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Medicine and business: Clash of cultures or a great opportunity for the 21st century?
COMMENTARY
Medicine and Business: Clash of Cultures or a Great Opportunity for the 21st Century? Frank James Lexa, MD, MBA The articles in this special issue of JACR are the result of a course that was inaugurated at the annual meeting of the ACR this past May in Washington, D.C. I want to applaud the leadership of the ACR and JACR for their vision and support in making this course a reality. I also am extraordinarily grateful to the faculty members for their hard work in producing a course that superbly met my goal of providing the first installment of a program to provide a core curriculum on business issues for radiologists. This goal grew out of my own experience at seeing the problems faced by radiologists in working with accountants, financial experts, and management consultants. The difference in cultures often resembles a “clash of civilizations” [1]. This clash takes on many guises and has many causes. First and foremost is the genuine issue of conflict over the ends of the enterprise. Successful management is about working toward goals, and not surprisingly, if the goals of a radiologist are different from those of another entity, there may be a substantial conflict. This leads to the perception that management is only about “bean counting” and/or that successful management stands in opposition to excellence in medical care. In fact, strong, successful management is a goal-oriented enterprise and can be applied to a wide variety of endeavors. The core issue is that of how those goals are aligned: is everyone on the same side? That is almost always the case in successful enterprises, and the converse, a lack of alignment and conflicting goals, 218
is a strong predictor of mediocrity or even failure in an organization. If a radiology team is using management techniques to further its goals, then in fact theirs is the agenda that will be pursued rather than that of another entity, and there will be a much greater chance that the radiologists will succeed in their endeavors. Finance and accounting are not limited to forprofit enterprises. In fact, these same disciplines of management science are also used by a wide spectrum of entities, including the military and charity organizations, for whom profit is not a goal at all. To reiterate, the three key issues are what is being managed, to what end, and for whom. The common misconceptions about business and management lead to a second and very damaging set of assumptions that we would like to rectify in these articles. Because we are busy, highly trained physicians, we may not see the value or have the time to take the lead on financial matters, service quality, operations efficiency, or other management issues. This attitude may stem from the sense that this is someone else’s job or that there are other qualified “experts” who should be doing this. This assumption that decisions can or should be delegated to some other expert is particularly damaging for our work as medical experts. No one else understands the processes, goals, pitfalls, and other issues in our profession better than those of us who practice it intensively every day. No one else is better positioned to understand how radiol-
ogy procedures and practices can be improved and what types of changes are likely in the future. When there is a vacuum in physician leadership, I repeatedly see examples in both private and academic practice of extremely poor decisions being made by so-called business experts, who lack a foundational understanding of what we do in radiology. This extends through the operations, contracting, human resources, and financial realms. One of the most interesting 21st-century “megatrends” is the convergence of management expertise with those who are technically adept. The old dichotomies of “us” versus “them” have broken down in many fields. It is not uncommon now to meet investment bankers who have not only financial expertise but PhDs in chemistry, or to meet software entrepreneurs busily writing code while putting their MBAs to use “day trading” in the stock market. This convergence is occurring now in other highly technical fields, such as biotechnology, pharmaceuticals, and software development. Our profession will not be immune, and in fact there is a world to win if we take the lead rather than delegating this role to outsiders. The third related assumption is that this is not important relative to our role as physicians. In fact, to retain our positions as leaders, we will need to learn to work with these other types of experts and even lead them if we are stay at the forefront of how our practices are run. The challenges from managed care, from all levels of the govern-
© 2005 American College of Radiology 0091-2182/05/$30.00 ● DOI 10.1016/j.jacr.2004.07.005
Commentary 219
ment, from contracting entities, and even from nongovernmental organizations have never been greater. Although the future cannot be predicted, the trend has been toward increasing complexity in our environment, and that will likely increase rather than diminish over the next decade, with increasing challenges to our practices and our autonomy from all sides. These articles exceeded my original goal in providing both an introduction to the concepts used in the financial and accounting realms as well as providing as many practical applications to our field of radiology as possible in the time allotted. As will be discussed later, our intent is not to turn our fellow radiologists into accountants. On the contrary, all of us who started out as radiologists have continued in our
profession despite taking time to get business educations. We believe strongly that medical professionals can and should be more cognizant of the terms and methods used by their business colleagues. We also believe that there is a marked asymmetry in the opportunity at this interface. Most accountants and business managers will never be able to really understand the imaging process at the depth that we do. And although most of us may have no desire to really do what those nonradiologist colleagues do on a daily basis, we can learn enough to be effective leaders and managers of those who do handle those tasks for us in our organizations. The alternative is an increasingly complicated and more challenging practice environment in which we will risk abdicating our leadership roles
and become managed by others in our practice of medicine. As you consider the factors that will make a difference in how successful you will be in the next 10 years, it is likely that the most critical ones will be found within the realms of management and administration. Improved attention to quality, better operations, improved financial management, and marketing are all very important differentiators between long-term success and failure in other businesses, and our fate will likely be no exception in the long run. I hope that this special issue of JACR provides a helpful start on this important journey. REFERENCE 1. Huntingdon S. The clash of civilizations. Foreign Aff 1993;72(3):22-28.
Frank James Lexa, MD, MBA, Wharton School, University of Pennsylvania, 302 Steinberg-Dietrich Hall, 3620 Locust Walk, Philadelphia, PA 19104; e-mail: [email protected].
