Dr. David Bowman was shopping for Brussels sprouts on a Saturday morning in January when he and his wife, Nancy, an intensive-care nurse, heard gunshots outside the Safeway store in Tucson, Ariz.
Moments later, they became first-responders at the shooting rampage in which six people were killed and 13 others—including U.S. Rep. Gabrielle Giffords (D-Ariz.)—were wounded.
While their quick work to triage the shooting victims won headlines, it is a different kind of leadership that gets Bowman noticed by his professional colleagues.
Bowman, 62, named the 2011 Physician Executive of the Year by the Medical Group Management Association and the American College of Medical Practice Executives, is executive director of the Tucson region of IPC The Hospitalist Co. In that role, he manages about 75 hospitalists working in several Tucson facilities—and takes shifts when needed.
He was recognized for the way he is guiding the physicians he works with to the future of healthcare.
If more physicians thought the way he thinks, the world would be a better place, says Todd Kislak, IPC's vice president of marketing and development. “There is nothing wrong with the healthcare industry that another 1,000 Dave Bowmans couldn't cure,” Kislak says.
Leadership means peering into the future, recognizing changes that are coming, preparing for those changes—and trying to influence them.
Like many healthcare leaders, Bowman forecasts that the industry's fee-for-service payment system is on its way out.
“It's not going to come to a screeching halt, but we are going to be paid for patterns of care for a population, rather than for an individual transactional event between one patient and one doctor,” he says. “And that's going to be a challenge.”
The physicians who are up for that challenge will be those who deliver the best possible care to their patients—and can prove it to their payers.
That means physicians' performance will be measured not by the volume of services they provide, but rather the value of those services. And, in Bowman's perspective, that means physicians should work to influence how they will be measured.
“Be prepared to be measured and ‘be prepared' means we should measure ourselves first and make sure that people who are measuring us know what they are doing,” he says. “Don't just sit back and allow it to happen. Go to the meetings, raise your hand, speak up—not in a paranoid, somebody-is-picking-on-me way—but in a constructive way that asks ‘wouldn't it be better if we did it this way?'”
Bowman also recognizes that the future belongs to hospital executives and physicians who can work together well. The power struggle in which physicians and administrators often engage doesn't wash with him.
“We are both after the same thing: What's the best for this patient and the other 300 patients in that facility?” he says. “We really preach hospital-physician alignment because we like working here … and in general, when people are trying to do the same thing, it's easy to come to common ground.”
Likewise, Bowman insists on the kind of communication with referring physicians that is essential to well-coordinated patient care. When a patient is discharged from the hospital, his or her primary-care physician and any specialists are automatically alerted to the patient's status, medications and other clinical data.
“If you're going to be one of us, this is the kind of work we do—not just curing sepsis, but communicating effectively,” Bowman says.
Bowman keeps track of whether his physicians are adhering to their communication responsibilities; failure to do so can result in losing part or all of their productivity bonus.
“If you play the game and do it right, you're going to benefit financially,” he says. “If not, it hurts you financially because you are not delivering good patient care.”
Bowman has been organizing physicians to work together since he completed his residency at the University of Arizona's Health Sciences Center in 1981. He started an internal medicine practice group that year and ran it until 1994, when he founded a large primary-care group in partnership with Carondelet Health Network.
In the mid-1980s, he helped start an independent practice association that created a local HMO. Later, he was a founding physician of a management services organization and a for-profit physician-hospital organization, both in partnership with Carondelet.
He had always gravitated to consultation work with inpatients and, when the hospitalist movement got under way, Bowman started spending more time in the hospital. By 1996, he was a full-time hospitalist working at two hospitals.
He joined IPC in 2000, when the company's Tucson presence consisted of fewer than a dozen hospitalists at three hospitals. Today, IPC's Tucson group has contracts with four acute-care hospitals and three long-term-care facilities, and it has grown to 55 full-time hospitalists and another 20 who work on an as-needed basis.
Bowman is a full-time administrator but he occasionally falls into the “as-needed” group.
“I am able to keep my clinical skills up only on nights, weekends and holidays because that's when they call me when someone cancels: ‘Bowman, what are you doing Saturday night?'” he says. “So I do clinical work, but I don't get to choose when the clinical work arrives.”
He has practiced at 429-bed Carondelet St. Mary's throughout his career. The hospitalists he oversees care for about 75% of the hospital's inpatients through an exclusive contract with Carondelet St. Mary's.
Those hospitalists are helping St. Mary's work toward its goals.
“They do understand the pressures that we are under and has done a phenomenal job of helping us be successful,” says Dr. Amy Beiter, the hospital's chief medical officer.
The hospital's average length of stay has fallen from 5.5 days combined for commercial and Medicare patients five years ago to 3.9 days for commercial patients and 4.3 days for Medicare patients currently.
The hospital's scores on Joint Commission core measures have risen and its mortality rate, particularly related to sepsis, has decreased. Bowman has influenced all those trends, she says.
“In all of those areas, he has been a leader in setting the expectations for his group—and it has trickled over to the other physicians as well—that this is the way we will provide care. We will be consistent and we will decrease variation,” Beiter says.
Bowman uses peer pressure and competition to motivate the hospitalists that he manages. He believes the only standard should be the highest one possible.
“You don't want to be OK; you want to be the best physician and group of physicians at that hospital. And we sort of preach that,” he says. “If people are at 98, why can't we get to 99?”
Lola Butcher is a freelancer healthcare writer in Springfield, Mo. Contact Butcher at lola@lolabutcher.com
