Well, it was my first day on the job at my new community health center in the Great American desert. I came across management that expects the CEO to be hands on and a CEO who is working at 30,000 feet. It remain unclear what the organization needs, but expectations are what they are.
I came across physicians frustrated with a series of ineffectual management teams that they are not giving the current group a chance. I would not have come if I didn't believe the current group was worthwhile, but the docs may have seen too much over the years to believe in their current managers.
When doctors and medical staff are not given the credence and attention they deserve, they become passive-aggressive and actively subversive. That partially explains why I met a physician with angle closure glaucoma taking a sick day two days before a routine screening dilated exam!??!
[Angle closure glaucoma is precipitated and/or exacerbated by the dilating drops. The chronic open-angle form requires annual pressure monitoring and only occasional dilation. In any case, there was plenty of time to set up a screening exam within the required 30 days for a planned preventive service.]
Doctors are sometimes too smart for managers to handle. Managers need to spot BS quickly. In the end, it is the community and the patients that are the priority for both managers and doctors. When the environment has become full of mistrust, reminding both parties of their common mission is the only way out. It's been too short a time, but I see no reason this group cannot pull it out.
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Are there practicing "in the trenches" physicians involved in substantive management positions in the group?
It seems this is often a necessity, otherwise management and physicians often inhabit different worlds with neither side feeling like the other side has any idea about the realities of modern medicine.
Good observation. Over the years the "trench docs" were brought into management, where they not effective, burned out and moved on.
It would be interesting to know what "not effective" means.
Often, not effective means "not rubber stamping every idea that comes down the management pipeline, instead often providing annoying resistance on organizational 'progress'."
"Progress" being defined by the bean counters or CEO, or whatever. (at a level above the management of the "trench doc".
As I point out, perspectives can differ between management and docs. That is one of the reasons I prefer to remind everyone of the patient's perspective.
Management and physicians actually need each other, whether or not their conduct reflects that understanding. In either case, our purpose is to improve the health of individuals or communities, not the health of either managers or physicians.
Therefore if a physician manager gets tossed on his keester because various players have made him/her unable to forward the betterment of the health of patients or the community, that manager has failed.
Just to be clear, I have failed in this capacity on more than one occasion in the past. Where I have succeeded, I have done fairly well. It just doesn't seem to happen as often.
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