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by Nick Jacobs

The book, Eat the Rich, by P.J. O’Rourke, is a funny tale of money. Well, it makes money both interesting and funny. Mr. O’Rourke is a witty story teller who makes learning fun. One interesting chapter in the book explains Hong Kong. He states: “The British Colonial government turned Hong Kong into an economic miracle by doing nothing. Hong Kong is the best contemporary example of laissez-faire. The economic theory of “allow to do” holds that all sorts of doings ought, indeed, to be allowed, and that government should interfere only to keep the peace, ensure legal rights and protect property.”

While recently pouring through numerous professional journals this week-end, the memory of this paragraph struck me during my reading as one continuous theme continued to emerge, the need to align physician-hospital relations. What this phrase really means is that the physicians want to find more and better ways to make more and better money, and the hospital CEO’s are trying to avoid having their hospitals eviscerated from the exodus of these medical entrepreneurs.

Many of the O’s are desperately trying to control these situations completely in what is most assuredly not a laissez-faire manner. The primary concern of some of our peers seems to be that these creative docs, like the ophthalmologists, plastic surgeons, and heart teams have already done, will skim the cream payers off the top and leave the hospitals with the critically sick and underinsured.” Surely, this could happen and has happened, but the innovators in our field have found completely different paths to successful partnerships.

As some of our peers run in small circles chasing the future through the past, it is clear that there is a need to look at this challenge in a much different manner. It is our belief that innovation will always win. Innovation, co-operation, patience, courtesy and open discussions are the keys to physician-hospital relationships. It is not the use of raw power, control, bullying, and vindictiveness that will create the necessary results. As this new movement morphs more quickly and creatively, those of us in hospital administration need to be there supporting, suggesting and sharing our ideas, strengths and weaknesses. The deals should always be based on a formula that one plus one equals three. What was is no longer, and what will be is yet to be seen.

How do you stop physicians from being entrepreneurial? You don’t. You encourage them, work with them, and explore their propositions. Yes, it may sometimes be trying as they attempt to learn about the pitfalls of what seem like certain “no brainer” business decisions that are unmanageable or just not feasible in the current health care environment, but these are gifted individuals with a lot at stake.

Look into your crystal ball and realize that whatever was is no more. Whatever is, will not be, and only partners can make a future that is sustainable for both.

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