Does Clinical Specialist Training Prepare Doctors To Be Health Administrators?

This is a very interesting question. And indeed there is a lot of debate within the health corridors of PNG for sure. Does a clinical speciality training prepare a doctor to be a health administrator? I really do not think so.

The clinical speciality training prepare physicians to be the head, the consultant of the team in that particular field in a hospital. But there is no clear training done to equip trainee registrars with the knowledge and skills to be good administrators and managers. I know there are guidelines on what attitudes and behavior a registrar should develop in the course of his or her training. But formal lectures, course work or research on administrative roles? Nil.

And yet, specialist clinicians are expected to be administrators as well. Why is that?

Is this because they are consultants they are supposed to solve all the health problems in our nation? Is it an expectation from the public or from the medical fraternity? When the CEO of Port Moresby General Hospital was appointed (a non-medical person), the National Doctors Association of PNG voiced their disagreement on the appointment. Reason? He was not a specialist medical officer. In the public’s eye, specialist medical officers do not have a good track record of managing public hospitals. At least in Papua New Guinea. Some view it as the next step in their career after some years of being consultant specialist clinicians.

After attending the 2010 annual PNG Medical Society symposium and networking with friends, I realised that most of the specialist medical officers in PNG were now in administrative positions and there was a generation gap in some speciality areas. In fact some time last month, there was an article in one of the daily that there were no specialist clinicians in some hospitals to train registrars because they have been moved to the National Health Department! The kick back of this is that with the added public pressure of putting specialist medical officers in public hospitals in the country, we at risk of producing specialists who are not trained to the level we feel they need to be.

There seem to be an unwritten law that to be a health administrator/manager of a public hospital you must be a clinician with specialist training. Where did this come from? This mind-set is from old teachings/practises and it has to give way to new breed of doctors in PNG who want to see change happen.

I don’t think that for a doctor to be a health administrator or health manager in PNG they have to be a specialist clinician. Even though it seems administrators who are specialist medical officers seem to get more respect and there is a perception that their views and opinion have more value and insight to PNG health problems compared to that of a non specialist clinician in an administrative role. If we are to implement the National Health Plan, PNG doctors have to be better managers and administrators. That means they need to have specific training in that area, e.g. a MPH or MBA or a combined MPH/MBA degrees. There are now young PNG doctors doing such training and it should be encouraged and promoted.

Of course being a good administrator or manager not only depends on the training but certain attitudes and behavior. Especially how to deal with people. In essence, being a manager is managing people. And making sure they follow set procedures and protocols guided by specific rules/policies. Unfortunately the health department policies and procedures are not taught to registrars in PNG. Registrars learn them while on the job. And senior specialists have the fun of instilling required behavior and attitudes in registrars.

I was talking with a volunteer doctor from St. Vincent’s hospital who specialises in addiction medicine recently. And we were discussing this very issue of whether a specialist training in a clinical field prepare doctors to be good administrators. He told me that in China most manager’s position are filled by engineers. And you know why? Because they are very good at finding solution to problems! No talking. No discussing this or that. No meetings or workshops or conferences where you sit all day (and night sometimes) re-inventing the wheel. Engineers see a problem and calculate a solution to it. Simple as that. Logic. I was once talking with Dr Mathias Sapuri, former president of the PNG Medical Society and Former Executive Dean of the PNG School of Medicine and Health Sciences, and he said: “I see a problem and I fix it”.

The CEO of one of the biggest steel companies in American history, as told in “How to make friends”, by Dale Carnigie, made millions for the company because he was very good at finding solutions to problems. And yes, he was an engineer. Can medical practitioners become engineers? Problem solvers? Almost all medical graduates are very good science students so that’s a start.

So if you are considering a clinical specialist training to be a health administrator or manager some day, forget it. Consider training in MPH/MBA programs. Here is my tip for you to be a good health administrator or manager.

  • Remember you will be dealing with people, not robots who will respond exactly how you program them.
  • If there is a problem, define the problem in measurable terms and fix it.
  • How? Form a team and brain storm possible solutions to the problem.
  • Next, prioritize the solutions based on cost, effectiveness, resource availability, attainability (time constraints, deadlines) and availability of the right person with the right skills and knowledge required to solve the problem.
  • Next, implement the solution by assigning specific tasks to appointed persons. And set specific measurable targets and dates to assess where you are in the implementation process.
  • Review and re-assess your solution process with your team. Should you continue or change some processes/add resources/change personal?
  • Continue implementation process.
  • Review again as above.
  • Repeat this process with your team until the problem is solved.

But that’s just me. You may have a different management philosophy.


About rodney itaki

Medical doctor and public health specialist from Papua New Guinea.
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