Join host Patty Fahy, MD as she shares the evidence for why physicians must lead healthcare and lead us out of the current healthcare system morass. Patty has twenty years of experience working with leaders in healthcare—as a member of an executive team, founder of a successful coaching and consulting firm, and as a committed physician advocate. This podcast is for you if you want expert physician leaders at the helm of U.S. healthcare systems and if you want practical advice and critical conversations about honing the leadership skills of physicians.
The Licensed to Lead Podcast offers new angles on the neuroscience of leadership, challenges a “burnout industry” that is profiting from physician burnout, and offers a no-holds-barred investigation into the business school mindset that puts profits over patients. Patty and her guests provide provocative and clear recommendations for changing the business of medicine so that it fulfills the professional obligations of medicine.
The physician identity is deeply rooted in doing the right thing for patients. It is time for the financial preoccupation that arises from a business school mindset to be subordinated to the professional obligations we have to patients. Find out more about Patty and Fahy Consulting at LicensedtoLeadPodcast.com.
033 - Physician Autonomy: A Legal Perspective and a Blockchain Solution
Leah Houston, MD is a serial entrepreneur, emergency medicine physician, and activist. She is the founder of: HPEC: Humanistic Physician Empowerment Community is a platform physicians can use to own and store their own digital identity and credentials. A secure, self-sovereign identity is the foundation for restoring physician autonomy. (Find out why!)
EverCred: The system used by institutions to manage certification data and issue physician credentials that puts physicians in control of the primary source verification process.
Dr. Houston joins me on the podcast with Florida attorney Abbigail Webb. Ms. Webb raises an alarm about the loss of physician autonomy and points to the striking differences in professional autonomy between the medical profession and the legal profession. She raises questions about why non-physicians are in control of healthcare institutions and physician practices. She underscores how compromised physicians are in their ability to meet their fiduciary duty to patients because of the obvious conflicts of interest in healthcare systems run by non-physicians. In the U.S., only lawyers are allowed to own law firms—in marked contrast to ACA language (link to glossary below) that prohibits physicians from owning hospitals.
She draws additional comparisons between medicine and law:
•Legal oversight bodies such as State Bars and State Supreme Courts are made up of attorneys—unlike medicine where regulatory bodies have a variety of competing agendas creating oversight policies for the medical profession.
•Law firms are not publicly traded because lawyers are not allowed to be governed by or beholden to the interests of non-lawyer shareholders. Contrast that with the behemoth Fortune 50 healthcare systems driven by a profit motive, not medical professional values.
•Lawyers are not subject to non-compete clauses because it is deemed unethical to restrict clients’ ability to freely seek legal assistance from whomever they choose. The 70% of physicians who are employed are very often hamstrung in their career decision-making by non-compete clauses.
•The legal profession closely safeguards the practice of law, not allowing non-lawyers or paraprofessionals to hang out a legal shingle or use terms like lawyer, attorney, or Esq. Not so in medicine, where consumers and patients are unclear, sometimes misled, about who is a physician.
Ms. Webb believes quality of care for patients would be served by physician leadership of healthcare and she is an advocate for the digital solutions that Dr. Houston proposes.
What are those solutions?
Moving ownership of physician credentials to physicians themselves. This can be accomplished by storing credentials in an immutable, immediately accessible, blockchain wallet. A self-sovereign identity (SSI) means physicians themselves retain control and thus provide the primary source verification of their credentials and decide who has access and for how long. HPEC provides this capacity for physicians to have a wallet containing their credentials (and other digital assets). Dr. Houston’s other company, EverCred, provides a mechanism and platform for certifying bodies to issue credentials directly into decentralized identity wallet systems (like HPEC, but others as well—as long as they use rigorous established security standards). These systems are in development with pilot projects underway including a physician training program that is issuing credentials directly into HPEC.
The use of blockchain for establishing secure self-sovereign identities (SSI) for physicians opens the door to Dr. Houston’s bigger vision of physician autonomy and leadership. This includes: physicians creating their own referral networks; establishing patient records that belong to the patient (and not a healthcare system that uses patient data for their own profit-motivated purposes); and physicians establishing specialty-specific or other groups...
