Edward Lowenstein, M.D., could serve as the mold for physicians in charge of group practices.
As president and chief executive officer of Orlando (Fla.) Health Care Group, Lowenstein works part time as a clinician, draws no perks with his salary, has no management degree and considers communication with his staff to be the most important--and enjoyable--part of his job.
That Lowenstein's experience as a physician CEO is typical is borne out in a survey conducted recently by Tampa, Fla.-based Physician Executive Management Center. The physician executive search company polled physician CEOs of group practices to find out about their compensation, education and other facets of their working life.
Based on his experience as a recruiter, David Kirschman, president of Physician Executive Management Center, says, conservatively, about 25% of group practices are led by physicians. With that percentage increasing, according to Kirschman, some of his clients pushed him to put together a snapshot of the typical physician CEO.
Because he received responses from just 50 of the 129 physician CEOs to whom he sent surveys, even Kirschman isn't sure the results can be considered scientific.
Nevertheless, Lowenstein says the center's survey is the first and best information collected regarding physician-led group practices.
"Some of us drove David to do this survey so we'd have some decent data," says Lowenstein, who leads a 90-physician multispecialty practice.
The physician executives responding to the survey were between ages 43 and 76, spent an average of 16 years in clinical practice before entering management and all were male. They lead groups of between 38 and 300 physicians. Surveys were received last fall and summer.
Among the findings:
Given the number of physicians with either short or nonexistent contracts, plus the number without parachute agreements, Kirschman wonders whether they were working without a net.
"It's my perception that the more volatile the job, the more protective people ought to be" of CEOs, Kirschman says. "If the board fires them tomorrow, (contractually) they're out in the street. No private company would do that."
But no record exists yet of group practice boards of directors getting rid of their physician CEOs in the style of New York Yankees owner George Steinbrenner and his many managers--early and often. That's a reflection of the comfort level group practices have with physicians in charge, Kirschman says.
"The implication is that the (CEO's) priority is the clinical side," Kirschman says.
Earning the trust and credibility of their doctors is why many physician CEOs don't get perks like company cars and golf club memberships, and why they continue to work as clinicians. Lowenstein, who has been president of Orlando Health Care for 13 years, says a physician CEO must be "out in front, but there can't be much distance" from the doctors in the practice.
In fact, most physician CEOs said the most important, and pleasurable, part of their job is meeting with and leading their staff.
"It's part of the guild mentality: 'We will follow because he's one of us,"' Lowenstein says.
However, if the experience of CareNet Systems President Jim Greer, M.D., is any indication, the guild model may be on the decline.
At Columbus, Ohio-based CareNet, Greer negotiates contracts annually that include bonuses and parachute agreements, but he performs no clinical work. Greer joined CareNet at its founding in 1995 as part of an integrated health system run by the three-hospital Mount Carmel Hospital System. His new role differs from his previous group-practice CEO post at Wichita (Kan.) Clinic.
"In group practices of long standing, obviously there's a history and culture," says Greer, who oversees 55 staff physicians and about 180 others contracted through the hospital's management service organization. "Especially in a multispecialty group, it's important to have the white clinical coat. In those environments, it's difficult to see your brethren get bonuses and perks the others don't have."
Because CareNet was a new organization, "I would not have entered without a contract and parachute deal," Greer says. At Wichita, Greer would have had a chance to stay on as a clinician had he failed as an executive.
Greer tried to bolster his management knowledge while he was in Wichita by earning a master's degree in business administration from the city's Friends University. However, most physician CEOs surveyed aren't following Greer's example, even though they think getting some sort of business training would be a good idea.
About 18% of the physician CEOs surveyed have an advanced management degree, and 6% are working on one. A lack of time prevents many from going back to school, Kirschman says. Others, like Lowenstein, occasionally take classes through organizations such as the American College of Physician Executives to stay current on business trends.
Only one-third said it would be a good idea for other physician CEOs to have an advanced management degree. Many recommended aspiring leaders take other management positions within group practices to gain experience and knowledge.
Some physician CEOs did acknowledge that a lack of education and experience is their greatest disadvantage. However, not many were concerned; half the CEOs polled said there was no downside to having a physician at the top.