October 6, 2017 Owen Carey

Giving Physicians the Tools They Need to Succeed

When David Perlstein, M.D., MBA, was a young medical director, he soon realized the limitations of his knowledge about billing and hospital reimbursement.

“I was interested in quality and started hanging out in the DRG office and began to learn about billing. I knew private practice billing and Part B billing, but I didn’t understand how hospitals got paid,” Perlstein says, adding that he immersed himself in the subject, earned an MBA and gave lectures inside and outside his organization to share what he knew.

Today, as president and CEO of SBH Health System, the Bronx, N.Y., Perlstein can’t help but see a growing number of parallels to his own experience and the challenges awaiting new physicians as they enter the field. In short, today’s physicians often aren’t trained in areas like leadership, group decision-making, data and statistical analysis that they’ll need to succeed in today’s rapidly changing health care environment.

This point was underscored in a LinkedIn survey conducted earlier this year of more than 500 physicians about their professional goals and the nonclinical skills they believe are most essential to their careers. Respondents listed skills such as business and finance, practice management, productivity and computer and technology skills as the most important to take their careers to the next level.

Other key survey findings included:

  • 75 percent of respondents indicated that nonclinical skills are more important than they were in the past because of how deeply and rapidly health care is changing.
  • About two-thirds of physicians said their career goals include better work-life balance, with early-career doctors more likely to desire balance than career-established physicians.
  • Only one in 10 said they plan to start their own practice.

Thomas R. Yackel, M.D., chief clinical integration officer for Oregon Health & Science University in Portland and associate dean for clinical practice at the OHSU School of Medicine, says the nonclinical skills identified by the physicians responding to the survey are important, but he emphasizes the need for what might seem like more abstract skills. physician-skills-chart

“In leadership, where I see physicians getting challenged oftentimes is when they have to come together and create a group and make group decisions that everybody stands by. That’s really challenging for us,” Yackel says.

Robert M. Pearl, M.D., executive director and CEO of the Permanente Medical Group, the largest medical group in the nation with more than 9,000 physicians, and Alexander L. Fogel, MBA and an MD candidate at the Stanford University School of Medicine, earlier this month also weighed in on similar issues in an article they wrote for NEJM Catalyst, part of the NEJM Group, which includes the New England Journal of Medicine.

Pearl and Fogel note that “graduating [medical] students still lack the fundamental business and leadership training needed to effect the changes required and simultaneously maximize quality and reduce cost in clinical practice.” The authors propose that medical schools in conjunction with business school faculty develop an interdisciplinary four-week clinical rotation during the fourth year of medical school.

“By the end, students would have developed the business skills needed to lead multidisciplinary teams, serve as contributing team members and apply data analytics to improve clinical practice,” Pearl and Fogel wrote.

Whether four weeks would be sufficient to accomplish such goals may be debatable, but sentiment clearly seems to be growing for developing and implementing nonclinical training and education that will help to prepare physicians for leadership roles in their organizations.

“I think so much of medicine today is going to require doctors to be managers at a different level than ever before. More and more doctors are expected to lead teams, so it has to start in medical school,” Perlstein says.

Jay Bhatt, D.O., chief medical officer of the American Hospital Association and CEO of its education and applied research arm, the Health Research & Educational Trust, notes that the AHA’s Physician Leadership Forum, in which Perlstein and Yackel also participate, is developing educational tools to help doctors develop and improve leadership and management skills.

“We’re doing webinars, simulations, learning collaboratives, case studies, immersion experiences and podcasts that illustrate the approaches that people are taking. We will also have a leadership track at this month’s AHA Leadership Summit,” Bhatt says.

In early August, HRET also will be conducting adaptive leadership training for a group of 40 dyad participants in the Hospital Improvement Innovation Network, teaching skills related to managing uncertainty and change.

Bhatt says other issues the AHA Physician Inclusion agenda will address include helping physicians implement strategies to deliver high-value care, improve quality and manage populations. Furthermore, the team will continue to work to improve physician resilience and well-being. “If folks don’t have resiliency and are challenged with burnout, that’s going to impact their ability to lead; so, it’s important that we are working with partners such as ACGME, AMA and the National Academy of Medicine to address this at a personal and system level,” he adds.

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