Dr. Philip McKinley

The Rx for Doctor, Entrepreneur Communication: Improving global health care includes speaking the same language

Preface: There is a large range of altruism among physicians. In my experience teaching first- and second-year medical students at Duke University, more than 90 percent of the students enter medical school with the primary intent of helping others. There are those physicians with a burning desire in life to work in underdeveloped countries for little or no pay. My thoughts below refer to the majority of physicians in the U.S., and in other developed and developing countries whom I have encountered.

“What are your numbers?” was the first question from a young, affable entrepreneur to a slightly younger, non-American physician at the breakfast table one morning at the SEAD Conference. It’s a question definitely important in the context of innovative health care, but perhaps not the greeting the physician expected.

This brought to my mind the difficulty I have seen in communication between physicians and their MBA counterparts. In a medical setting, emphasizing patient numbers without emphasis on quality of care can be a disaster. Physicians, at least in many parts of the world, do not speak MBA jargon such as “lean processes,” “right skilling” and “scalable.”

Entrepreneurs may not think like, and therefore, may not understand physicians’ concerns and the medical culture that created their thought pattern. This can lead to miscommunication, engendering physician or administrator mistrust and possibly poor physician performance and retention.

Perhaps miscommunication emanates from the difference between the cultures of medicine and business. Physicians are an independent sort and when confronted by those outside the medical sphere, are guarded, if not suspicious. Tending perhaps to be relatively conservative compared to entrepreneurs, physicians have had to deal frequently with life and death in their training and work. Trying something new and/or unproven is not often in their vocabulary. It’s imperative that the medical information they receive is accurate. If right skilling of medical care allows less trained medical personnel to perform tests or procedures previously relegated to the physicians who rely on this data for patient care and outcomes, the physician may balk, even if this is cost effective. Trying to build a scalable business that right skills physicians, allowing less skilled and hence less expensive personnel to perform a job, may be important to the sustainability and growth of the enterprise, much to the physicians’ chagrin.

Physicians are also interested in their future and balance in their work and life outside of medicine. After having traveled the travails of medical corridors for at least eight years of rigorous, postgraduate education and training, which is sometimes demeaning and difficult, they may feel that they deserve to live a reasonable lifestyle relatively soon after graduation. They have delayed gratification and are willing to do so if they have a clear picture of their future. Setting up clear, definable and attainable goals for physician pay in writing at the onset of employment is very important to physician satisfaction. If a startup is focused excessively on owners’ profits without “reasonable” physician compensation, there may be backlash.

Pairing these individuals with perhaps younger and enthusiastic entrepreneurs can be a formula for conflict. Disruptive innovation with a focus on constantly moving forward is often the realm of entrepreneurs. They will find a way to succeed. This often leads to out-of-the-box thinking and innovation. Satisfaction for the entrepreneur may come with the ability to succeed in offering health care that was unavailable and previously thought too costly. Achieving what was thought impossible and against all odds can be a goal in itself, regardless of profits. Physicians should understand the goals of the administrators, owners and entrepreneurs. If the physicians are kept informed and regularly asked, they too can be a valuable source of innovation.

Both physicians and entrepreneurs, hopefully, are interested primarily in improving the lives of the medically underserved around the world. Entrepreneurs need the physicians and physicians need the entrepreneurs to make the medical enterprise function. Innovation, even disruptive and radical, if proven to provide equal or better quality of care, can be accepted and flourish. However, the quality of health care, must be maintained when challenging the health care norms of the community.

Communication on a regular and transparent basis is essential. Trust between the two groups built on honest and open communication is very important to form a workplace culture that fosters a sense of community and engenders a purpose greater than self in service to the underserved.

Dr. Philip McKinley, an ophthalmologist with more than 35 years of experience, is a mentor to health care innovators through the Social Entrepreneurship Accelerator at Duke (SEAD).

Education, Health Care
scale, skill development