Hospital management professionals are of the opinion that doctors should restrict themselves to clinical practices and leave administration to professionals. In this regard, we had invited our readers to send in their opinion on ‘Do doctors make good hospital administrators ?’ Here are some views...
Dr Vivek Desai
MD, Hospital Consultancy Services Pvt Ltd
Faculty, Dept. of Health Services Studies,
Tata Institute of Social Services
Mumbai
I strongly feel that Doctors TRAINED in management will make good administrators as they have a long background of having worked in hospital environment. This necessarily does not mean that non-doctors do not make good administrators. Its just like a engineer turned IIM graduate will make good CEO in his/her respective field. The major advantage doctors have is that they are better suited to deal with doctors/techincians and even dealing with patients as they understand the field realities better than non-doctors. Doctors NOT TRAINED in management may not make good admninistrators unless in exceptional cases.
Ranjeet Menon
Sr business executive
Medical Computer Society of India (MCSI)
Chennai
As far as the medical management alone is concerned, it is true that doctors would indeed make good hospital administrators. It is always better for a doctor to be appointed to the post of a medical director and look after the clinical and operational aspects of administration. Also, it is easier for a doctor to command respect from his own colleagues and the rest of the medical community which, may not be possible for a non-medico to do.
On the other hand, a large number of management cadres feel that doctors largely are not able to handle the non-medical side of hospital administration. Basically, there are two sets of hospital administrators emerging these days one group comprises the medicos who have branched out into hospital administration after completing their medical education. The other group comprises the non-medicos who choose to specialise in hospital administration. It is the latter group that is better able to handle issues such as HR, marketing and other peripheral asects of the healthcare business. So, in my opinion, it would always be better to choose a non-medical person as the administrator of any hospital.
Joy Chakraborty
Asst . Administrator
Sri Ramachandra Medical College &Research Institute (DU)
Chennai
Hospital is one of the example of complex structured organisations amongst all industries at present . The scenario was entirely different about 20-25 years ago. Because of IT revolution, consumerism and specialisation in different fields , hospital as an organisation has got a new dimension. Earlier it was easy to manage ahealth care setup with so called “most experienced and bureaucratic medical professionals “. But this trend has become back dated now.
All of us have observed that what a dramatic, revolutionary change has taken place after the opening of first corporate hospital in our country, i.e Apollo hospitals by Dr P C Reddy. More and more private hospitals are coming upin all the cities of India. Why? Is it indicating the insufficient infrastruture of government hospitals? Probably Yes, because all of us know that government organisations are going for tie up with private hospitals for the treatment of its own staff covered under CGHS, ESI, etc.
It is not only because of the availability of privatised superspecialsed service but also due to government incapabilities to ensure sophisticated institution who can render quality care. We can’t blame those health administrators entirely for this situation, because we can see the outlay of our finance, we can study our fiscal policy where we can see the percentage of GDP ALLOTMENT FOR HEALTHCARE INDUSTRY; and compare the same with the outlay for nuclear weapon. With all this constraints also we could have expected a better outcome if we could have adapted a proper Health Management Infomation System (HMIS ), to optimise the uses of our resources.
After the independence, health caremanagers at the government level didn’t integrate the country’s healthcare centres by adapting a holistic approach. As a result many resources starting from manpower, materials and finance were remained idle. Consequently, marginal productivity became low which led to improper network between healthcare providers, one of the basic cause of that was non-availability of competent and trained personnel.
But now the situation has changed. The field of hospital administration is growing up very fast. The question may arise who should be trained in that field ? Definitely we cann’t say it is only the doctor or some other class of population. But if a doctor becomes administrator his approach sometimes may be narrow because of his inclination towards medicine.
On the otherside we see, being a professionally trained person in medicine, a doctor is not fully utilised in his profession if he is in administration. When there is a lack of healthcare specialists in the country, why should we misuse doctors, one of our valuable resources by involving themin administration. It will be one of the example like selection of engineering graduates of top colleges for the bureaucratic post in our administration.
For this reason it is adviasable to recruit /hire people from the specialised professional group for the administrative job in the healthcare sector for the proper utilisation of human resources. Moreover, manpower, finance, materials, etc. are not simple terms in this sector nowa days , these are all playing a vital role in this era of competition where competence is the key word.
Dr S V N Reddy
Principal
Apollo Institute of Hospital Administration
Hyderabad
Modern hospitals are so sophisticated that a specialised training is essential to manage the institution apart from the medical training or understanding to bring efficiency in healthcare. This is the reason why the Apollo Institute of Hospital Administration has a specialised Master’s level course in hospital management spanning two and a half years, recognised by All India Council of Technical Education: it involves study of 23 subjects including finance, accounts, health economics, human resource management among others. A six-month internship in any Indian hospital is also part of the study program.
There is no doubt that it is the hospital and health-related inputs in conjunction with management curriculum that hone up the administrative skills of the candidate for a career in hospital administration. In fact, 90 percent of our students come from science background and a few from medical stream as well.
Of the five batches already through with the program, several have found placement in hospitals across India including PD Hinduja Hospital, Bombay Trust Hospital — both in Mumbai, Apollo Hospitals across the country among others- all in an executive cadre.
