Deciding the Future of Healthcare Leadership: A Call for Undergraduate and Graduate Healthcare Administration Education

Good medical leadership is the cornerstone of quality healthcare. However, leadership education for physicians has traditionally been largely ignored, with a focus instead on technical competence. As a result, physicians in many cases have abdicated their role as medical leaders to others, usually businessmen without medical training or expertise, and often a lack of understanding of the human issues inherent to healthcare. Recently, the Southwest Journal of Pulmonary, Critical Care & Sleep published a manuscript, “Leadership in Action: A Student-Run Designated Emphasis in Healthcare Leadership”, describing a curriculum designed to develop future healthcare leaders (1). Hopefully this and similar curricula will prepare physicians in setting direction, demonstrating personal qualities, working with others, managing services, and improving services (2). 

The US suffers from a crisis in healthcare partially rooted in a lack of physician- and patient-oriented leadership which has led to “hyperfinancialization” in many instances. Beginning in the 1980’s there has been an explosion in administrative costs leading to reduced expenditures on patient care but a dramatic rise in total healthcare costs, the opposite of efficient care (3). The substitution of primarily businessmen for physicians as healthcare leaders has at times led to the bottom line being the “bottom line” for assessing success in healthcare. Although it is true that metrics of “quality of care” are often measured, quality of care is hard to define and implement in a way that functionally addresses the concerns of the healthcare system, patients, and physicians. Furthermore, the concept that business personnel acting alone can improve the quality and efficiency of healthcare is difficult to support. It seems to us that the combination of business acumen, an understanding of financial realities, an appreciation of physician needs and their careers, and a deep understanding of the human side of patient care is what is needed. We believe that educating and empowering physician leaders could begin to address this need.

As can be seen in many instances in the country, new medical schools and many training programs are being created as part of, and “report” to, large health care systems, including for-profit, “not-for-profit”, and non-profit organizations(4-6). We must be very cognizant of the potential conflicts in priorities that may occur in such situations, as well as potential opportunities. While a concern could justifiably be that a system or organization focused primarily on finances might neglect the human or science-based aspect of medical training, there could also be opportunities to create leadership training that takes advantage of leadership qualities and skills from both business and medicine. On the other side of the coin, university-based training programs cannot neglect the realities of today’s healthcare system where a facility with administrative and financial issues is required for successful leadership.

We must begin to train physicians to be administrative leaders early in their careers. Leadership training in medical school such as the program described in the article by Hamidy et al (1), and other programs like a residency dedicated to providing a broad medical experience as well as administrative experience under the supervision of physician administrators would be a great start. We already see many physicians in leadership returning to school to complete MBA programs, but training must start earlier if physician leaders are to be successful. The Institute of Medicine has recommended that academic health centers “develop leaders at all levels who can manage the organizational and system changes necessary to improve health through innovation in health professions education, patient care, and research” (7).  To this end, a few healthcare organizations such as the Mayo Clinic, the Cleveland Clinic, the University of Nebraska Medical Center, and UT Tyler are all headed by physicians and could provide the necessary education with administrative emphases on care and financial stewardship, rather than pure profit (8-11). These better trained administrators would hopefully earn the cooperation of their providers and business partners in providing high quality care that is focused on the humanity of our patients, while keeping in mind strong financial stewardship. 

Richard A. Robbins MD, Editor, SWJPCCS

Brigham C. Willis, MD, MEd, Founding Dean, University of Texas at Tyler Medical School of Medicine Medical Center, Tyler, TX USA; Associate Editor (Pediatrics), SWJPCCS

References

1. Hamidy M, Patel K, Gupta S, Kaur M, Smith J, Gutierrez H, El-Farra M, Albasha N, Rajan P, Salem S, Maheshwari S, Davis K,  Willis BC. Leadership in Action: A Student-Run Designated Emphasis in Healthcare Leadership. Southwest J Pulm Crit Care Sleep 2022;24(3):46-54. [CrossRef]
2. Nicol ED. Improving clinical leadership and management in the NHS Journal of Healthcare Leadership 2012;4:59-69. Available at: https://pdfs.semanticscholar.org/3cc3/36f891d6a4b47d951b2bd280e46f4687dd5b.pdf (accessed 3/25/22). 
3. Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med. 2003 Aug 21;349(8):768-75. [CrossRef] . [PubMed]
4. Banner University Medical Center-Phoenix. https://phoenixmed.arizona.edu/banner (accessed 3/28/22)
5. HCA Healthcare. https://hcahealthcare.com/physicians/graduate-medical-education/ (accessed 3/28/22)
6. Kaiser Permanente School of Medicine. https://medschool.kp.org/homepagJCe?kp_shortcut_referrer=kp.org/schoolofmedicine&gclid=CjwKCAjwuYWSBhByEiwAKd_n_kFPWcSP0Mj_VbqHJEsnwSwT_YkIErrb1PhcWQgQnRI_odNs5qbHZRoCaMIQAvD_BwE (accessed 3/28/22)
7. Institute of Medicine (US) Committee on the Roles of Academic Health Centers in the 21st Century. Academic Health Centers: Leading Change in the 21st Century. Kohn LT, editor. Washington (DC): National Academies Press (US); 2004. [PubMed]
8. Mayo Clinic Governance. Available at: https://www.mayoclinic.org/about-mayo-clinic/governance/leadership (accessed 3/25/22). 
9. Executive Leadership Cleveland Clinic. Available at: https://my.clevelandclinic.org/about/overview/leadership/executive(accessed 3/25/22). 
10. University of Nebraska Medical Center. Meet Our Leadership Team. Available at: https://www.nebraskamed.com/about-us/leadership#:~:text=James%20Linder%2C%20MD%2C%20Chief%20Executive,Nebraska%20Medical%20Center%20(UNMC). (accessed 3/25/22). 
11. University of Texas at Tyler. https://www.uttyler.edu/president/about/ (accessed 3/28/22)

Cite as: Robbins RA, Willis BC. Deciding the Future of Healthcare Leadership: A Call for Undergraduate and Graduate Healthcare Administration Education. Southwest J Pulm Crit Care Sleep 2022;24(3):55-57. doi: https://doi.org/10.13175/swjpccs006-22 PDF