The Intersection of Business and Medicine
Having experienced the roles of a medical facility owner and healthcare system employee, I have witnessed the intersection between business and medicine from both sides of the proverbial coin. The healthcare sector is a service industry designed to care for people who are ill and prevent illness. But, it is also a business. Caregivers need to be paid and supplies need to be purchased, amongst other expenses.
On the business side of things, patients can be distilled down to reimbursement units from medical insurance companies which is determined by the time spent with patients, procedures performed, and general evaluation and management plans based on medical complexity and diagnoses. All these metrics can be measured, and the reimbursement can be calculated and balanced against the financial cost of delivering medical care. However, measuring the effect of the business of medicine on caregivers in the healthcare system is often more difficult.
From a business standpoint, medical institutions and facilities would want to have patients seen in the least amount of time to increase the number of patients seen in a given period of time. Furthermore, they would want to care for the highest complexity of patients with extensive evaluation and management plans to give the highest reimbursement rate and perform as many procedures as possible. All of this would be accomplished with the least amount of overhead cost which usually boils down to medical providers and staffing. Employees are usually the greatest expense for any business. So, doing more with less would provide the most income for the business side, but is it actually best for the staff and medical providers? Also, is it truly good for the business side?
The Clash: Transactional vs. Relational Approaches
So, this is where the business of medicine and medicine collide. It is a juxtaposition that is brought on by the demand of business and the mission of medicine. Business is by nature a transactional activity meant to sustain the business and “keep the lights on”. Medicine is by nature a relational activity meant to create connections and establish relationships between those receiving care and those providing care. If everything is purely transactional, the business side thrives at the cost of overworking and disregarding the needs of the staff by doing more work with less staffing or support to maximize income and minimize expenses. If everything is purely relational, the business loses money and can’t be sustained because staffing support and other services are maximized relative to the work being performed which increases the expenses over the available income. Either activity extreme would adversely affect the other.
Impact on Caregivers and Medical Providers
Much of the satisfaction gained by professionals and staff in the medical field is achieved by spending time with patients, engaging in compassionate care, making accurate diagnoses through a thoughtful and thorough evaluation, and treating patients in the manner that is deemed best by the medical team and the personal context of the patient’s condition. But, these activities may not make sense from a business standpoint. These activities take time and often require more staffing support. The more time spent with patients, the fewer patients can be seen, and the less reimbursement is attained. The more staffing support, the more overhead that cuts into the financial reimbursement income. However, as these medical activities are compromised by the needs of the business, satisfaction with the practice of medicine is compromised because it hinders the medical team’s ability to deliver their perceived best medical care. The medical providers and teams begin to suffer from moral distress and burnout when they are not able to achieve their desired outcomes and work in the manner they feel is best for them and their patient’s well-being. So, ultimately, this will adversely affect the business.
The Pitfalls of Extreme Approaches
A purely relational business that is not concerned with expenses will ultimately fail because the income may not ultimately be able to support overstaffing and extra assistance desired to create the ideal work environment. Yet, the purely transactional business will fail because it will not be able to retain the right employees to pursue its mission and create a healthy work culture due to employee turnover caused by moral distress and burnout. A balance is needed to financially sustain a medical practice or institution and create an environment that is culturally viable. This brings us back to measuring metrics in the business of healthcare.
Striking a Delicate Balance
There are all sorts of metrics that can be measured to identify the ideal financial reimbursement in the business of medicine and balance it against the financial cost of delivering medical care. Business is business. However, a business is not just about dollars and cents or metrics. It is about people. If you don’t have people coming to your business or working in your business, there is no business.
While all that I’ve said may be quite obvious, why do medical staff still burnout or quit medicine and why do medical businesses still financially fail? This may ultimately come down to how firmly one holds to their philosophy. Financial metrics are important but shouldn’t be the endgame. Re-assessment of how the metrics are driving dissatisfaction or satisfaction with the staff is crucial.
Measuring the effect of the business of medicine on caregivers in the healthcare system is not easy, but it shouldn’t be ignored. A work environment that is completely shielded from the metrics of business is not realistic. Nevertheless, caregivers in the healthcare system should partially be shielded from business metrics in a manner that strikes a delicate balance between the demands of the business of medicine and the well-being of caregivers to ultimately create sustainability and success for both healthcare institutions and the individuals working within them.
How can we foster a culture within the healthcare industry that values the human element, recognizing the importance of both financial stability and the satisfaction and fulfillment of medical professionals?
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