As medics of the future, we are asked to spend a lot of time contemplating our career but there are not enough of us willing, once we are doctors, to consider a career in hospital management according to a recent poll undertaken by The Hay Group.
Published by the Guardian, Kate Wilson claims that careers in leadership roles are associated with heavier workload, a lack of resources and assistance and an underlying mistrust in management. This is a culture we are all aware of, having sat silently through dimly lit MDT meetings, when one consultant jokes to another, “this is a problem of management, they’re useless”. While the concept of the MDT is a great step for inclusion, participation and for well-structured medical management of patients, it does not yet include any discussion of management of the hospital itself, decisions that may impact our friends, peers and colleagues.
The problem doesn’t just lie in the real world, so to speak. I doubt that many medical students, myself included, often dream of balancing their lives on the wards with an office-working alter-ego. This is the case for doctors too; with 51% of those that The Hay Group surveyed citing an unmanageable workload as a primary reason for disregarding leadership roles. We must also be aware that these roles aren’t advertised to any real degree during our time as undergraduates. We are never spoken to at length by or about management roles and, outside of an intercalated BSc in Management, this is unlikely to change. Medical students see the ceiling as Consultancy and show little interest in smashing it.
Personally, the issue of trust in management is one that I see often. In an increasingly thrifty NHS, the decisions to cut funding are seen as being made on high, in some divine boardroom, far removed from the wards. It is this removal that is most troubling, it galvanises a medical team against “management” and therefore widens the gap between the two tectonic entities. Human beings are very adept at being able to form clans, to form common enemies. Though we become consultants, we are happy to be part of this team, rather than assisting in leading it.
This tendency to confine Management to the crosshairs is undoubtedly a barrier to physicians bold enough to make the leap into these leadership roles. A BMJ article from April explains that doctors’ unwillingness to take up management roles is a familiar cry and one that has been simmering on for years. They interviewed Stephen Gillam, a GP and director of undergraduate public health teaching at Cambridge University who believes that opinions on management form early on in the training pathway. “It’s quite surprising how, even at that stage, [medical students and junior doctors] have well developed preconceptions about managers and management. Managers are often a target for discontent. It is important to instill a more positive attitude to management and obviate some of those negative stereotypes.”
It is apparent, therefore, that more must be done at the early stages, by targeting the student-in-gestation, to establish a positive rapport with management that avoids the target-driven, tyrannical image that so many easily recall when prompted. It is important to teach medical students that an input from clinicians at the highest level is integral to ensuring an increasingly streamlined NHS is still viable. At the same time, the NHS must realise that ttempting to rectify the problem amongst registrars and consultants is not a preventative measure and will never truly cure the management malaise in medical circles. Finally, we must accept too that some of us will, at some juncture, be required to cross the great divide and move away from focussing on the individual and look towards the ‘broad strokes’ approach that those tasked with management roles must consider.
Understanding what a leadership role entails, by frequent exposure during our training, will dispel the fear of the unknown and attempt to nullify the ‘Us vs. Them’ mentality that currently plagues the upper echelons of NHS management. Coupled with improved support and infrastructure, such a career may one day be the in-vogue vocation for the newly qualified doctor.