7.27.2009

How to Ease the Conflict Between Medicine and Money

Culture change is often the most difficult part of a lean transformation. That may be doubly true in healthcare, where culture – how people think – is already subject to significant stress.

This problem was highlighted recently in a thoughtful essay in The New York Times by Dr. Sandeep Jauhar, a cardiologist and author of the recent memoir “Intern: A Doctor’s Initiation.”

Jauhar is disturbed by the fact that, while doctors want to focus on medicine, too often they find themselves focusing on money.


The reality is that most doctors today, whether in academic or private practice, constantly have to think about money. Last January, Dr. Pamela Hartzband and Dr. Jerome Groopman, physicians at Beth Israel Deaconess Medical Center in Boston, wrote in The New England Journal of Medicine that “price tags are being applied to every aspect of a doctor’s day, creating an acute awareness of costs and reimbursement.” And they added, “Today’s medical students are being inducted into a culture in which their profession is seen increasingly in financial terms.”

The rising commercialism, driven in part by increasing expenses and decreasing reimbursement, has obvious consequences for the public: ballooning costs, fraying of the traditional doctor-patient relationship. What is not so obvious is the harmful effects on doctors themselves. We were trained to think like caregivers, not businesspeople. The constant intrusion of the marketplace is creating serious and deepening anxiety in the profession…

Financial considerations have never been as prominent as they are today, probably because so many hospitals and doctors, especially in large metropolitan areas, are in financial trouble. More and more doctors are trying to sell their practices, or are negotiating with hospitals for jobs, equipment or financial aid…

Among my colleagues I sense an emotional emptiness created by the relentless consideration of money…


Reforming healthcare involves many complex issues, including insurance and reimbursement systems as well as the needs of the uninsured.

Applying lean thinking to healthcare is one part of the solution. By giving doctors and other healthcare professionals the means to eliminate waste (and cost) from healthcare processes, while simultaneously maintaining or improving quality, perhaps we can help ease the sense of emptiness that Jauhar describes.

1 comments:

Dean Bliss said...

Great post, Ralph. This is one of the many cultural issues we are dealing with as we work to improve the healthcare delivery system. There are many - but there were also many in manufacturing when Lean efforts started in that industry. We just need to continue to identify and address these issues as they come up in the process of improvement.