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Role of the surgeon leader in the medical enterprise has transformed
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There is a general perception that we, as surgeons, are losing clout in the leadership of the medical enterprise. The days of the surgeon leader who could presume to dictate a course of action to the medical enterprise appear to be largely over. The game is different and the rules now favor the informed and thoughtful leader.
Leadership of the medical enterprise requires interaction with a host of affiliate entities — hospitals, educational institutions, researchers, marketing executives, a variety of administrators and colleagues from a diverse spectrum that includes surgeons and non-surgeons. The varying entities are no longer willing to automatically cede leadership to the surgeon leader.
Raj D. Rao
Leadership process
It is possible that changing reimbursement patterns play a role in the retreat of the surgeon leader. There was a time when surgical reimbursement was high and surgeons ruled the roost. Over the past 10 years, surgeon reimbursements have decreased substantially, nonsurgical provider reimbursements increased and facility fees increased even further. Not too long ago, Medicare used to pay billed charges for surgical fees. Medicare now pays a surgeon about $1,000 for removal of a herniated disc or for a joint replacement procedure, both of which dramatically improve human quality of life. Further, hospital margins from surgical procedures are low, and continue to shrink as the cost of the technology we use rises. With the changing patterns of reimbursement, the role of the surgeon leader in the medical enterprise has transformed. These changing times provide an opportune time for introspection on the nature of physician leadership that is now required.
Standards of excellence
Leadership must begin with having, or setting, standards of excellence for oneself personally and for the entire team to emulate. I have been convinced that notwithstanding any initial reluctance, teams always enjoy playing for a leader who genuinely raises expectations and follows through by providing the infrastructure necessary to accomplish the task. Leaders cannot raise the bar unless they personally hold the highest standards in integrity, excellence in their profession and commitment to patients.
Leadership is about clarity in a forward looking vision for the enterprise. “Vision” goes beyond the paragraph on a web page. There has to be enough clarity in the vision that the organization lives and breathes the vision on a daily basis. The vision necessarily must be initiated by the leader who has his or her finger on the pulse of all of the different agendas that affect the team, and should have the most informed perspective. Having the team help to shape this vision for the future helps promote adherence and buy-in. Leaders then translate the vision into a drive to “get the job done,” with integrity, clarity and a sense of old-fashioned fairness in dealing with colleagues and staff.
Knowledge is power
Leadership is about having access to the facts and numbers. Decisions are no longer driven by individual perception, but by numbers crunched to the most miniscule detail. “Knowledge is power” is a somewhat obsolete adage that seemed to be going away, but is now back with a vengeance. We need outcomes on our patients, satisfaction scores for both ambulatory and inpatient settings, performance metrics for our administrators and streaming financial updates. The capable leader harnesses the power of this information to drive the agenda.
Leadership is about building a team around you who is driven by the same sense of purpose and excellence. This may be the toughest part of all, and requires recruitment of the appropriate like-minded individuals to expand the team, mentoring of younger team members to help launch their careers, and continued and careful nurturing of the talents and skill sets already in place. Equal importance must be given to every recruit on the team – from administrators, mid-level providers, nurse managers and clinical staff – to ensure the whole enterprise stays humming on the same frequency.
Spine Surgery Today embarks on this new venture to provide leadership in the spine information field, by providing facts and numbers for our profession. I wish their capable team the best of luck as they embark on this new venture that strives to provide information leadership in the world of spine surgeons. With the right vision, right team and clarity of purpose, this should be a cinch.
Disclosure: Rao has no relevant financial disclosures.