Power. Frustration. Self-determination. Income. Care standards. Health status improvement indexes. Benchmarking. Board memberships. New medical directorships.
Physician leadership at the dawn of the 21st century touches all these issues and more. While physicians over age 50 joke about joining a brother-in-law's plumbing business as a positive career move, a surprisingly high number of doctors really do quietly wonder if they would be better off in a nonpatient-care or even nonhealthcare role. This anxiety and frustration may be premature.
Assessments by integrated health systems, HMOs and the American College of Physician Executives indicate the past erosion of physician influence in U.S. health affairs has turned a corner. A new era of physician power seems increasingly likely, particularly if individual physicians conscientiously prepare for their new opportunities to lead, and if medical schools and journals increase their attention to the formal development of needed leadership knowledge, skills and attitudes.
Fifty years ago, most positions of influence in the U.S. healthcare sector were held by physicians. Today, in sharp contrast to many countries, most positions of power in healthcare are held by nonphysician managers and policymakers. Physician leaders were pushed--or chose to step--off to the side as business, finance and insurance specialists assumed positions of influence during the period of health-sector expansion in the 1960s, 1970s and 1980s.
The steady expansion of technology and organizational and managerial complexity of the past 20 years has simultaneously favored business and financial interests, while pushing the specialty-focused clinical interests toward the periphery. Now these same dynamics are leading to calls for a return to the physician "statesman" and to a modern health system designer/manager.
Recent surveys by the Medical Leadership Forum of the Governance Institute are identifying new leadership roles for physicians, and the knowledge, skills and attitudes required for success in these roles. Much of this innovation is being driven by the challenge of living within risk-sharing arrangements in integrated healthcare systems, HMOs and physician practice management companies.
These assessments indicate physician power increasingly will influence a diverse array of functional roles. Physicians are reasserting their weight to enhance the health of the entire population by shaping government policies and by re-examining medical-care delivery processes to improve both clinical outcomes and cost-effectiveness.
Physician leadership roles are not only focused on individual patient encounters, but also directed at new jobs located in new employer and organizational settings. Now physicians can move into executive roles in clinics but also in hospitals, HMOs, PPOs, management services organizations and even on television and in Congress (See chart, p. 62). Compensation for this expanded leadership comes both in the satisfaction of better patient care, improved health status for a community and in enhanced stock valuations and creative incentive compensation plans.
Where can we find the new experiments in physician influence? An estimated 1,000 hospitals have increased the number of physicians on their boards. Most of these organizations are adding full- and part-time medical directors.
Allina Health System, a Minneapolis-based pioneer in the creation of integrated networks, is redesigning its multisite physician clinic system to accommodate new risk management and risk-sharing arrangements. Scripps Health in San Diego is developing new physician executives beyond quality-of-care roles, including senior system management positions. PhyCor, a Nashville-based physician practice management company, is promoting and giving incentives to physician managers in managed care and physician-hospital joint ventures, as well as strong multispecialty group practices.
Henry Ford Health System, a well-established regional network headquartered in Detroit, has worked with several physician-focused systems to establish and support a national cooperative group, Group Practice Improvement Network, which champions innovation in the performance of physician systems. VHA and Premier networks are actively engaged in developing enhanced physician leadership skills and capacities. These organizations and scores more are scrambling to find, develop, support and reward new physician leadership. And in this way, new physician power is becoming evident throughout the U.S.
This new power, however, will need to be earned. Physician leadership success will be dependent on substantial investments to develop essential knowledge, skills and attitudes. Governance Institute studies have concluded the development of key attributes and skills should be the priority focus of physician leadership initiatives. Capturing these key success factors will need to occur in a variety of ways:
Only through such assertive development modes can we hope to see a sustained regeneration of physician power and influence for the 21st century.
Rice is a partner in the Governance Institute, a La Jolla, Calif.-based organization that provides information services to executives, physicians and trustees of healthcare organizations.