Fundamental rethink of medical management is needed

EDITOR—Smith in his editorial on the rejection of the proposed consultant contract in England and Wales cites as a principal cause the widespread distrust among clinicians of hospital managers.1 In the same edition, Houghton et al identify a lack of adequate training in writing business plans, negotiating change, and getting things done as specific difficulties for newly appointed consultants.2

Clinicians are often thrust into senior management positions with major responsibilities for substantial budgets without the necessary financial know-how. A fundamental rethink of medical management is called for. What is needed is the development of a distinct career track in medical management at a much earlier stage, with the necessary management training on a par with that available in the commercial sector. This model has worked well in Australia. Such medical managerial posts will need adequate sessional commitments for these managers to provide a high quality of executive function. A professional cadre of medically qualified managers in touch with clinicians involved in the delivery of service, setting realistic targets for service delivery in partnership with lay hospital managers, might restore the trust of the medical profession and deliver the standards of care to which the government aspires. …