032 - A Voice for Physician Leadership: Essential, Courageous and Magical
My guest this week is national healthcare leader Dr. Jack Cochran. As CEO of the Permanente Federation, he was the top national leader for over 20,000 physicians who cared for more than 10 million people in their Kaiser Permanente medical practices. In this animated conversation, the inspiring and articulate Dr. Cochran describes his non-linear and unexpected path to executive leadership and international activism on behalf of excellent and accessible healthcare.
In his early days as a practicing plastic surgeon, Jack encountered the healthcare system in a different way when his parents became ill. As he says, “four years of medical school, six years of surgery residency, five years of practicing surgery, did nothing to prepare me to be the son of dying parents.” This pivotal time changed him. Jack’s appreciation for all caregivers, especially nurses, led to the creation of nursing programs and a nursing scholarship that has endured for 33 years.
We worked together when he was selected for his first CEO role which prompts Jack to recall both his trepidation and his gratitude during this initiation into leadership. Encouragement from well-respected leaders who had “courage, values and substance” inspired Jack to take on a role which he says he was not prepared for.
Quick to call himself naïve at the time, Jack began his executive role with a listening tour, speaking personally with 500 physicians, 4-5 at a time throughout the region. What Jack heard, was shaped into the 3 constants:
•Preserve and enhance the physician career
•Streamline the care process
•Optimize the care experience
Determined to change a failing culture, Jack thoughtfully selected his executive team. This diverse group was made up of passionate, respected clinicians who were determined to keep the patient at the center of their decisions. The “Colorado turnaround” resulted in transformation of the organization’s reputation, finances, quality, service—and at the root of it all—remarkably ramped-up physician engagement.
When asked how important physician leadership in the C-Suite is he pauses before he responds:
“I’m trying to find a way to be thoughtfully objective and I’m having trouble.
I think it’s essential. Essential.”
•Physicians are not more important, but we are disproportionately impactful.
•Medical education and the resulting MD and DO degrees are a “pluripotent professional preparation” for leadership.
•Difference has to be a differentiator.
•When you are offered a leadership role: Don’t lean your ladder against the wrong wall.
•Complexity has made specialty care more primary and primary care more special.
•Be very, very careful when people tell you what cannot be done. Be very suspect of advice that tells you exactly why things can't get done or won't get done… or are impossible.
Meet Jack Cochran, MD
Dr. Jack Cochran is an innovative leader who has inspired countless physicians and healthcare workers, and driven health care transformation on a national level. He is a plastic surgeon, acclaimed leader, author, consultant, and international speaker.
He led the Permanente Federation which represents the national interests of the regional Permanente Medical Groups, which employ 20,000 physicians caring for more than 10 million Kaiser Permanente members. During his tenure as CEO, Kaiser Permanente was recognized as a national leader in clinical quality by the Medicare Star program and the National Committee for Quality Assurance (NCQA).
Prior to his national role, Dr. Cochran served as Executive Medical Director, President, and Chairman of the Board of the Colorado Permanente Medical Group (CPMG). He led physicians through the transformation of a culture faced with financial challenges as well as declining membership, and poor physician and patient satisfaction.
Philanthropy has long been a part of...
031 - Jung's Physician Archetypes and the Loss of Meaning in Medicine
Lisa Marchiano is a Jungian psychoanalyst and cohost of the marvelous “This Jungian Life” podcast. We discuss Swiss psychiatrist Carl Jung’s work and the implications for physicians and the ailing medical profession.
Lisa explains that Jung believed: “We are all on a path toward wholeness. The goal of life is to become more whole—and when that path is blocked in some way, we get symptoms.”
Unlike the so-called manualized therapies (following a manual with techniques outlined for various diagnoses) there are no prescribed “techniques” in psychoanalysis. The conversation and the relationship that is created between the analyst and patient are the therapy. Lisa Marchiano says that the therapist doesn’t have the solution but rather it arises from the wisdom of the patient. “I see my job as creating the space where the patient and I can listen for that solution to come forward.”
