Feminize medicine for better health care


By guest blogger Daniel Hoffman:

The goals of national healthcare – greater access, better quality and lower cost – represent a three-headed monster. Appease one and the other two become more ferocious. Very few practical changes can simultaneously improve all three goals. One thing that can favorably affect the overall picture involves more of a cultural change than public policy, but in the long run it can do more than anything else that’s on the horizon. It involves making professional healthcare delivery into women’s work.

For most of its history, the pharmaceutical industry has been a hyper-masculine enclave, both in terms of the people who run it and its orientation to customers. That worked as long as the industry continued to develop breakthrough cures, while private and public payers were willing to automatically pay for new drugs. Both of those conditions began to fade within the past decade, thereby making it necessary for pharma to rethink the way it does business.  They can nudge their thinking along by looking at the innovative companies in consumer-packaged goods.

There is an old axiom in the hallways of companies such as Procter & Gamble and other packaged goods giants. The refrain is that while the liberal arts see mankind as the proper study for man, womankind represents the proper study for consumer goods marketers. Pharma would do well to ponder this notion.

For years pharma’s customer base consisted of physicians trained in overtly macho environments. While the approach was applied more heavily in some specialties such as surgery than in others, the general pattern of most residencies has resembled military boot camps far more closely than Junior League events. The process involves disorientation, degradation leading to identity breakdown, a regression to dependency, and identification with the aggressor. Interestingly enough, this macho resocializing has been as much a part of residency training in fields such as obstetrics-gynecology as thoracic surgery.

Changes in the economics of medical practice are making such paratrooper residencies as useful as socks on a rooster. The consolidation of practices and their acquisition by hospital-based systems mean that a constantly growing percentage of physicians will work as salaried employees. Physician-employees will help control healthcare costs because not every practitioner will be a businessman seeking to extract profits from the system. Employees following evidence-based protocols will also improve quality while more patients will gain access to larger, efficiently run operations.

Now if medicine becomes a 9-to-5 occupation, instead of one where alpha males, sons of doctors and wannabe CEOs can make seven figures a year, then the profession’s secure, steady work life will attract more working women who want to balance career and family. To the extent that women physicians will represent the rank and file customers for prescription drugs, pharma will have to address their needs, and these remain vastly different than the “techno-balls” demands of male physicians.

Pharma has two other customer groups. One consists of the people that decide formularies and treatment patterns for the outpatient practices owned by hospital-based systems. That is a business-to-business sell and, as such, it represents a fairly gender-neutral process. The final customer segment, of course, consists of consumers, where it’s a well-established fact that in most families, women make the healthcare choices.

So at least two of pharma’s three, major customer segments in this country are becoming increasingly feminine. By properly addressing their needs, pharma can do well for itself while helping achieve the larger goals of healthcare.

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