The managerial revolution: medicine as a business

Medicine and management should be more closely integrated not just at the level of health policy and health services management but also in matters of professional education and training. Learning is a continuous process from entering medical school to retirement and should reflect the transition from learning shaped by the curriculum to learning driven by the needs of the qualified professional in a career service post. The senior clinician does much more than practise clinically. He or she is a leader, a manager, a resource allocator, a teacher and team player. In these roles the values and priorities of the professional and the organization will not always coincide. In postgraduate training and in continuing medical education more joint activity should be developed around 'medicine for non-medical managers' and 'management for doctors'. Much of this shared learning and development will be local and problem-based around local issues of quality, resources and priorities. However, the 'regional' postgraduate dean will play an increasingly pivotal role in maintaining the balance between the needs of the individual and the organization. To achieve this objective of closer integration postgraduate medical education funding should be brought together under a national finance levy against purchasers and allocated through devolved budgets managed by 'regional' postgraduate deans against explicit performance criteria agreed between the professional organizations, universities and health services management.