Medicine and Business: Clash of Cultures or a Great Opportunity for the 21st Century? Frank James Lexa, MD, MBA The articles in this special issue of JACR are the result of a course that was inaugurated at the annual meeting of the ACR this past May in Washington, D.C. I want to applaud the leadership of the ACR and JACR for their vision and support in making this course a reality. I also am extraordinarily grateful to the faculty members for their hard work in producing a course that superbly met my goal of providing the first installment of a program to provide a core curriculum on business issues for radiologists. This goal grew out of my own experience at seeing the problems faced by radiologists in working with accountants, financial experts, and management consultants. The difference in cultures often resembles a “clash of civilizations” [1]. This clash takes on many guises and has many causes. First and foremost is the genuine issue of conflict over the ends of the enterprise. Successful management is about working toward goals, and not surprisingly, if the goals of a radiologist are different from those of another entity, there may be a substantial conflict. This leads to the perception that management is only about “bean counting” and/or that successful management stands in opposition to excellence in medical care. In fact, strong, successful management is a goal-oriented enterprise and can be applied to a wide variety of endeavors. The core issue is that of how those goals are aligned: is everyone on the same side? That is almost always the case in successful enterprises, and the converse, a lack of alignment and conflicting goals, 218
is a strong predictor of mediocrity or even failure in an organization. If a radiology team is using management techniques to further its goals, then in fact theirs is the agenda that will be pursued rather than that of another entity, and there will be a much greater chance that the radiologists will succeed in their endeavors. Finance and accounting are not limited to forprofit enterprises. In fact, these same disciplines of management science are also used by a wide spectrum of entities, including the military and charity organizations, for whom profit is not a goal at all. To reiterate, the three key issues are what is being managed, to what end, and for whom. The common misconceptions about business and management lead to a second and very damaging set of assumptions that we would like to rectify in these articles. Because we are busy, highly trained physicians, we may not see the value or have the time to take the lead on financial matters, service quality, operations efficiency, or other management issues. This attitude may stem from the sense that this is someone else’s job or that there are other qualified “experts” who should be doing this. This assumption that decisions can or should be delegated to some other expert is particularly damaging for our work as medical experts. No one else understands the processes, goals, pitfalls, and other issues in our profession better than those of us who practice it intensively every day. No one else is better positioned to understand how radiol-
ogy procedures and practices can be improved and what types of changes are likely in the future. When there is a vacuum in physician leadership, I repeatedly see examples in both private and academic practice of extremely poor decisions being made by so-called business experts, who lack a foundational understanding of what we do in radiology. This extends through the operations, contracting, human resources, and financial realms. One of the most interesting 21st-century “megatrends” is the convergence of management expertise with those who are technically adept. The old dichotomies of “us” versus “them” have broken down in many fields. It is not uncommon now to meet investment bankers who have not only financial expertise but PhDs in chemistry, or to meet software entrepreneurs busily writing code while putting their MBAs to use “day trading” in the stock market. This convergence is occurring now in other highly technical fields, such as biotechnology, pharmaceuticals, and software development. Our profession will not be immune, and in fact there is a world to win if we take the lead rather than delegating this role to outsiders. The third related assumption is that this is not important relative to our role as physicians. In fact, to retain our positions as leaders, we will need to learn to work with these other types of experts and even lead them if we are stay at the forefront of how our practices are run. The challenges from managed care, from all levels of the govern-
© 2005 American College of Radiology 0091-2182/05/$30.00 ● DOI 10.1016/j.jacr.2004.07.005
Commentary 219
ment, from contracting entities, and even from nongovernmental organizations have never been greater. Although the future cannot be predicted, the trend has been toward increasing complexity in our environment, and that will likely increase rather than diminish over the next decade, with increasing challenges to our practices and our autonomy from all sides. These articles exceeded my original goal in providing both an introduction to the concepts used in the financial and accounting realms as well as providing as many practical applications to our field of radiology as possible in the time allotted. As will be discussed later, our intent is not to turn our fellow radiologists into accountants. On the contrary, all of us who started out as radiologists have continued in our
profession despite taking time to get business educations. We believe strongly that medical professionals can and should be more cognizant of the terms and methods used by their business colleagues. We also believe that there is a marked asymmetry in the opportunity at this interface. Most accountants and business managers will never be able to really understand the imaging process at the depth that we do. And although most of us may have no desire to really do what those nonradiologist colleagues do on a daily basis, we can learn enough to be effective leaders and managers of those who do handle those tasks for us in our organizations. The alternative is an increasingly complicated and more challenging practice environment in which we will risk abdicating our leadership roles
and become managed by others in our practice of medicine. As you consider the factors that will make a difference in how successful you will be in the next 10 years, it is likely that the most critical ones will be found within the realms of management and administration. Improved attention to quality, better operations, improved financial management, and marketing are all very important differentiators between long-term success and failure in other businesses, and our fate will likely be no exception in the long run. I hope that this special issue of JACR provides a helpful start on this important journey. REFERENCE 1. Huntingdon S. The clash of civilizations. Foreign Aff 1993;72(3):22-28.
Frank James Lexa, MD, MBA, Wharton School, University of Pennsylvania, 302 Steinberg-Dietrich Hall, 3620 Locust Walk, Philadelphia, PA 19104; e-mail: [email protected].