Physicians Vs professional managers? Who should be running the hospital?

The idea that physicians should be better hospital managers is deeply embedded in medicine. Put simply, the folks that have “walked the walk” should be able to lead by example and should instil more confidence in their medical colleagues. A recent study in Social Science & Medicine [doi:10.1016/j.socscimed.2011.06.025 ] suggests that  Physicians, compared with non-physician leaders,  with  do make better leaders. Data were collected on the top-100 U.S. hospitals in 2009, as identified by a widely-used media-generated ranking of quality, in three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery. Three areas of healthcare performance are reflected within the Index Health Quality scores: structure, process, and outcomes. For example, the researchers looked at metrics such as availability of key technologies, mortality rates and diagnostic tests ordered. The authors caution us that the study is cross-sectional and doesn’t improve that doc’s are better leaders. The most interesting aspect of the paper relates to the unanswered questions. For example, top hospitals maybe more likely to seek out top physicians as leaders, or the mere presence of a physician leader may attract more talented medical staff. The authors acknowledge that they didn’t evaluate actual leader behaviour, which would give us a better insight as to mechanisms of successful leadership. We don’t have information on the type of individual who are leaders in hospitals, but don’t have traditional medical backgrounds. Finally, performance metrics are important, but it would be interesting to assess the experience of staff in the two different regimes.