When the author first started as a doctor, it was not unusual to find physicians, attorneys, CPAs, and businesspeople as hospital administrators and CEOs of insurance companies.
If an automobile company has a problem with a car's design, it does not call in an MBA to fix the problem. Rather, it calls on the company's engineers. Engineering is a science. It teaches design and thought processes to break down what is wrong and what is the goal of success-and how to get from here to there. Frequently, this requires innovation.
If MBAs are being hired throughout the healthcare system for their managerial expertise, then who is best suited to address its structural problems? Who can bring the innovation necessary to move the healthcare system forward to meet the ever-changing complexities that confront us? We can take a cue from automobile companies by calling on the right people to lead and innovate.
When talking about who should have a seat at the table when discussing changes to our healthcare system, we use terms such as "stakeholders." Stakeholders represent the politics of our profession. As the saying goes, all politics are local. Thus, all healthcare is local, and as a result, stakeholders stake themselves to the ground in rigid positions to protect their political and economic investments. How can anyone expect innovation when innovation and change disorient and confuse people to begin with? And no one wants his or her political or economic turf tampered with.
Courage to innovate is truly necessary. The medical profession is where the food distribution industry was in 1946. How do we go from the baker, the butcher, and the grocer to a grocery store with everything in one place? Another way to look at it is that we are where the retail industry was in 1960. How do we go from a department store to a mall, where the mall is the department store?
Could we bring society on board with small yet profound innovations? For example, could we pass legislation mandating that universal codes be placed on drivers' licenses in every state indicating whether drivers want to be organ donors or whether they want CPR to be administered? Can you imagine the effect on society if people were forced to address end-of-life decisions when they obtain or renew their drivers' licenses? We would save billions of dollars each year by placing these decisions into the hands of individuals, rather than in the hands of their family members or conservators, and making them legally binding.
Do we have the courage to discuss the economics of medicine and creativity in the same breath? Artists use the term "aboxic," which refers to the old concept of whether you think in the box or outside of the box. An aboxic individual does not think in the box or outside of the box. An aboxic individual does not recognize that the box exists. I think that we can adopt this concept as well. Without recognizing the box, you are not limited. Everything you do goes beyond what is. You cannot create in a box or outside of the box. You create. Limited individuals, however, including some of those who have business degrees, will try to place you, the physician, into a box to fit you into their mental models.
We, as a profession, need to make huge jumps in courage to lead. We no longer can place leadership in the hands of MBAs. They can be very boxic.
The author has practiced family medicine for the past 23 years. He also teaches medical students throughout the United States. He is the founder and medical director of Westminster Free Clinic. Send your feedback to firstname.lastname@example.org
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