The businessman
The typical view of a surgeon or a healthcare professional is that they’re not in any way intertwined with business.
In recent decades this is how the system has panned out in NHS with business managers being ‘dropped in’ to departments to keep surgeons in check who spend too much money treating patients, sometimes with expensive whims and styles that don’t add up to evidence-based practice.
I remember when I first encountered this philosophy when I worked in hospital myself and was able to see the variation in how different surgeons treated different patients and how long some surgeon’s patients stayed in hospital compared to others for the same procedure.
This is a stark reality.
If there are 5 surgeons providing knee replacements in a major hospital and one of them has patients staying in hospital for weeks while the rest have patients leaving after 1 day, then there is a significant problem with the individual with the long hospital stay.
Although this is an exaggerated example you can see how applying the principles of business and efficiency and effectiveness and evidence base and consensus of procedures can improve the outcomes for populations.
This becomes all the more clear and even more complicated when the surgeon works in a private environment.
In an NHS environment the surgeon is salaried for providing the treatment (in general terms although there are incentives) this means that the thought of financial immunisation really doesn’t enter into the decision making for patients and only the thought of how long it will take for the surgeon and how much it will keep them away from other activities that they may do.
When the surgeon is the person who’s paying the bills to run the organisation it’s almost impossible to see how perverse incentives do not start to play into decision making.
The first thing to do to try to solve such developing problems is to be able to see and identify them.
In order to be able to see and identify them you must understand how the business and the systems within which you work actually function.
The second part of the businessman as surgeon is the entrepreneur.
To be able to innovate and challenge and risk take (within a framework) is absolutely fundamental to success.
Implant dentistry (the sphere in which I work) has changed to an unrecognisable state in the past 20 years, probably an extraordinary amount even in the last 5 and the lack of ability to adapt and create and move on that is inherent in so many hugely successful entrepreneurs meaning the surgeon is likely to fall behind.
The business and entrepreneurial considerations that are required for modern surgeons to adapt and to work and also to sell (they all have to sell ideas to so many different people at so many times) adds a level of complexity to the work which never existed before.
This is another learnable skill but one which many surgeons rail against because they see themselves as healthcare professionals or others take far too far because they see themselves as businessman and not healthcare professionals but to strike a balance between these two requires some deep consideration and thinking which relates fundamentally to the next part of the personality required which is ethics.
Blog Post Number - 3186
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