Metamorphosis to management.

Metamorphosis to Management

Traditionally, graduation marks a transition between two totally different lives. However, whatever the nonresidential program in administrative medicine at the University of Wisconsin is, it is not traditional. You are not leaving the academic cocoon for the first time. You are going back to where you were and to what you were doing. You are not, however, going back to who you were; you've been changed. You have changed from health care giver to health care administrator, from hands-on care giving to managing those who give the health care; from treating people one at a time to treating many at a time.

Was it a worthwhile trade, a good shift, this change of direction? Will it be a worthwhile career? I think so. In fact, it is an essential career. Health administration is vital to our society. Health care, which was once inexpensive, is now very expensive. Once simple, it is now complex. Once an individual affair, it is now more a team process and often the team is huge. It has gone from personal judgments about the individual patient to societal judgments concerning health insurance, the role of the government in health care, the values of the HMO and the PPO compared with those of the individual member, and even all the problems of rationing that have been so clearly accentuated in Oregon but are present everywhere.

It is no secret that the costs of health care are rising rapidly, but it's administrative costs that are rising fastest, that are causing us the most trouble. The payers' concern is with cost but even more so with cost effectiveness and the desire for quality assurance. At the same time, physicians are more and more concerned with the hassle, with the red tape, with the administrative complexity of dealing with the health care system.

The health system cannot run itself. It needs management and leadership and it needs lots of it. That takes lots of well-trained people. Who then should do it? Most of us already in this field simply worked our ways up. This is no longer possible. There are billions of dollars being spent. There are fast-moving changes in ethics, regulation, law, and systems of financing. More and more bankruptcies of HMOs, hospitals, and group practices are being reported. This is no time for on-the-job training. There is a need to merge the values of the health care giver with the knowledge and skills of the administrator. Either administrators must learn about health care or health care experts must learn administrative skills.

It is easier and more valuable to teach the nurse or the physician the knowledge and skills of administration than it is to try and inculcate health care values into an administrator. Today, you are making the official transition from hands on giver to the manager of others, but never forget what you started out to do at the beginning of your career. Your goal was to improve health, working as an individual then. You will be a group leader now, but the goal remains the same. The systems goal is health, not wealth; it's freedom from disease, not from debt. A positive bottom line is important, but it is the means to an end, not the end itself. So add your new skills to your old values, don't replace the old values with business values or with marketplace values.

As the "pilot model" of this educational program, you have a special responsibility. These two years at the University of Wisconsin should have taught you what you have to know to succeed. You have multiplied your opportunities to do good or evil. You have been taught what the program planners believe you needed to know. Were they the skills that you need in medical administration? Were things taught that you won't need? Were things left untaught that you will need? The program you have just completed will have to be tested for its validity. All tests themselves must be looked at for their validity. Does an examination in, say, orthopedic surgery really separate those who are best qualified to practice that specialty from those who are not qualified. If it does, the test is valid. In the same sense, we must look at the training in this administrative medicine program and ask if it was valid for the tasks that you will be performing. That is, will it pass the standards of reality testing.

There may be 20 different realities for the persons in this class. Nevertheless, each of you should ask whether the skills you were taught are the skills you need in order to be efficient in health care management and were they taught to you in an efficient way. Both the content and the methodology of the program need to be looked at. Was the method of teaching the least disruptive of your life, the least stressful to family, career, and health? Of course, this information is important to the University of Wisconsin program, but it is also vital for the rest of the country.

In this country, 15,000 doctors have listed themselves as administrators although few have had any of the training they need to be effective and to serve the health care system well. Their success and the success of the health care system requires them to have that training. On-the-job training isn't enough any more. The system is too complex, the changes are too rapid, and bankruptcy is too close. The training must be done right, it must be efficient.

Your graduation is a personal transition for each of you. But your graduation is also an educational transition from traditional residential programs to this new program. This program is new for the University of Wisconsin and for the country. Your charge is to go forth and perform and also to go forth and evaluate, to be an ongoing part of the continuous improvement of this and other programs. Even if the program was designed perfectly on the first attempt, the rapidly changing health care system will demand continuous program changes.

In accrediting continuing medical education, the ACCME asks each program to do a needs assessment test. What is it the persons going through this program really need to know? We ask that each program write out good objectives so that the physician who will attend the program knows what to expect. Who should attend the program, and how they will be different at the end? Did you know what this program would be like when you started out in it two years ago? And we ask that there be ongoing evaluation and constant feedback to improve the program. We ask that you participate in all of these functions to continuously improve this administrative medicine program.

You have done a great deal already, but a great deal more is desired of you. You have earned congratulations on your personal accomplishments and on your group accomplishment as the pilot class. Pioneers don't have it easy. But you showed it can be done. You have made it easier for all those who will follow here and elsewhere. Each of you and all of you together deserve the gratitude and admiration of all of us in health administration.