Samuel D. Evans, M.D., practiced medicine as an obstetrician/gynecologist for 20 years before taking on administrative duties at 300-bed Blount Memorial Hospital in Maryville, Tenn., where he has been medical director for a year and a half.
When he accepted the job, he knew he had a lot to learn about the business side of healthcare. So he began by taking physician leadership development courses sponsored by the American College of Physician Executives, Tampa, Fla., and the San Diego-based hospital alliance Premier.
Physicians in leadership roles have to know about management issues and how to interact with a team to accomplish goals, