Audio Transcript

The weekend is over. We’re back to work, and back to work thinking about work — particularly how we can be most fruitful by leaning on strong administrative structures that we need in place. We’ve never talked about this angle of leadership on the podcast. So it should be interesting. How do we build the structures we need so that we can fulfill our calling in the world?

The topic is relevant for ministries and relevant for Christian business leaders and relevant for health-care providers too. In fact, today’s question comes from a doctor, who writes this: “Dear Pastor John, I’ve greatly enjoyed Ask Pastor John over the years. Thank you for blessing and strengthening my faith in Jesus Christ. My question is this. I’m a doctor. I’ve tried to live and serve by 1 Peter 4:10–11. However, I’m also the practice owner. My family and our two dozen employees and their families all financially depend on the profitability of our practice. Increasingly, I find my thoughts and efforts consumed by the profit-seeking aspects of running a business. Biblically, is there a way for me to reconcile a God-honoring attention to patient care with my responsibility as a business owner to generate a profit so that employees can provide for their families?” Pastor John, what would you say to this doctor?

The answer to that last question is yes, there is a way to reconcile a God-honoring attention to patient care with the responsibility of the clinic owner to manage the affairs of the clinic in such a way that it remains financially viable — that is, remains in existence. It may be that you don’t need to talk primarily in categories of care versus profit, but maybe in the categories of clinic existence and clinic care.

Two Kinds of Care

In other words, perhaps the way to think of these two sides of the clinic’s life is that there are two kinds of care, not care versus something else, but two kinds of care that one must attend to in order for patients to be helped. One is the immediate care of diagnosis and treatment for all the maladies that people come to the clinic with, and the other kind of care is to see to it that the very possibility of diagnosis and treatment exists — namely, a clinic with doctors and the resources they require to do the healing work they’re called to do. These are really two forms of caring, aren’t they?

Now, admittedly, the one is more immediate and feels more like care, because the doctor or the nurse is sitting face to face with a sick patient and talking about how healing might be pursued. But if there were no clinic to come to, and no doctors and nurses and laboratory staff to follow through with, the diagnosis and the treatment wouldn’t have any effect, or they wouldn’t even happen.

So the more immediate care is dependent on the more general, broad, behind-the-scenes care, the business side of the clinic, which must take into account costs of rent, and utilities, and upkeep, and sophisticated medical devices, and receptionists, and scheduling, and insurance reports, and computer support, et cetera. One can feel why our friend would begin to feel submerged under that kind of demand, but they really are two essential forms of caregiving, even if it’s less direct in one way and more direct in another. If the clinic goes out of existence because of poor management, poor pricing structures, poor collections, poor planning for patient load, everyone suffers and care ceases.

Trellis Work, Vine Work

So let me say a word to the actual inner struggle the doctor is feeling as he wrestles with these two kinds of care. He says, “Increasingly, I find my thoughts and efforts consumed by the profit-seeking aspects of running a business.” Now, how many pastors, how many educators, teachers, how many leaders of inner-city ministries have felt this very same sense of being consumed by the financial and structural demands that undergird a ministry, on the one hand, while they long to be doing face-to-face, actual ministry or teaching or counseling to people, on the other hand? There’s nothing unique, it seems to me, about a medical practice in that kind of struggle. This is true of churches. It’s true of schools. It’s true of all kinds of ministries.

For example, a book was published some years ago by Colin Marshall and Tony Payne called The Trellis and the Vine. The description of the point of the book goes like this:

All Christian ministry [and you could say the same thing about a lot of secular service providers, I’m sure] is a mixture of trellis and vine. There is vine work: the prayerful preaching and teaching of the word of God to see people converted and to grow to maturity as disciples of Christ. . . . And there is trellis work: creating and maintaining the physical and organizational structures and programs that support the vine work and its growth.

And then the authors ask, “Has trellis work taken over for you in your ministry? Has it begun to consume you?” They say it does have the habit of doing that.

In Acts 6:1–7, the apostles were about to be overwhelmed, consumed by the demands of trellis work (providing the personnel and structures for the distribution of the food among the widows) when they needed to be giving themselves to the vine work of the word of God and prayer. And the remedy for that was the putting in place of gifted people who were really good at trellis work in order to free the apostles to do the vine work that they were called to do.

“The diversity of gifts for maintaining the viability of a clinic or a church or a school or a ministry is crucial.”

I recall, very personally, when our church got to a certain size, and I was about to be consumed, overwhelmed as the lead pastor, and we put in place for the first time in the history of the church an executive pastor alongside me, and that resulted, I would say, in twenty more years of flourishing as a staff and church. And then, eventually, we put in place financial specialists, who could handle all kinds of complex workings behind the scenes of a growing church, and so on.

All Christian ministry, and even secular service providers, is a mixture of trellis and vine. There’s vine work: hands-on, face-to-face meeting of people’s needs. And there’s trellis work: creating, maintaining the financial and organizational structures that support the vine work.

Four Words of Encouragement

So maybe I could sum up my counsel to this beleaguered doctor with four statements.

First, view both the trellis work and the vine work — the financial, structural work, and the diagnostic and treatment of patients face to face — as two kinds of love, two kinds of care.

Second, put in place gifted people who are really good at the kind of business management your clinic requires in order to free up medical staff to do their more immediate care. This is right at the heart of what Peter was saying in 1 Peter 4:10: “As each has received a gift, use it to serve one another, as good stewards of God’s varied grace.” The diversity of gifts for maintaining the viability of a clinic or a church or a school or a ministry is crucial. Pray that God would lead really gifted people to do the kind of specialized tasks that a complicated clinic — or business or ministry — requires.

“God will not honor the cutting of corners, the loss of integrity, in order to do good.”

Third, don’t ever do evil that good may come (Romans 3:8). That is, don’t try to justify dishonest business practices because they will keep the clinic alive for the sake of love, for the sake of patients and employees. God will not honor the cutting of corners, the loss of integrity, in order to do good. There’s always a way to help people by doing the right thing.

And finally, I would say, God has promised — he really has, and he keeps this promise — in Philippians 4:19 to meet all our needs “according to his riches in glory in Christ Jesus.” Trust him. Trust him to do that, and roll the burden that you feel for the complex side of this clinic — roll that burden onto the Lord. George Müller, who had to keep an infrastructure running to maintain thousands of orphans, used to say when people asked him about his peacefulness, “I rolled sixty burdens onto the Lord in prayer this morning.” I love that. I want to be like that.

So, God bless you for bearing the burden of a medical clinic that serves both patients and employees, both by its immediate medical care and by its trellis-like financial viability. May God give you the wisdom and the grace to put the people and the structures in place that enable you to do what you love to do and so find everybody flourishing in that great work.