Hippocrates, MBAs, and Physician Leaders

Something rather remarkable apparently took place at the Harvard Business School just before graduation last week. According to Forswearing Greed: A Hippocratic Oath for Managers, which appeared in The Economist print edition of June 4, half the graduating class took an oath to advance the integrity, moderate personal ambition, and seek to make choices that serve the greater – rather than the individual’s – benefit. Having personally graduated from both pieces of training, I took the bait when The Economist connected the “MBA Oath” to the Hippocratic oath and figured there must be something worth connecting here. And there is. It has something to do with what sometimes happens when physicians become practice or organizational leaders with financial responsibility and accountability.

Purity or Split Personality?

More and more physicians these days either get MBAs or learn business and management on their own sufficiently to effectively manage multimillion-dollar practices, hospitals, or health-related businesses – often while practicing as well. I regularly write about some of the leadership challenges faced by physicians turned organizational moguls, however I never express much doubt about the financial acumen of these colleagues. My concern is usually about other skills or values that are required for success as business leaders.

The Economist editor makes the point that:

“A set of shared values is one of the defining features of a profession. Lawyers and doctors have their own codes, but business-school professors tend to embrace Milton Friedman’s claim that the only responsibility of business is to maximize profits.”

Reflecting on this I do find that something curious sometimes takes place when physician leaders become organizational or practice leaders. They become pretty tough business people – more than a match for hospital executives, contractors, vendors, etc. Profit maximization is something I hear a lot about when conversations turn to freestanding imaging centers, labs, surgi-centers, who will care for indigent patients, etc. And even younger physicians who are not in leadership positions (other than for their own families) are looking very carefully at the bottom line (in dollars and workload) before entering into any healing deals.

Profit is not inherently a bad thing. But sometimes it seems as though profit maximization runs as deep (or deeper) than the Hippocratic commitment to: “…preserve the purity of [our] life and [our] art.”

Good for the Patient or Good for the Wallet?

The Oath obligates us to “… prescribe regimens for the good of [our] patients according to [our] ability and [our] judgment and never do harm to anyone.”

As physician leaders seek economic profit maximization, is the patient always first? Is quality and safety always first? Or does some impurity sneak in there when business pragmatism supervenes and we are in financial negotiations? When it does, it always seems a little unbecoming to me. Especially when the tough negotiators are highly respected physicians who provide impeccably – sometimes legendary – patient care and attentiveness. Or promising young physicians who seem less attentive to the opportunity to serve than finding balance in their lives.

So when physician leaders are in roles of hard-nosed profit maximizers, are they behaving contrary to the Oath or merely outside of its purview? Does the Oath’s obligation cross over to our business roles, or do we, as do the nascent and pure MBAs, also need a supplemental Oath to: “serve the greater good”, “act with the utmost integrity” and guard against “decisions and behaviour that advance [our] own narrow ambitions, but harm the enterprise and the societies it serves?”

Both, And

Ideally, we should be able to both make a buck (or three), provide outstanding patient care, safety, and experience, seek the greater good when there is a choice between sufficient profit and more profit, all while preserving amicable – or even productive – relationships with other elements of the healthcare continuum. According to The Economist, supporters of the new MBA oath argue that:

“the goal of maximizing shareholder value has become a justification for short-termism and, in particular, rapid personal enrichment. They are concerned about managers doing things that drive up the share price quickly at the expense of a firm’s lasting health. Management gurus such as Jim “Good to Great” Collins argue that shareholders are likely to earn better returns in the long run if firms are led by managers with integrity and a desire to play a constructive role in society.”

Pie in the sky or the right talk before we groom a new generation of profit maximizers who, incidentally, do some healing when the risk-reward ratio favors it?