It is true that Dr Pratap C Reddy, chairman and managing director of Apollo Hospitals never underwent any formal training in this regard, but used his hard work and sheer innovative genius to build the organization. But, to manage the different wings of the Hospital, there is no escaping the fact that really trained hospital administrators make all the difference, given the complexities of an IT-driven healthcare scenario now.
Administation is a serious business. Casual approach will not bring the desired results.The following points must be deliberated upon before coming to any conclusion in the matter:
1. A doctor spends a period of nine to ten years before he is conferred the degree of Masters in a discipline of medicine.Having spent such a long period in acquiring the professional degree, he must be properly utilised. His utilisation will be proper as well as optimal if he is able to concentrate on clinical matters and adds to his medical knowledge by the experience he gains in treating the patients. He will be doing justice with both the medical profession as well as himself.
2. The doctor may not have the necessary skills, knowledge and experience to deal with the matters pertaining to complex management situations. Hospital management is a serious business and the person who is at the helm of affairs must have necessary aptitude for it. The doctor may not have the aptitude for management due to lack of training and he may not be able to analyse the various complex situations. Also, unproper handling of situation may prove disastrous for the organisation.
3. Today, healthsector is being professionalised. There is demand for trained hospital administrators. The person equipped with the MBA
degree or the degree/diploma in hospital managment will definitely be the right choice for the job. Since, they have specialised in the science of the management, they will learn the art of management easily. They will be career oriented, too and will work with their heart at the job. This will benefit all. The similar may not be case with the doctor who may consider the job of administration not as his main job and such an approach will not serve the purpose.
4. Our experience tells that doctors being appointed as administrators have not yielded desired results. Unlike UK & USA, where management job has been entrusted to management professionals, hospitals in India have been dependent on doctors only. This has been a major roadblock in improving the efficiency and productivity of healthcare sector. The changes are being intoduced but the resistance to change is also there. Healthcare sector has not responded to the liberalisation policy of the Government to the extent it should.
5. Unlike other streams of knowledge, medical fraternity has not understood the importance of management. Their response to the MBA
curriculum is not so favourable. The ’B.Tech + MBA
’ combination has become the order of the day and the engineering sector, therefore, does not have dearth of techno -management talent. But the same is not the case with healthcare sector. The ’MBBS + MBA
’ combination is not so popular. It shows the lack of management aptitude on part of the medicos.If it is the case, how can they be good management professionals?
So, keeping in mind the ground realities, it will be proper if qualified health professionals are encouraged to come forward and take responsibility to run the affairs of the hospital.
6. To manage the healthcare delivery system in the countries like India, we need trained hospital administrators in good number. Doctors must not be encouraged for th job because it will add unfavourably to ’doctor - patient ratio’ which is already very low. Also, by employing doctors as administrators, we shall not be doing justice with anyone - organisation, doctor and patient.
Keeping in mind what is aforesaid, let us not argue whether doctors can make good hospital administrators or not. They may or may not. But entrusting doctors two jobs at a time clinical and administration is similar to standing with one leg on one boat and the other on the second boat. Such a situation does not bring results but creates instability in the system, breeds in-efficiency and lowers productivity of the organisation. Now let us conclude by answering the quesion Is the doctor best choice for the administration. The answer should be ’No’. Then, do we have better alternative?
Yes, we have. Ninety percent of the job of hospital administration does not require medical knowledge. It is application of management knowledge pertaining to basic fucntions of management. However, ten percent of his job may have to say with medical matters and necessary training can be imparted for the same. So, there is no need for doctors to occupy the position of administrators for the simple reason that ’right person in right job theory’ is violated.He can be best utilisied for clinical matters for the reasons which do not require any explanation. The graduates with post-graduate diploma/degree in personnel management/HRD/ Hospital administration/Healthcare Management/ Psychology are better choices and they must be encouraged to take the lead and handle the affairs of a hospital.
Dr U V N Das
Resident Medical Officer &
Manager — Family Health Plan Ltd (Medical Insurance)
Apollo Hospitals. Hyderabad
Yes, doctors do make good hospital administrators too. Take the example of, Dr Pratap C Reddy, chairman, Apollo Group of Hopsitals; Dr Badrinath of Shankar Netralaya, Chennai and many senior, well-qualified and experienced administrators at AIIMS
, New Delhi. There are many others in the country.
It is needless to cite more at this juncture.
A hospital as every body is aware is maent for patient care. How can any one look at a hospital without a patient and a doctor? The scenario of hospitals and their management/administration have changed drastically since late 1960s, after the introduction of hospital administration courses for doctors at AIIMS
and later at other institutions. Earlier, during the British regime, it were the senior doctors who managed the hospitals and medical students, as hospital superintendents and prinicipals, respectively. This practice is still in vogue in almost all the government institutions, as well as in a considerable number of private institutions.
The respect one gains a ‘Physician administrator’ is immeasurable, when compared to a non-medical adminitrator. It does make a difference, particularly to the patients and attendants. This is a truth, whether one accepts it or not. It is also true that the contribution of the non-medical administartors or paramedics is no less. All put in their efforts towards patient care. But a physician administrator’s perspective or the outlook will always be different from that of the others.
