Dual Roles: Surgeon and Administrator

Physicians are often called upon to lead and manage organizations. Some do well, others poorly, and there has been a lot of interest in how physicians fare when in a dual role of physician and administrator.

Yesterday, I discussed the role of a managing physician in a practice, and reference Reed Tinsley’s blog post. Today, Knowledge@Wharton, a newsletter for the University of Pennsylvania’s famed Wharton School of Business, published an interview (and podcast) with Dr. Larry Kaiser, chairman of the department of surgery and surgeon-in-chief for the University of Pennsylvania Health System. His perspectives on some of the challenges in his multiple roles are interesting and applicable to managing a medical practice.

As a surgeon, Kaiser talked about how to achieve quality and patient safety when the team changes for each surgery:

“So on the one hand, if we're working with different people each day, one has to very quickly be able to form a team, work closely with that team, but we do that by standardizing a lot of the things that we do in the operating room.”

A very important lesson which I’ve written about here many times. Think checklists, think enabling and encouraging OR staff to speak up if they see a problem looming.

Another challenge is the changes in how surgeons do their work. The upside is less invasive surgery, the downside is higher direct cost, although the net result may be lower costs to society:

“I think in terms of how the specialty has changed -- and when we talk about surgery as a specialty we're talking about really multiple areas of specialization -- [it comes down to] the improvement in technology. What we've seen is a marked shift in the kinds of things that we're able to do, especially in high priced technology.”

Kaiser’s final comments summed up the complexity in which we live with in the health care industry:

“I think the most challenging parts of this job [stems from the fact that] I serve a lot of different masters. I have the health system where I have concerns. I have the school of medicine where I have concerns. I have my own patients where I have concerns.”

It’s this very complexity that is our challenge to work through, to make the basic mission of caring for patients simpler and making a difference.