Running A Hospital: Does A Doctor Make A Better Chief Executive?

New research suggests that when a doctor (as opposed to a business manager) runs a hospital, it may help improve patient care and boost quality overall.

The New York Times reports:

The findings, published in the journal Social Science & Medicine, are based on a review of 300 top-ranked American hospitals in the specialties of cancer, digestive disorders and heart surgery. Amanda Goodall, a senior researcher at the Institute for the Study of Labor in Bonn, Germany, tracked the professional background of each hospital’s chief executive and then compared the performance of physician-run hospitals with that of hospitals overseen by someone with a nonmedical background.

The study found that overall hospital quality scores were about 25 percent higher when doctors ran the hospital, compared with other hospitals. For cancer care, doctor-run hospitals posted scores 33 percent higher.

Dr. Goodall said the finding was consistent with her research in other fields, which has shown, among other things, that research universities perform better when led by outstanding scholars and that basketball teams perform better when led by former top players.

All of this begs the local question: Should the new chief of Beth Israel Deaconess Medical Center be a doctor?

In a letter obtained by The Boston Globe earlier this year, former Beth Isreal Deaconess President Mitchell Rabkin (an MD who ran the hospital for 30 years) argued vehemently that a doctor at the helm of the hospital would make a better leader, particularly for an academic medical center. According to the March 25th letter, Rabkin said former CEO Paul Levy managed the hospital well, on some levels. For instance, he says Levy returned "the Medical Center to financial stability, creating a climate of candor about aspects of clinical performance." But, in other areas, he fell short:

"...Paul (Levy) has displayed less appreciation for and support of the academic activities of scholarship, whether in clinical care, teaching or research, than is necessary to sustain and further strengthen the essential academic character of the Medical Center," the letter, printed in The Globe, said. "With that concern comes a dominant feeling by our Medical Staff that the next CEO and President be a physician with both demonstrated success in medical center management and significant involvement in academic medicine, similar to that seen in ranking academic medical centers throughout the USA."

I asked Levy, who is not a physician, what he thinks of the new pro-doctor research, and of the issue in general. He said he is completely uninvolved in the search for his successor, but did have some comments on the study:

The research suffers from a common problem, drawing causality when the only thing demonstrated is correlation. It is always important to conduct a rigorous review of other factors and variables that might account for higher rankings.

But this study is even weaker than that in the it relies on “a widely-used media generated ranking of quality,” i.e., the US News and World Report ranking. That ranking is suspect in many ways, not least of which is the self-referential aspect of it. That is, doctors are asked to give their subjective impression of other hospitals. This is based on personal connections and reputations. Of course, they are more likely to rank more highly the hospitals in which they are familiar with their colleagues. The author recognizes this when she says, “media-generated league tables cannot be viewed as entirely reliable measures of quality,” but then she goes and uses the USNWR rankings anyway.

This quote in the article reflects a stunning level of disrespect, arrogance and ignorance.

“M.D. C.E.O.’s are more likely to prioritize patients because patient care is at the heart of their education and working life as a physician,’’ she said. “When it comes to making hard budgetary decisions or rationing choices, M.D. C.E.O.’s may be able to make more informed decisions.”

If we want to talk about professional background, let’s look at her CV and see that she has had virtually no experience in actually running anything, except holding some kind of administrative position at two universities in England, where she “worked with” one of the senior leadership team. Using her own logic, she is not qualified to have sufficient judgment about the attributes needed by someone to run a complex organization like a hospital to draw this type of conclusion.