The physician who accepts management responsibilities and becomes an adminitrator, brings attributes that serve the institution as well. Status derived from medical education, practice, medical acculturation and membership in the medical clan affords a level of communication and trust difficult for those outside the profession to obtain. Physician administrators have excellent insight and instincts about medical politics, something of constant concern to the organisation.
Access to and normal understanding of the informal network of the medical staff are valuable tools available to the physician administrator. Physicians can bring in additional strength to the hospital management or administration. A clinical view of non-clinical problems can be a valuable asset to management and can prevent embarrassing administrative ‘gaffs.’ The skill of management can be enhanced by the respect by the respect the medical professional may bring with hierarchy, with the patients/consumers and the outside world. Doctors have a distinctly different perspective on the consumer’s view of the institution (or hospital) derived from dealing one-to-one with patients at the bedside and in the consultation room.
The management/administration of a hospital in providing quality healthcare has many major aspects that can only be managed by a doctor-administartor. This is most obvious in attempts to understand the linkage between the quality of output and the quantity of required resources (input). Moving to the management of medical delivery operations, the doctor administrator is essential in addressing the quality of clincial care, clinical productivity, clinical cost-effectiveness, physician performance evaluation and professional reimbursement, etc.
Doctors basically are trained to work in one-to-one situations where the doctor is dominant. They are excellent short term diagnosticians, trained to make decisions on the basis of care fully and logically collected and analysed data. Physicians function in the classical medical model a scientific model in which, to arrive at a conclusion, data are required. If left to wonder, they are inclined to perform the infinite experiment, always asking ‘where are the data?.’ By contrast, non-medical managers often tend to deal with problems using limited data, trusting their reason, intuition and experience. The two groups (camps) clash when the non-medical manager desires to act and the physician holds back, striving to be objective. The two professionals are also different in their orientation to people and organisations, in leadership and behavioural styles, and in the constrains of their working environments.
A comparative analysis of some of the major traditional characteristics of differences between a doctor as a hospital administrator and a non-medical hospital administartor as below, provides an insight into the overall hospital administration attributes.
A doctor administrator is autonomous and makes decisions alone, where as a non-medical administrator, has to use team work and is also probably involved in line reporting.
A doctor administrator works one-to-one where as non-medical hospital administrator works primarily in groups.
A doctor administrator is totally patient oriented which is of primary importance in a hospital administration, where as a non-medical administartor is organisation oriented.
A doctor administartor is empathetic, where as the non-medical administrator a long range planner, and the management of crisis is one of the most important aspects in a hospital functioning and patient care management.
A doctor administrator is quality oriented where as a non-medical administrator is cost oriented.
A doctor administrator is a doer, where as the non-medical administrator is a delegator and gets things done through others.
A doctor administrator reacts, a non-medical administrator proacts.
A doctor administrator is a classical scientist, a non-medical administrator is a social scientist.
A doctor administrator is discipline oriented, a non-medical administartor is more a socially oriented.
The above analysis may lead us to conclude that a doctor does make a good hospital administrator.
It may also be noted that over the past one or two decades the importance of physicians in the management and administration of hospitals (mostly corporate level) has become much more evident. The success of the organisation/hospital functioning requires effective decision making in an environment of synergism between both the medical and the non-medcial management components of the institution/hospital.
On economic front, getting control over the hospital expenditure is difficult to be accomplished without the treating doctors’ involvement. The good will of the public will be served by a blending of clinical practice, patient care and smooth mangament concerns.
There shall always be a place for the doctor who is willing, who can work to acquire the managerial skills and knowledge, in a hospital administration. As a manager/administrator, the doctor has some unique attributes, skills and experience to offer. Medical administrators have demonstrated their ability to function in all types of positions and at all levels of organisation. The pioneer of corporate sector hospitals in India.
Doctor administrators benefits from their practical knowledge of healthcare to patient, certain legal realities, social attitudes towards physician and their status with the medical profession. They all have the greatest advantage of speaking the language patient care and also of administration, bringing a ‘‘legitimate authority to medical and healthcare delivery to which neither non-physician administrators nor physicians without management training can aspire.’’
And hence it may be strongly said that a doctor does make a good hospital administrator, and more so a well trained and experienced doctor.
and this for those who were born half way across the globe and consider themselves IVY LEAGUE material!!!!..........
Harvard to Offer Medical-Business Degree
Thursday May 6, 2004 8:16 PM
CAMBRIDGE, Mass. (AP) - Harvard University will offer medical students a chance to earn a management degree along with their M.D. to help them deal with HMOs and other businesses when they become doctors.
The university will offer a combined medical and master of business administration program starting next year, medical school Dean Joseph B. Martin said Wednesday.
Harvard will join 41 universities who have such programs, according to the Association of American Medical Colleges. They include Dartmouth, Tufts and Yale.
Under the plan, the students, about 12 per year, will earn both degrees in five years, Martin said. Normally, it takes four years to earn an M.D. and two years for a business degree.
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