Can you imagine Bill Gates as the new Apple CEO while holding his position at Microsoft? Or a manager working for BurgerKing and responsible for a McDonald’s restaurant? Or Cristiano Ronaldo playing for Juve, Milan, and Internazionale at the same time?
These cases may sound awkward, but you would not feel surprised if you were seen by a doctor who works in the three largest private hospitals in Lisbon. Physicians who work at only one hospital are more of an exception than a rule.
The reason why the market has shaped itself in this way is non-trivial. Moreover, we know little about how this impacts healthcare performance. We may guess it involves at least three aspects: the diffusion of knowledge and practices; the role of social relations and reputation; and the presence of some perverse incentives that may be hidden within this arrangement.
Each dot represents a healthcare facility in the Brazilian city of Porto Velho. Lines are doctors shared by facilities. Line’s thickness indicates the number of doctors shared.
The academic training of a doctor never ceases with the conclusion of their university degree. The medical residency itself indicates that it is in the work place that the physician absorbs much of the medical practice. Also, at that time they have contact with topics that end up not being covered by academic training such as soft skills[i].
Most of physician’s improvement occurs in the professional environment as a patient care outcome rather than motivated by competence improvement personal goals[ii]. Furthermore, it is through discussions with colleagues about patients that much of the learning takes place.
Adam Key tells an anecdote in his book “This Is Going to Hurt: Secret Diaries of a Junior Doctor” that illustrates this point.
At lunch, in the doctors’ room, sharing stories of nonsense “symptoms”: sudden improvement in hearing, arm pain during urination, and someone sweating from only half of their face. After this last symptom there is a silence in the room. After a while, one asks: So, it was Horner’s Syndrome? The doctor rushed to call his patient…
It seems reasonable to conjecture that physician’s interaction among multiple healthcare facilities can be beneficial to practice-based learning.
Websites such as Portal da Queixa, in Portugal, and Reclame Aqui, in Brazil, have created a mechanism for publicizing the reputation of medical services. Surely, this is a huge advantage for good professionals who can now differentiate themselves from those who provide a poor service.
However, these mechanisms are not always able to truly reflect patient dissatisfaction[iii].
Then, mouth-to-mouth dissemination of the physicians’ behavior becomes relevant as an informal mechanism to deal with poor care. Physicians working in several hospitals create a dense network and make the dissemination of reputation testimonials exponential.
Some perverse incentives may be hidden in each highlighted topic.
Firstly, there is the risk of disclosure of sensitive and strategic information to competitors. After all, a doctor working daily in two companies, sometimes even in management positions, may face moral dilemmas about sharing information.
Secondly, social relations may also be the first step to corporativism. Then, a credibility mechanism becomes a strategy to smooth things over, hiding peers’ bad behavior.
It makes no sense to have Ronaldo playing in both Juve and Inter. However, Medicine may have good reasons not to follow this rule. We also should ask ourselves whether this open-to-share arrangement can be replicated in other segments. Software Engineers, Data Scientists, and Designers may have much more to offer if they are not limited to work at one place. For the record, a sharing economy may not be only about consumers sharing goods and services but also organizations sharing resources.
[i] Arthur Lazarus, M. D. (2013). Soften up: the importance of soft skills for job success. Physician executive, 39(5), 40.
[ii] Van de Wiel, M. W., Van den Bossche, P., Janssen, S., & Jossberger, H. (2011). Exploring deliberate practice in medicine: how do physicians learn in the workplace?. Advances in health sciences education, 16(1), 81–95.
[iii] Widmer, R. J., Maurer, M. J., Nayar, V. R., Aase, L. A., Wald, J. T., Kotsenas, A. L., … & Pruthi, S. (2018, April). Online physician reviews do not reflect patient satisfaction survey responses. In Mayo Clinic Proceedings (Vol. 93, №4, pp. 453–457). Elsevier.
Nova SBE PhD Alumnus, and a former member of Nova SBE Health Economics & Management Knowledge Center. Today, Daniel is a Researcher at Rede Transparência & Sustentabilidade, in Brazil.Website
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