Why Does Physician-Hospital Integration Fail

Generalizations are dangerous. The generalizations about the white coats and the blue suits can no longer be universally applied. Physician training and education is becoming more team focused and taking on some of the more positive attributes of a typical MHA or MBA learning experience. There are certainly residual cultural attributes that reflect how those later in the careers were trained, as well as how they practiced medicine and ran hospitals in the past. For any personal or business relationship to be productive, individuals must know themselves and those with whom they work. Physician and administrative leaders need to recognize this reality and invest accordingly as the basis for developing new levels of collaboration.

Yet, some differences may influence relationships. Physicians are trained to process lots of diagnostic data to pinpoint the ailment. Those with different training and experiences such as hospital administrators use information to generate options, analyze these options and then make a decision. Real different. One is short and at times not very inclusive, while, the other can be time consuming and require patience (not patients!). Also, physicians and administrators tend to have a different sense of time around certain issues. The later plan with a much longer time horizon influenced by qualitative and well as quantitative data.

Physician employment does not equal physician engagement. I continue to be amazed at the miss-steps made by physician and administrative leadership here. Before the acquisition, everybody makes conceptual agreements that are reflected in numbers—salary, patient referrals, economies of scale, etc. The problem is that these assumptions are not effectively communicated to physicians, and there has not been mutually developed plan to “integrate” what is jointly owned at the time of the acquisition. Once doctors are getting a paycheck from the hospital, administrators naively think they have engagement. Not! Physicians seek to create a shared vision for how their work can make a difference. Not that much different than the blue suits, eh? So why don’t leaders make this a plan to optimize ROI?

Most meetings are a waste of time. Physicians will say this openly as they most don’t get paid for sitting in meetings, and the one’s that they do have a very focused and fact-based. On the other hand, many old school hospital administrators have flat bottoms from sitting in so many unproductive meetings. It is also about sincerity—are physicians invited to provide input and collaborate or to show up and provide their “blessing”?

Hospital Administrators view physician practices as an expense problem, not a core asset. Now this one is really unbelievable. A practice of practice was acquired. The financial proforma approved by Boards of Directors. Now the P&L is doing exactly what anyone should have known from the beginning. The only way to value creation is through collaboration in new ways with an unwavering focus on creating community and patient centered value. At the end of the day, the mindset (and well as the skill sets) of physician and administrative leaders must change. Or, maybe the leaders themselves need to move on.