Modeling leadership in health care

Check out this great interview published yesterday by the NY Times. Found in the weekly "Corner Office" section, the article features Tachi Yamada, M.D., current president of the Bill and Melinda Gates Foundation's Global Health Program. Dr. Yamada discusses his experience managing a variety of organizations including a small lab, a large department of medicine, an even larger R&D firm, and his current team at the Gates Foundation.

A few notable topics include: the importance of delegation, staying in touch with the organization, mentors, giving employees undivided attention, working with "what you have" and bringing out the best in people, the ability to endure change, humor, emotional intelligence, and giving feedback.

He is a true model and a rare example of successful health care leadership.

Have six and a half hours to spare?

President Obama's bipartisan Health Summit took place last week. Despite many political talking points clearly directed at the cameras in the room, there were some candid discussions that actually made the group of elected officials appear concerned about the health care debacle in this country.

While it seems that little progress was made in terms of major compromise, there were some promising steps towards inclusion of certain Republican concerns about the health bill. If nothing else, the six and a half hour summit acts as a good summation of the major debates regarding health care that occurred in Washington over this past year.

My dream seminar

The newest "Short White Coat" entry, an interesting blog written by a fourth-year med student at Harvard University through the Boston Globe's website, discusses an extremely important idea: teaching doctors about competition and quality in health care delivery.

Ishani Ganguli, the blog's author, details a seminar she recently attended through Harvard's B-school. Taught by renown business scholar Michael Porter and Elisabeth Teisberg (who co-authored Redefining Health Care: Creating Value Based Competition on Results, an intimidating 430-page book that has sat unopened on my shelf for a year), the seminar brought together health care executives, physicians, and students.

Ganguli gets it right when she says this topic is "critical for all doctors to understand." Further, this was pretty much my dream seminar. I wonder how I can get invited to the next one..?

More U.S. med schools, fewer opportunities?

My brother-in-law, Tom, brought this article from the NY Times to my attention. It discusses the expected surge in new U.S. medical schools. Some takeaway points:


During the 1980s and ’90s only one new medical school was established...If all the schools being proposed [today] actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country...And beyond the new schools, many existing schools are expanding enrollment, sometimes through branch campuses...

The proliferation of new schools is...a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system...

Many of the developing medical schools...are billing themselves as different from traditional medical schools, more focused on serving primary care needs in immigrant and disadvantaged communities. Administrators say that they expect that approach to be buttressed by a shift in state and federal reimbursements from specialists to primary care doctors....

Whether the demand for new medical schools exists among patients, it clearly exists among prospective doctors...The Association of American Medical Colleges, a trade group, has called for a 30 percent increase in enrollment, or about 5,000 more doctors a year. The association’s Center for Workforce Studies estimates that 3,500 more M.D.s will enter graduate training over the next 10 years...


Although the article points out that new schools in the U.S. will supply physicians for residency programs that would otherwise have to recruit international students, both Tom and I are weary that there will be enough residency spots for the higher demand. Either way, this is certainly a positive sign for anyone hoping to get into med school in the next few years.

Less autonomy than you might think

Physicians base their medical decisions on the clinical training they have received in school, practice of that knowledge during residency, and the vast experiences they have confronted during their career...right?? Well, not exactly.

A 2010 survey conducted by Health Leaders Media examined the external forces that affect physicians' decision-making. The study came in response to discussions about health reform in which proponents cite unnecessary tests prescribed by doctors (due to external pressures) as a major cause for rising health care costs. From the article:

While most doctors make clinically-sound decisions for nearly all patients, there are external pressures that can influence and increase the tests and procedures doctors order at the margins. An occasional unnecessary test times thousands of physicians and millions of patient encounters can quickly equal billions in unnecessary healthcare spending.

The survey measured four major factors: patients, fear of malpractice lawsuits, reimbursements/revenue considerations, and pressure from administrators and other third parties. There were some interesting results.

27.5% of physicians surveyed said that patients were a major influence, while 54.6% said they had a minor influence on medical decisions. This category measured how patients' requests determined medications, treatments plans, or tests. I have a feeling this number will continue to increase as pharmaceutical companies invest more money into marketing efforts aimed at getting patients to ask for certain drugs, tests, etc. Case in point: this article about patients requesting robot-assisted prostatectomies regardless of their doctors' recommendations largely due to the marketing efforts of specialists with the technology.

33.1% of respondents believe that fear of lawsuits has a major influence on decisions; 48.1% said malpractice has a minor impact. We have heard a lot of dialogue about malpractice or "tort" reform in the past several months. Perhaps these results will help push legislation through that limits the amount of a physician's influence (and cost) expended on fear of lawsuits.

