Should Hospitals Be Run by Doctors?
By TARA PARKER-POPE
Should a doctor also be a manager?Should an M.D. also be a chief executive?
Are the best hospitals run by medical doctors or business managers?
The conventional wisdom is that doctors should focus on patient care, and managers with a business or administrative background are better suited to running the day-to-day operations of a hospital. Among the nearly 6,500 hospitals in the United States, only 235 are run by physician administrators, according to a 2009 study in the journal Academic Medicine.
But now new research suggests that having a doctor in charge at the top is connected to overall better patient care and a better hospital.
The findings, published in the journal Social Science & Medicine, are based on a review of 300 top-ranked American hospitals in the specialties of cancer, digestive disorders and heart surgery. Amanda Goodall, a senior researcher at the Institute for the Study of Labor in Bonn, Germany, tracked the professional background of each hospital’s chief executive and then compared the performance of physician-run hospitals with that of hospitals overseen by someone with a nonmedical background.
The study found that overall hospital quality scores were about 25 percent higher when doctors ran the hospital, compared with other hospitals. For cancer care, doctor-run hospitals posted scores 33 percent higher.
Dr. Goodall said the finding was consistent with her research in other fields, which has shown, among other things, that research universities perform better when led by outstanding scholars and that basketball teams perform better when led by former top players.
“I was surprised by the strength of the finding,’’ Dr. Goodall said.
The research doesn’t offer any evidence as to why doctor-run hospitals appear to post better results, but Dr. Goodall said it may be because doctors truly understand “the core business of health.”
“Hence, they are more likely to better understand the conditions under which their fellow core workers — doctors and nurses — will function best,’’ she wrote in an e-mail. “If a leader creates optimal working conditions for the core workers, then that is likely to create a more efficient organization.”
The data, based on annual hospital rankings compiled by U.S. News and World Report, included only three hospital chief executives with nursing experience, so it’s not clear how hospitals perform with a nurse executive versus a traditional manager.
Dr. Goodall also noted that spending time caring for patients puts doctors in a better position to make the hard decisions that a hospital administrator faces.
“M.D. C.E.O.’s are more likely to prioritize patients because patient care is at the heart of their education and working life as a physician,’’ she said. “When it comes to making hard budgetary decisions or rationing choices, M.D. C.E.O.’s may be able to make more informed decisions.”
The findings simply show an association between high hospital scores and doctor C.E.O.’s and do not prove that doctors make better leaders, Dr. Goodall noted. It may be that top hospitals are simply more likely to seek out doctor leaders, and top doctor managers seek out the best hospitals. However, the study notes that at the very least, the data show that the best hospitals appear to be choosing physician executives, while lower-ranked hospitals typically rely on managers with a business or administrative background.
Dr. Goodall said the findings run counter to the practices at many hospitals in the United States and Europe.
“I think the pendulum may have swung too far in the favor of managers,” she said. “This is partially because business schools have become so prominent, as has the M.B.A. These qualifications are helpful, but it is possibly not enough just to have a management education.”
:naughty: >:(