Lisa offers this WHIRLWIND TOUR OF THE PSYCHE ACCORDING TO JUNG:
Persona: The mask we adopt based on our role (e.g., CEO or professor or caregiver). It is useful and socially adaptive and allows us to meet the demands of our culture but becomes a problem if we over-identify with a persona.
Ego: This is the conscious personality, when I say “I”— that’s the ego. It’s the part of our personality that gets stuff done and also manages our inner world of emotions.
Personal Unconscious: Things we’ve forgotten about or repressed but that still affect us and motivate us.
Collective Unconscious: A more mystical element of Jung’s framework which points to broad patterns of behavior and motifs (archetypes) that are not inherited from recent ancestors but are a priori and related to instincts.
The Self: A central non-verbal intelligence that is considered the unconscious guiding self or in Jung’s words: the God within.
The concept of the unconscious is central to Jung’s work. The process of becoming whole, or individuating, involves being open to the unconscious Self and bringing more of that content into consciousness. Because one access point to the unconscious is the content of dreams, most Jungian analysts pay close attention to patients’ dreams.
In this episode:
·Jung believed that most of his patients were suffering from a lack of meaning.
·“Ideally, physicians are well-placed to have a sense of meaning in this world- but that’s less and less true.”
·Medicine’s plight of systemization, corporatization and the loss of autonomy threatens the sense of meaning in this noble profession.
·There is protection in the transpersonal energy of the physician-patient relationship- but this ability to connect is disrupted in the dehumanizing setting of corporate medicine
·“When you're just a cog and told exactly what to do and you don't have any autonomy - could you still feel like that was meaningful?
·“Doctors should rise up- those with the heroic energy- and say we need to take this back.”
Meet Lisa Marchiano, LCSW, Certified Jungian Analyst:
Lisa Marchiano is a writer, Licensed Clinical Social Worker, and certified Jungian analyst in private practice in Philadelphia, Pennsylvania. She is the co-founder and co-host of the podcast This Jungian Life. She received her MSW from New York University and completed analytic training at the Inter-Regional Society of Jungian Analysts. Lisa is on the faculty of the Philadelphia Jung Institute. Her writings have appeared in Quillette, the journal Psychological Perspectives, and the Journal of Analytical Psychology. She has presented on Jungian topics across the US as well as in Europe. Lisa’s first book Motherhood: Facing and Finding Yourself explores motherhood as a catalyst for personal growth.
Lisa's webpage: https://lisamarchiano.com
To buy Lisa's book: a href="https://www.amazon.com/Motherhood-Finding-Yourself-Lisa-Marchiano/dp/1683646665"...
030 - Monetization of the Physician Imagination
This episode is a continuation of my animated conversation with Professor J.-C. Spender, a nuclear engineer-turned-business school professor, author, expert on the history of business education, and former executive and business school dean.
At the onset of episode #30 I asked Dr. Spender if getting an MBA degree would provide what’s needed if someone wanted to efficiently manage a healthcare organization.
His response was YES. But he added “that’s a kind of modified and slightly tangled yes.”
What I heard was “No.” Take a listen and see what you think.
Professor Spender’s contrarian penchant is delightful and provocative. He offers no instant gratification: no conversational closure rewarding me with a satisfying hit of dopamine. No schmoozy cooperation providing a squirt of oxytocin. The effect of this professor’s conversational style is attention—what IS he saying? How does this comment jive with that last one? Where are we headed?!
He paints a bleak picture when it comes to the management training or even the management potential of someone who has been awarded an MBA degree. Non-partisan in his criticism, he also deemed my assertion that physicians must lead healthcare as “a misdiagnosis.” And what did I hear with that? I heard that Dr. Spender’s primary interest is spotlighting the “multiplicity, the plurality of conversations, that is the fundamental challenge for leadership.” Agreed.
