Should Physicians Run Health Departments?

This transcript has been edited for clarity.

I'm David Kerr, professor of cancer medicine at the University of Oxford. Today I'd like to pose a question to our community of Medscapers: Do we think that physicians make better health ministers? If we look at the complex world of politics or if we look at health policy, do we think that these areas are better managed by doctors?

An interesting article popped up recently in Lancet Oncology. It was a nice review in which the authors made some very, I thought, pungent points about how those who are most committed to cancer political policy have experience with the disease personally or through family.

They gave some excellent examples of committed campaigners in positions of political power who made a real impact, including Joyce Banda and others in sub-Saharan Africa. One could argue for Joe Biden, given his close, personal contact with cancer — though there is slight controversy here in terms of his current Medicaid proposals that might push a little against his desire to overcome cancer. But these are leaders of import and impact who've experienced cancer very closely and personally.

The authors draw some reasonable links between these leaders' personal life experiences and what happened in terms of their commitment to driving important cancer policies through.

They then go on to discuss whether it would be better if those delivering health policy had a strong background in cancer themselves. This is Lancet Oncology functioning, appropriately, as a cancer lobbyist, and they give some examples of physicians who became successful politicians and who delivered real, lasting, and impactful change.

They quote a great man and a great example to us all, the former president of Uruguay, Tabaré Vázquez. While leading that country, Vázquez imposed some of the most stringent anti-tobacco laws in the world with great success, in terms of reducing the number of his citizens who smoked.

He was a practicing oncologist. He continued to practice, God bless him, through his tenure as president. He had an interest in breast cancer because he had a strong family history of it. There was a collaboration between two worlds — physician and politics — and a very close family experience of cancer, which drove him to make great political change and truly benefit the citizens of this country.

Set against that, though, I've heard the discussion in my own set of health policy travels: Isn't it better to step back? Isn't it better to have a calmer, cooler pair of eyes rather than a doctor who is too close to the profession? Isn't it better to have someone from a different discipline and background who can examine the delivery of healthcare in a rather more intellectually divorced way?

There was an interesting article in the American Journal of Health Economics, written by two distinguished German health economists who looked at the German state healthcare delivery system in which the state ministers of health have enormous power over budgets.

Over a period of around 30 years, they looked at the output of hospitals, which is a commonly agreed metric for measuring the efficiency of hospitals, and they compared and contrasted that output depending on whether the ministers of health were physicians or came from a different profession.

Interestingly, they found that health ministers who were physicians were more successful in voting more money into the hospital system, and the hospitals responded to that increase in budget by hiring more physicians. Despite that increased budget and despite increased physician number, their metric of hospital efficiency of delivery of effective healthcare did not improve.

If you look at the input, such as money and new doctors, compared with output, actually, the health ministers who were physicians fared significantly less well than those who came from different professions. Not surprisingly, when measured, the physicians — whom one could argue benefited from this largesse — were much more supportive of having a physician health minister than the other way around.

There's another interesting argument that perhaps a degree of professional distance lends a degree of credibility, perhaps a cooler or a more divorced look at what the optimal model for delivering healthcare is. Nothing is ideal. There are heroes in all walks of life.

Jean-Paul Sartre's take on existentialism is that we need to look at the essence of the life that we lead, how we deliver it, and how our lived experience is what makes us the people that we are. We could take an existentialist approach to this as well.

I'd love your comments. What would you prefer? Would you prefer a minister of state who came from one of the health professions to lead health policy in your state or country? Or do you think it is better to have somebody who can come in and look with a different set of eyes to examine strengths and weaknesses, and perhaps be more impactful in improving overall the delivery of healthcare for one's citizens?

I'd be really interested in your comments. Thanks for listening. For the time being, Medscapers, over and out.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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