering, physicians are compensated under a salary model that enables them to give their full attention to every single patient they see. This has helped create a healing culture that enables world-class physicians to focus on world-class care delivery.
And it’s not just the medical staff. At Memorial Sloan Kettering, every single employee I encountered — from schedulers and clinic managers to nurses and physicians — was emotionally engaged. They conveyed an appreciation of my fears and always made me feel they were there to help me.
Second, we need to appreciate the leadership skills that physicians bring to the table and give every employed physician a meaningful opportunity to use those skills.
Minimally, physicians should have substantial control over how their individual practices are run. Ideally, hospitals should create physician-dominated boards to make key decisions about their employed medical groups. At one organization I recently worked with, this approach not only cut financial losses on employed practices but improved physician engagement along with staff and patient satisfaction.
If every health care organization embraced these two suggestions, I believe that my recent world-class care experience would soon become much more common.
Today, I am about two months post-surgery and optimistic about my future. And as I said, I have learned more about world-class health care through this journey than in my 45 years in health care leadership.
Physicians who are unhappy struggle to show empathy for their patients. If we want to improve patient care, we need to take better care of physicians.
Jeffry A. Peters is a health care executive.
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