When it comes to leadership and management he would have us attend to:
•The history of business education--from whence the “b******t” came
•Practice (experience) vs. principles (rules)—and the true crucible of leadership when principles don’t serve us
•Uncertainty as the state which drives the engine of business
•The fundamental ethical problem of business: monetizing someone else’s imagination to serve oneself
•The lack of conversation in business school about human beings’ capacity for imagination—yet it is imagination which produces an organization’s value
In this episode:
•The balanced scorecard—developed as a remedy to the dominance of finance during board-level strategic conversations
•Business geniuses are those who flourish in business as an “artistic medium”
•The demise in popularity of managerial accounting and the ascendancy of financial accounting
•Clouding true intentions by invoking “trust” when monetization to satisfy shareholder demands is the business objective
•Economic discourse as an arena that is incapable of creating new economic value
•Tacit knowledge is knowledge derived more from practice than from principle
•Racism and oppression as actions to silence the language of entire communities
For more information including “A Glossary of Sorts” (aka Spenderisms) see the 11/9/21 newsletter
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029 - Medicine and Managerialism: A Clash of Values
J.-C. Spender, PhD, is an engineer-turned-business school professor, an author, an expert on the history of business education, and he’s a former business executive and business school dean. These credentials equip him to have insight into the goings-on of business schools and real expertise in the practical challenges of graduate business education. Dr. Spender has a distinct philosophical bent which surfaces in this episode (and more so in Part 2 of this interview—Episode #30). He sports a professorial persona, likely honed with endless graduate students, which means a few pugilistic remarks punctuate our conversation even when we are in “violent agreement.”
I asked him to come onto the LTL podcast to talk about Managerialism. He and Robert R. Locke co-wrote the book Confronting Managerialism—How the Business Elite and their Schools Threw our Lives out of Balance.
Dr. Spender makes it clear from the get-go that controversy related to managerialism must be seen in terms of conflicting values. By necessity, there are distinct values driving people who are involved in the financial or operational details of large organizations. He believes critics of managerialism might suffer from the delusion that it’s possible to run a complex organization without applying attention and resources to maintaining the multiplicity of needs of the enterprise itself. This “idiotic and fruitless” stance ignores the fact that friction between managers and professionals represents an inevitable clash of values.
In this episode Dr. Spender says “The issues of managerialism in the healthcare sector are extraordinarily important--they are the cutting edge of getting a sense of how on earth do we manage these systems?”
In this episode:
-Principles and theory—the scaffolding for the actual practice of a profession
-Tacit knowledge—you won’t escape this podcast without a clear picture of the critical nature of experiential learning
-Principles and theory must step aside to allow tacit knowledge, practice, and the “real you” to assert agency in times of uncertainty
-The mystifying chasm between the business community and business school curriculum
-The “deadly, fatal” loss of critique in academic business literature
-Business school faculty priorities: getting published, tenured, and pensioned
-Being “present” vs. sacrificing yourself to a principle
Meet J.-C. Spender, PhD
Dr. Spender is a Research Professor at Kozminski University, Warsaw; an Emeritus Research Fellow, Rutgers Institute for Ethical Leadership; and a Visiting Scholar with Fordham Center for Humanistic Management.
He served in Royal Navy submarines and he worked with Rolls-Royce on nuclear propulsion, IBM on financial computing, and as an investment banker before earning a PhD at the Manchester Business School (UK). He retired in 2003 as Dean of the School of Business & Technology at FIT/SUNY (New York).
He has published eight books, and over 100 journal articles and book chapters. His most recent book is Business Strategy: Managing Uncertainty, Opportunity, and Enterprise (Oxford UP 2014) which is his dissident view of strategy as a practice that includes the need to manage a business's creative responses to uncertainty. He also writes about the theory and ethics of the firm, business strategy, and the history of management education.
In 2014 he was awarded an honorary doctorate in economics by the Lund University School of Economics & Management. He is also Commissioning Editor for the Cambridge University Press Elements in Business Strategy.
