Doctors Power
Neither Waxing nor Waning:
The changing power of the
omnipresent group
EHMA Annual Conference, Athens, June 2008
M. HEMADRI
MBBS (Madras) FRCS (Edinburgh) MBA (Leicester)
In this presentation…..
 Using
Porters 5 forces tool
 An analysis of NHS consultants powers
 Reveal doctors’ omnipresence in
healthcare
 Doctors’ and change: dealing & controlling
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Porters Five Forces
Wikipedia image
Five Forces Analysis assumes that there are five important forces that determine
competitive power in a situation
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Impact of NHS Consultants on
Porter’s Five Forces
Threat of New Entry
High Cost
Tough Regulation
Specialist knowledge
Supplier Power
NHS
Private hospitals
Private clinics
Intensity of Rivalry
Number of players
Quality
Patient loyalty
Threat of substitution
Medical tourism
Telemedicine
Alternative medicine
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Buyer Power
Patients
Private hospitals
Commissioning
Supplier Power
 NHS
major supplier
 Private hospitals minor supplier
 Private individuals very minor supplier
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Supplier Power
What is supplied?

Access pathways

Consultations
Tests
Drugs
Surgery
Follow up
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
Who really decides?

Single-visit, one-stop,
two-stop, direct to test etc

Five major PPIs
Dozen different hernia
meshes
Frequency, need, type


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Buyer Power
 Who
is the real
buyer?
 Patient?
 Commissioners?
 Private Hospitals
 Insurance
companies
Patients?
Self pay patient
Waiting list patient
Insurance patient
Cost restraining
buyer power?
Private Hospitals
Buy work
NHS CONSULTANTS
Recommend the hospital for private patients
Go to private hospital for NHS w/l patients
Power to bar
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Barriers to new entry
 Cost
 Regulations
 Limited
specialist manpower
 Legal
 Impossibility
of introducing radically new
models
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Doctors dealing with reduced barriers
EU
EWTD - Bane
Calman
MMC
PMETB
Non EU recruitment
Government
Driven
changes
INCREASED NUMBERS
Dilution Efforts?
Narrow subspecialisation
EWTD – Boon
New activity
Registration Vs Job
Consultant
Driven
Changes
Consultant inputs
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Balancing Efforts?
Threat of substitutes
THE CHALLENGE

THE RESOLUTION
Physicians assistants
 Anaesthesia practitioners
 Surgical practitioners
 Sonographers
 Nurse led clinics
 Remote diagnostics
 Technology
 Patient empowerment
 Medical Tourism
 Alternative Medicine

Non independent
environment, parallel
service, very limited role,
very limited numbers


Pathology reporting
Radiology reporting
Ethics & Emotion

BMAS

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Intensity of rivalry: LOW

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Specialisation
Regional
Cross ‘ownership’ of NHS & private patients
Chambers, cartels, group practice
Dominant NHS
Strong, vocal, respected Trade Union
Strong vocal respected national specialty
associations/Royal Colleges
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Is it that a problem?
 Uniformity
 Less
of a commercial agenda
 Reputation for standards
 The
strong NHS shadow on private care
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WHY?
 Expertise
 Scarcity
 Image
 Other
 What
is in a name? (Employer, employee
or consultant)
 Where does the loyalty rest?
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Trainer – Boss Dualism



MBA
IT
Pilots



Army
Engineering
Finance
Teacher/Trainer – Boss - Colleague
Synchronism
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Plan – Execute Dualism
Board – Managers – Workers
 MOD – Generals - Soldiers

Plan – Execute Synchronism
 NHS

Consultants
Pilots
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Inferences
 Doctors
powers are not waxing or waning
 Due to their omnipresence in the healthcare
 The healthcare industry has changed, doctors
powers within healthcare have changed
 Doctors ability to control the changes and the
changed environment remains largely intact
 New and innovative management paradigms
may be needed to deal with such unique
groups
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THANK YOU