Friday, July 31, 2015

60% of the CEOs of America's "Great Health Systems" Have No Educational Background in Health Care

We have noted that US health care has been taken over by generic managers.  A recent article about the CEOs of purportedly some of America's best hospitals provides some quantitative data.

A few days ago, Becker's Hospital Review published a list of the educational background of the CEOs of the "50 great health systems to know | 2015," (at least according to Becker's.  The article noted that their educational experiences took place at,

Ivy League schools, small liberal arts colleges, Big Ten universities, law schools, medical schools and more.

That is nice, but I decided to simply look at how many of the CEOs had educational backgrounds in medicine, other health care professions, public health, or the biomedical sciences.

Here is the breakdown of their most advanced degrees:

16 (32%) had medical doctorates
26 (52%) had a business administration degree, all but one at the master's level, and one a doctorate. 

The rest had various masters  and doctoral degrees in other fields. 

Note that two of the MDs also had MBAs, and one had a JD (law degree).

The business administration degrees included MBAs, but also degrees in health, hospital administration.  Of those with these degrees, one also had a bachelors degree in pharmacy, and one in biology.

One CEO was listed as attending a nursing school, but no degree or certificate from that experience was listed.


In any case, the majority, more than 60% of the CEOs of some of America's most prestigious hospitals (by at least one measure) clearly had no educational background in medicine, another health profession, public health, or biomedical science.  Again, this demonstrates that the top leaders of the top US health care organizations are more often management, rather than medicine, health professional.

This is corroborated by other observations.  In 1988, Alain Enthoven advocated in Theory and Practice of Managed Competition in Health Care Finance, a book published in the Netherlands, that to decrease health care costs it would be necessary to break up the "physicians' guild" and replace leadership by clinicians with leadership by managers (see 2006 post here). Thus from 1983 to 2000, the number of managers working in the US health care system grew 726%, while the number of physicians grew 39%, so the manager/physician ratio went from roughly one to six to one to one (see 2005 post here). As we noted here, the growth continued, so there are now 10 managers for every US physician.

Why is this a problem?   The managers who first took over health care may have had some health care background.  Now it seems that health care managers are decreasingly likely to have any health care background, and increasingly likely to be from the world of business.  Meanwhile, for a long time, business schools seem to have been teaching managers that they have a God given right to manage every organization and every aspect of society, regardless how little they know about what the particular context, business, calling, etc involves.  Presumably this is based on a faith or ideology that modern management tools are universally applicable and nigh onto supernatural in their powers.  Of course, there is not much evidence to support this, especially in health care.

We have discussed examples of bizarre proclamations by generic managers that seem to corroborate their belief in such divine powers.  Most recently, there was the multimillionaire hospital system CEO (who is on the list, and whose highest non-honorary degree is a masters in philosophy and political science) who proclaimed new artificial intelligence technology could replace doctors in short order (look here).    We have noted many cases of management of health care organizations that was ill-informed, and indifferent or even hostile to the core values of health professionals

I believe true health care reform would enable health care leadership by people who understand the actual care of patients, uphold health care professionals' values, and are willing to be accountable for putting patients' and the public's health first. 

But this sort of reform would challenge the interests of managers who are getting very rich off the current system.  (See some examples of grandiose executive compensation in health care here.)  So I expect lots of resistance to any proposals to push health care leaders to be more knowledgeable about health care and sympathetic to its values. 


Anonymous said...

I'm assuming your assertion would not be that only physicians should lead health care organizations? One would assume that a candidate with a Masters in Public Health, for example, might be acceptable? And one would hope that would then include years of increasingly responsible positions in health care organizations.

Roy M. Poses MD said...

Anonymous of 3 August, 2015,

I don't have rigid ideas about exactly what sort of experience and education top leaders of health care organizations should have. Obviously, physicians and nurses have explicit education in the science and practice of health care, and at least most physicians (and I think nurses) swear some sort of oath to uphold core values. Physicians and nurses who maintain US state licenses also must at least show they avoided doing egregious acts that violate core values.

An MPH could provide relevant training, depending on the particular courses taken and what practical experiences would be involved. Also, presumably people with predominantly business backgrounds could take courses and have structured clinical educational experiences that might work. But I also think that those who have not sworn oaths and are not subject to current professional licensing should have to somehow demonstrate their willingness to be accountable for upholding core professional values.

Having a history of "responsible positions" might be nice, but what sort of positions? Those responsible for actual clinical care? Or those responsible for marketing campaigns, public relations, finance, etc? Obviously, I would not count the latter.

Cynthia said...

I’ve noticed that an increasing number of hospital CEOs got their start as RNs, even if they worked only briefly as clinical nurses. This has resulted in a power shift in the hospital industry, IMO. More power has shifted away from physicians and towards nurses.

Even though I'm a nurse, I don't have many good things to say about nurses running hospitals. They tend to reward managerial skills over clinical skills. They create wasteful white elephant like "The Center of Nursing Excellence," which is nothing more than corporate welfare program for master's and doctorate prepared nurses. And most of all, they deserve most of the blame for hospitals becoming way too top heavy, which is causing administrative costs to outstrip the cost of providing care.

If I had my way, I'd turn the hospitals back over to the physicians. They tend to be less bureaucratic in the way they manage things. And they don't believe that it's beneath them to put their clinical skills to use from time to time. Nurses in middle management, much less the ones in the corporate suite, would never, ever stoop to doing clinical work!

Anonymous said...

Hospital CEO's should absolutely have experience and education as a nurse or physician! It's ludicrous to thing that a general business degree would result in the same level of informed decisions experience brings. We're going backwards folks!