For details of his current work, broader interests, and a detailed resume go to: https://jcspender.com/
For a Glossary of Sorts (aka Spenderisms) in this episode, read the 10/19/21 Licensed to Lead newsletter a...
028 - Corporate Practice of Medicine Laws: Employed Physician’s Remedy—or Nightmare?
What is the Corporate Practice of Medicine?
In this episode, Brad Adatto, a business law and healthcare attorney, takes us on a journey through the intent, implications, and risks associated with state laws that “ban” the corporate practice of medicine. He describes how these state laws arise from a variety of legal and regulatory sources, and prohibit corporations (or any “non-physicians”) from employing physicians or owning medical practices.
The Corporate Practice of Medicine Doctrine (CPMD) originated in the early 1900s and sought to prevent:
1. Commercialization of medicine or lay people profiting from physician practice
2. Business interests conflicting with the best interests of patients
3. Obligations of employment interfering with physician decision-making
How do the Corporate Practice of Medicine laws vary by state?
Widely! To further complicate the legal landscape—there are big variations in enforcement. Mr. Adatto divvies the states up into three categories:
1. Strict adherence: only physicians can own medical practices (example: New York)
2. Mixed: Physicians and non-physicians can co-own a medical practice as long as physicians own a majority (example: California)
3. Lenient: Anyone can own a medical practice (example: Florida)
How could a physician get in trouble with the Corporate Practice of Medicine?
Well, I have to admit, Mr. Adatto did not reassure me that Corporate Practice of Medicine Laws were the answer to my quest for bolstering physician leadership and physician autonomy. In his business law practice, he not only advises non-physician entities about how to avoid legal snarls—he also counsels physicians about how to stay out of trouble with the Corporate Practice of Medicine laws.
Here is some of his advice:
1. Do not assume “because everyone is doing it” your practice structure is legal.
2. Hit “pause” and hire a healthcare attorney to make sure the contract you are about to sign protects your interests AND is legal.
3. Have you been asked to be a Medical Director to help out a non-physician entrepreneur and make a few bucks yourself? Don’t be an “absentee” medical director just so a non-physician can check the “physician-run” box. It’s YOUR hard-earned license at risk if you are prosecuted for “aiding and abetting” violations of these laws.
4. Believe it or not, if you submit to corporate practices that could harm patients then you are putting your medical license at risk. Regardless of corporate pressure, poor staffing, prior authorization mandates, or practice management chaos—YOUR obligation is to protect the patient. (THIS is the stuff of burnout and moral injury.)
Wait a minute Brad Adatto—don’t all healthcare systems violate Corporate Practice of Medicine laws? How is this legal?
Our new friend of the show, healthcare legal whiz, and business law podcaster walks us through how corporatized medicine is allowed to exist:
1. Some states allow “not-for-profit” systems to employ physicians.
2. Management Services Organizations (MSOs) established by non-physicians (or physicians) can contract with physician groups through a Management Services Agreement (MSA). This structure gives non-physicians an opportunity to profit from medical practices.
3. Even with various exceptions, there must be no interference with the physician’s clinical decision-making. (After all, corporations are not allowed to practice medicine, right?)
Other questions that are answered in this podcast:
-How is a physician’s medical license like a Ferrari?
-Why is filing a lawsuit like driving at high speed and throwing your steering wheel out the window?
-Who is always ultimately responsible for patient care?
Meet guest, Brad Adatto, JD
Bradford E. Adatto is an...
Excellent for everyone
I am not a medical professional, but I love this show. It’s like peeking behind the curtain of how the world of medicine really works. Who knew there was so much sneaking around? Thank you for enlightening and educating me!
Patty Fahy MD, offers authentic content, rarely heard in healthcare.
A voice in the wilderness
Patty Fahy is a voice in the wilderness for physician leadership. Corporate MBA’s have overtaken health care in America to its detriment. The loss of autonomy for physicians has led to increased burnout and compromised patient care. Dr. Fahy presents a compelling case for the return of physician leadership. Anyone interested in the future of healthcare would be wise to listen to her words.