Square One

Jo Stephenson writes in this week’s BMJ about different approaches to equipping doctors for management and leadership roles. This is how we need to start thinking in Nigeria now. We cannot continue to leave the management of our hospitals and health care institutions and system in the hands of those who are not trained to manage them, no matter how senior or clinically experienced.

I sent this article to Dayo Osholowu, a sports physician in Nigeria who replied by saying: “We have to embrace the responsibility that is falling on us or someone else will. The ownership and management of health service insitutions will fall on an elite corp of financially sophisticated management experts. Lets join this corp with open arms and the venture will reward the few.”

He went ahead to paraphrase a quote from Dr Strangeglove, where General Jack D. Ripper says: “Clemenceau (himself a medical doctor who later became French PM) once said that war is too important to be left to the generals. When he said that, 50 years ago, he may have been right, but now, war is too important to be left to the politicians. They have neither the time, the training, nor the inclination for strategic thought.”

Health care management indeed in the same vein, is too important to be left to doctors/clincians. Here are excerpts from the BMJ article:

However, many people would like to see management skills introduced earlier in doctors’ training. In America there are a growing number of dual MD/MBA courses on offer. Harvard set out to create a truly integrated programme, explains Richard Bohmer, medical professor at Harvard Business School.

Students concentrate on medicine for the first two years but do a management internship in a hospital or healthcare firm between the two years. In their third year they continue medical training as well as doing several management courses, including looking at management problems on the wards.

“Students are getting clinical experience. At the same time we’re teaching them about some of the organisational issues they’re seeing,” says Professor Bohmer.
During the fourth year they do an MBA with a clinical rotation and in the fifth and final year they complete their MBA and clinical rotations.

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Meanwhile other US medical schools are introducing leadership elements into graduate medical education, such as Dartmouth Medical School’s leadership preventive medicine residency. It is a two year programme on top of a traditional three year clinical residency, offering the chance to earn a masters degree in public health and gain skills to lead change and improvement in health care.

The programme includes clinical leadership rotations and a major practical assignment in which trainees are expected to apply what they have learnt to a real health service situation.

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Many doctors combine management with clinical work, but in Australia and New Zealand it is possible to be a registered specialist in medical administration by becoming a fellow of the Royal Australasian College of Medical Administrators. Doctors with three years’ postgraduate clinical experience can go straight into a three year training programme providing supervised medical management experience in posts such as deputy medical director.

Alternatively, senior doctors trained in other specialties can gain fellowships in a minimum of 18 months depending on previous experience.
This approach has boosted the status of medical managers. Fellows can command higher salaries, and in some states fellowship is a requirement for directors of medical services.

“There is that feeling that a doctor who has gone into administration has gone over to the dark side. Making it a recognised vocational skill certainly goes a long way to dispelling that myth,” says college president David Rankin

The full article is here.