From Marcus Welby to House: How Did We Get There?

Originally posted March 21, 2013

By Steve Klasko, MD

In the 1960s, the quintessential doctor show featured Marcus Welby, MD: a primary care physician who made house calls, didn’t charge patients who couldn’t afford it, maybe even delivered a calf on the side of the road — all before performing difficult surgery on a young patient.

Fast forward to 2012, and we are treated to non-stop House, the drug-addicted, narcissistic (but brilliant) 21st century physician.

How did physicians go from saints to sinners so quickly in the public’s eye?

How did we physicians go from saints to sinners so quickly in the public’s eye? Solving that question has driven my research for the last ten years. Why do physicians resist change rather than lead transformation? How would we need to change the way we select and educate physicians to turn us back from Dr. Houses to Dr. Welbys?

As we now train physicians, we draw them into a cult. That cult is centered around four biases—competitive, autonomous, hierarchical and non-creative. A young medical student often begins his or her studies as an idealistic, optimistic overachiever, but by the end of the process, he or she often has lost those endearing qualities.

In 2012, we still accept medical students in this country based on their science GPA, ability to memorize organic chemistry formulas and scores on the MCATs. Yet somehow we are amazed that doctors are not more empathetic, communicative and creative.

As a practicing OB-GYN physician with a Wharton M.B.A., I have spent much of my career investigating why business leaders are so excited about change in healthcare and why those of us who actually have to live with and implement the change dread it. In one study, we compared physicians and M.B.A.s from around the country. We challenged the participants to participate in a “pheasant egg auction.” The rules of the auction were designed so that solving the problem required collaboration, creativity and navigating ambiguity. That was no problem for the MBAs; 82 percent of them reached an “everybody wins” scenario. But only 11% of the docs were able to find a solution.

In our “auction,” physicians seemed hesitant to risk cooperation, fearing a win/lose result that might make them look bad. In fact, doctors sometimes they would rather have everyone lose than give anyone else a chance to get more than his or her fair share. This autonomy bias is a significant liability in a health reform environment that increasingly calls for working partnerships and “teams” with a variety of playersin the health care arena.

So, no wonder, in a recent survey we completed, sixty percent of physicians practicing three years or less felt insecure about the future of medicine. They felt that they had learned half of what they needed to know. They learned microbiology and biochemistry, cardiology and surgery. But they didn’t learn how to manage change, effectively communicate, be an individual in an organization, be a leader (or a follower for that matter), make patients happy, run an effective meeting or market themselves or their practice.

Trying harder will not work. Changing systems of care will.

The Institute of Medicine, in their monograph on the “Quality of Healthcare in America,” stated that the “American healthcare delivery system is in need of fundamental change. Trying harder will not work. Changing systems of care will.” It is clear that the selection and education mechanisms that we have employed in our training of physicians in the last fifty years require a similar transformation.

Just about the time that Marcus Welby was airing his final episode, almost forty years ago, the USF Health Morsani College of Medicine was born. Some of the founding leaders of the college spoke of a more “holistic” approach to medical education. I am proud to say that today in 2012, USF Health is leading the charge for training 21st century leaders through a program we call SELECT (Scholarly Excellence, Leadership Experiences, Collaborative Training.) This program embraces the challenges of the Josiah Macy Jr. Foundation Report, which states that: “Medical education has not kept pace with the growing demands of an increasingly complex healthcare system. Medical students too often graduate without the knowledge and skills that 21st century physicians need and without fully appreciating the role that professional values, leadership competencies and attitudes play.”

Medical students from around the country are looking at the USF College of Medicine as a model for training for the future. In order to choose the students most likely to succeed in this environment, we have supplemented our SELECT admissions criteria. We are working with the Teleos Leadership Institute, founded by two Wharton scholars, to actively search for emotional intelligence characteristics of students — such as self-awareness, empathy and the ability to be a change catalyst– that make it most likely for them to be successful in a leadership role. Letters of recommendation will be replaced by one-on-one interviews probing for emotional intelligence traits and flaws, and we are utilizing a behavioral experience interview, commonly used in choosing business leaders and aviation pilots, to look for potential leadership experiences and traits. The end result is less reliance on science GPA and MCATs and more on parameters that will create physicians less prone to the “biases” of the past.

Since over 3,000 students apply to our program, choosing these future healthcare leaders is a great responsibility. We want to make sure that we have a futuristic curriculum that emphasizes leadership education, values and ethics and health systems and policy, so our students can become leaders in reforming healthcare.  Another unique aspect of our program is mentoring and coaching. There will be a summer internship between years one and two in which students will be expected to follow and interact with a leader of their choosing. This may be a physician entrepreneur, the state’s surgeon general or a health network medical officer. Each student will be given an opportunity to take a “minor” in business and entrepreneurship, health disparities, engineering, international medicine, law, medical humanities, public health or even medical writing or music.

The first goal, as in any uncertain journey, was to find the right partner. We decided that philosophy was more important than proximity, and so the SELECT program was born from parents who lived 1100 miles apart—USF in Tampa, Florida, and Lehigh Valley Health Network in Allentown, Pennsylvania

As a medical school dean, I don’t have much time to watch TV these days. But as one of those baby boomers who will eventually slow down and most likely become a consumer of healthcare services, I am hopeful that my future physicians will be empathetic, holistic, creative and caring. While they may not be able to memorize the Krebs cycle, they will have enough intelligence to know when to consult their iPhone 8.  And yes, I hope that the personality of Dr. House as a model of physician behavior becomes as dated as Dr. Marcus Welby might seem to us today.

Stephen Klasko, MD, MBA, is dean of the Morsani School of Medicine at the University of South Florida and CEO of USF Health. You can follow him on twitter at @sklasko or read his “Tomorrow’s Health” blog athttp://hscweb3.hsc.usf.edu/steveklasko/.

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