30.2% indicated that reimbursement/revenue considerations had a major influence; 38.1% felt a minor influence on decision-making. I feel that this is a significant finding, especially as our health care system ponders whether or not to reform the way primary care physicians are paid. Clearly, reimbursement plays a role in the quality and nature of medical decisions.

11.2% of physicians said that pressures from administrators and other third parties had a major impact; 34.0% cited a minor impact. The article indicates that this is perhaps the most surprising finding and I agree. It is comforting to know that physicians can make medical decisions without overwhelming pressure from hospitals and health care groups to focus on the bottom line.

The point here is if you plan to go into medicine, be prepared to balance the many factors that affect a physician's decision. As if diagnosing a problem and prescribing a treatment plan weren't hard enough...

Its not me, its you

Check out this article from the Wall Street Journal about physicians "firing" patients for unruly behavior, continued drug abuse, etc. As you can imagine, there are strict rules for this process. Interesting read about something you might not otherwise consider.

Snow day

Classes cancelled tonight despite only getting a dusting. Too bad I had to submit a paper via email; I guess that's the downside of technology.

Who is walking barefoot through the icy sidewalks??

120 hours/week, 13 days straight

A new article in the American Medical Association's Graduate Medical Education e-newsletter addresses the highly debated topic of a hospital resident's working hours. Some surgical residencies require up to 120 hours per week, 13 days straight. Does this make the resident more prone to mistakes or contribute to his/her training??

Personally, I believe in the recommendations of medical professors over those of the state or federal government (who set the often ignored standards). However, I now know where they derive the term resident as this leaves the physician less than 50 hours per week at "home."

There are other nice features of the newsletter, like a link to this NBC Dateline special on the job of the first-year resident.

A new prerequisite for med school, experienced speed-dater!?

Check out this article from the American Medical Association on one hospital's use of a patient-physician matchmaking event based on the speed-dating model. Patients have a chance to screen physicians for a period of 5 minutes before deciding if they want to make an appointment with the doc. This has apparently supplemented the hospital's marketing efforts and appears to be a successful program.

Could a new question to the medical school application ask: what experience have you had with speed-dating? More importantly, were you successful??

Saints, buffalo chicken, ETrade

The Saints pulled through! That made the delicious Super Bowl feast taste even better. MVP goes to my girlfriend's homemade buffalo chicken fingers...




It was a close game with some gutsy play calling by Saints coach Sean Payton.

After all that investment from Doritos and Bud Light, my favorite commercials belong to ETrade doing what they do best: toddlers and financial-speak.

Super bowl XLIV and undercover boss

I don't know which to be more excited about. If you haven't seen the preview for the new CBS reality show, Undercover Boss, check out a sneak peek below.

While I am not a reality TV fan, I am intrigued by the premise of this show. I only hope that it is not merely staged melodrama, but that it reveals something about the importance of upper management being attuned to an organization's employees. Further, the concept of a corporate boss on the front lines could work well in a health care setting (e.g., the CEO as a patient transporter, food service worker, etc.). We will have to see.

As for the Super Bowl, go Saints!!

Air travel and a better education

I recently saw this interesting parody of the health care industry in the form of a viral video titled "If Air Travel Worked Like Health Care." It was inspired by an article in the National Journal by Jonathan Rauch, which posed the question: what would the airline industry look like if it were run like the health care industry? The video is a good, comprehensive presentation of the administrative failures that are plaguing health care and driving up costs. Check it out.



Related, I found this great post on the NYTimes "Well Blog" discussing the implications of only educating med students on clinical topics while failing to address the social/economic aspects of health care.

An interesting piece of evidence--as cited by the article--was this study conducted by the journal of Academic Medicine that revealed that "the vast majority of students felt they had received adequate clinical training during their four years of schooling. But fewer than half felt they had had adequate exposure to health care systems and practice, an area of study that extends to subjects like medical economics, managed care, practice management and medical record-keeping."

The students that did receive the non-clinical training felt more satisfied with their education and did not believe that the extra courses took away from their clinical preparation. Further, medical education programs that have offered courses in these areas reported that it did not take long to teach students about such concepts (only about 16-17 lectures).

Dr. Pauline Chen, who authored the post, wrote about her education, "It was possible to learn about the economic and social aspects of health care while immersed in the details of biology, physiology and pharmacology...it was impossible to become a good clinician without doing so."

I am curious to see whether or not my future training will include such areas of study. Hopefully by then, programs around the country will have adopted a system of educating future physicians on the social/economic issues involved in medicine. Perhaps then will the health care industry begin to look not so frighteningly similar to the video above.