CEO, Atlas Surgical Group, the largest private ASC group in the U.S. Author of “Success in Ambulatory Surgery Centers: The Next Gold Rush.”
The hardest jobs require the balancing of two opposing concepts. In medicine, there is no greater philosophical challenge than that of managing a healthcare facility and caring for those for whom that health care facility operates. The principles of economics dictate that profitability supersedes everything else. Put crudely, how far does the CEO of a medical entity cut corners before care suffers? At some point on the Venn Diagram of business ledgers, profits and patients have to diverge. Managing that divergence through a delicate balance of business and humanity is only possible if that CEO is attuned to the sufferings of his clients, and does not merely see them through the prism of money. The only person with that skill has always been, and always will be, a doctor.
First, Do No Harm
In all other fields, a savvy business leader’s vision is expressed through profit and loss. But applying these metrics to an industry that deals with physical human suffering is not just unethical, but goes against everything that we, as humans, stand for: empathy, care, selflessness.
As CEO of a surgical center franchise, I long for the bygone days when dollars and cents took a backseat to patient care; when a healthy discharge took precedence over a healthy financial report; when doctors were in charge and patients loved it. The corporatization of healthcare started with the glorification of the business degree to manage what clearly is, first and foremost, a caregiving entity. The slow takeover of healthcare by business-minded but medically ignorant individuals magnified the financial rewards of this heretofore hearts-and-minds field. The sounds of cash registers drowned out the cries of patients, who ended up losing the most in this transition. Doctors were relegated to pure patient care, while “money men” took over.
“Above all, do no harm” has evolved into “Above all, do what’s best for business.” Avoiding negative impacts means always playing catch-up. Only a bona fide pursuit of positive impacts will prepare the chess board for victory. Doctors are uniquely positioned to achieve that goal. A doctor’s awareness is sacred, imbued in the work ethic of healthcare providers everywhere. It is a moral and ethical sensibility. This is why the CEO/doctor amalgam is uniquely suited to head up an institution that puts patients above all else.
Rationalization And Staying Ahead Of The Inevitable
Yes, balancing the best interests of the medical business with what’s best for patients is possible—and necessary. But the plot thickens, because rationalization is a slippery slope.
Let’s take anesthesia in surgery as an example. Diluting anesthesia to save money would be absurd and just plain wrong on all levels. Yet, “diluting” anesthesia personnel (as in, not hiring enough anesthesiologists) might seem like less of a moral infraction. If the primary definitions of good anesthesia management are less pain for the patient and optimal recovery, does it matter whether these falter because of an empty tank or a more burdensome anesthesiologist/patient ratio? Anesthesia, of course, is just one aspect of the tangled web that holds a successful hospital together.
If patients suffer, to continue the anesthesia metaphor above, then hospitals will go out of business. If hospital employees suffer from understaffing or corner-cutting, they will quit. These things are inevitable. Only a prudent doctor/CEO knows where and when such seeds of discontent begin before they mature into ugly realities that will paint him or her into a corner. In this way, it really is like a chess game, but unlike other purely mercantile businesses that vie for customers, there are unique undercurrents inherent in healthcare, and a doctor in the CEO position will know them.
The prudent doctor/CEO strategizes several moves in advance, known and tangible only to medical personnel, to avoid a checkmate. Thankfully, running a healthcare business is not as hostile as a chess match, simply because all healthcare players are on the same side. This means there can be an esprit de corps as everyone works toward a happy ending, regardless of whether the issue at hand is bartering within the supply chain or contractual negotiations with other doctors and staff. The difference between the doctor/CEO and the chess player is that in chess there can only be one winner; in a medical entity, everyone needs to win. Draws don’t count.
Profit Margins Versus Patients
Is the doctor/CEO doing everything possible to increase profit margins? Hopefully not, because of the medical degree. A great doctor/CEO must juggle elements that affect the profit margin while also acting as the steward of the patients who come through. A great doctor/CEO will do the most that can be done to make an organization profitable while avoiding crossing the line of medical ethics; that’s where the MD comes in. The MD training guarantees that the doctor/CEO can seamlessly integrate their knowledge of business with the medical acumen needed to see the pulse behind the wallet. One needs a clinical mind to read the fine print of running a medical business. A business degree won’t help when faced with a long-term ventilator patient. That’s when the true balance of humanity and business of an MD/CEO shines.
Lawyers own and lead law firms—it is actually illegal for non-attorneys to have ownership in a legal firm. Engineers command machineries. It makes logical sense. But given the sheer amount of profits involved, businesspeople have justified their takeover of medical businesses from the true medical leaders: doctors. Doctors know diseases. Doctors know medical equipment. Doctors know the progression and atmosphere of healthcare better than any non-physician out there, much like the engineer who knows the mechanics of his equipment better than anyone else. We have betrayed ourselves and generations to come by taking the most valuable medical leader, the doctor, out of the business of medicine.