Healthcare Leadership: A New Paradigm in Modern Medicine with New Faces at the Forefront

“Healthcare is defined as efforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals” as defined by the Merriam-Webster dictionary. Leadership is defined as “the act or an instance of leading” as defined by the Merriam-Webster dictionary. Now let’s imagine the act of leading a group or service line of trained and licensed professionals that maintain or restore physical, mental, or emotional well-being. The delivery of healthcare can be broken down into two categories: 1) Administration and 2) Clinical. Anytime you enter a healthcare facility be it a hospital, clinic, surgical site, etc. you undergo a registration process prior to actually receiving clinical care/services. The pre-clinical process can be categorized as the administration process. Once the required paperwork and information are obtained the clinician is now assigned to assess, diagnose and treat the patient.

The delivery of healthcare is a business of its own, various hospitals, clinics, and practices are business entities of their own, PLLC, PC, LLC, non-Profit’s, corporations, etc. Even with the non-profit model of business, funds are obtained via grants, fund-raising, etc. to sustain the operations. “U.S. healthcare spending grew 9.7 percent in 2020, reaching $4.1 trillion or $12,530 per person. As a share of the nation's gross domestic product, health spending accounted for 19.7 percent” as per data from CMS. A clinician’s job and focus should be on the delivery of efficient, cost-effective, timely, effective, safe, respectful, and sensitive healthcare. The administrator’s job should be revenue cycle management, service line integration, compliance, regulations, business development, and the delivery of proper healthcare by properly trained and experienced professionals. 

This is where healthcare leadership comes into play, there are various routes to enter healthcare leadership, management, or administration (all synonymous terms). Colleges offer courses of study at the undergraduate and graduate level to gain insight into this field with classes in the course of study including healthcare finance, management, human resources, accounting, etc. Unfortunately, the medical education system does a poor job of training clinicians in the business aspect of healthcare. The medical education system is designed to train the new generation of clinicians to practice cutting-edge and evidence-based medicine. With shrinking third-party reimbursements and claims governed and capped by the insurance industry, it discourages providers to venture on their own and creating practices. The “Mercedes-ages” or days where being a solo practitioner was a substantial model are slowly fading away. The majority shares of private/out-patient practices are held by healthcare systems. 

Now, imagine a combination of clinical and administrative knowledge from a clinician. This individual would be trained to deliver the un-paralleled healthcare he/she was trained to do so in their medical education and understand the reimbursement, service line integration, and lead teams of peers to maximize delivery and revenue. This is what we are seeing today; doctors, nurse-practitioners, physician assistants, nurses, etc. pursuing higher degrees (MBA, MHA, MPHMS, etc.) in healthcare leadership to understand the processes. Some educational programs offer residencies/fellowships in healthcare administration leading to credentials such as FACHE, CPCO, CHPC, etc. 

The physician-executive combination is a highly favorable and productive designation. This individual is trained in the language of medicine, etiology, and pathophysiology of diseases and understands the process of delivery of medicine. Also, this individual understands the back end of third-party reimbursements, compliance, and administration. We are seeing new faces at this forefront, typically medicine was dominated by MDs for decades, arguably centuries. Today healthcare leaders come in the form of DDS/DMDs, DCs, DPMs, RNs, NPs, PAs, PhDs, DBAs, etc. The healthcare team is not comprised of solely MDs & RNs, we need to recognize the efforts of the MAs, clerks, administrators, PBTs, etc., who contribute to the daily operations delivery, and workflow of healthcare. 

Imagine a system or service line where administrators did not oversee the revenue cycle management of reimbursements for services. Physicians, hospitals, clinics, etc. would lose/miss out on millions of dollars from claims/services. Claims are already denied, audited, fixed, etc. with current protocols in place, today. The push for physician executives is vital in today’s healthcare arena to increase productivity, efficiency, and revenue. Many clinicians perform both clinical and administrative duties. We see physicians/providers setting days in their schedules where they see all their patients/cases on certain days while the rest of the bulk of their schedule includes leadership roles (I/e: Chairperson, director, managers, etc.). Some clinicians find their passion in simply administration and forego clinical practice. This newly rising niche in medicine/healthcare is on the rise and well needed. Professionals with solely administrative privileges/autonomy are limited to an administrative role, now a professional who can combine the clinical care and administrative role can serve in a greater capacity such as a medical director, clinical director, chairperson, etc. Imagine following your patient's care from bedside to reimbursement.

Overhead in any business is crucial and an acquired cost shrinks greater profit margins. The physician/professional who can serve both roles becomes an asset to any organization by utilizing both his/her skill set. Imagine running a practice and not knowing how to bill, not knowing how to chart properly, or not knowing how to staff accordingly. This can be a disadvantage that will force the business owner who in most instances is probably a clinician, to outsource to consultants, and management companies, when the revenue can be kept in-house. These models are currently in effect in various urgent care, multi-disciplinary practices, clinics, ambulatory surgical sites, laboratories, etc. A new paradigm in modern medicine with new faces at the forefront currently and will include an array of professionals as mentioned above. One example we can admire, and praise is the U.S Department of Veterans Affairs Hospital’s- Rehabilitation and Prosthetic department which is headed by: Dr. Anthony J. Lisi, who is a chiropractic physician by training and also serves as the director of this department; overseeing the administrative duties of the department highlighting the true definition of the physician executive combination.

It is anticipated this niche of healthcare will expand to various sectors, systems, and integrations across service lines nationwide. Being a doctor and a businessman is the future of healthcare, the interest in true entrepreneurship has always been a dream/goal of various professionals however the fear of failure has detruded individuals from taking the leap. Let’s praise the quote " Never was anything great achieved without danger. "said by philosopher Niccolo Machiavelli. With the proper training in any subject, discipline, and/or process, anything is possible. The word doctor means teacher, also, many would agree on the lifelong learner. Why not master and own every aspect of your profession, encompassing this physician executive role is doing such. This model also assures the true practice of patient-centric and evidence-based medicine practices by providing an added layer of a checks and balances system; for compliance, reimbursement, and healthcare delivery.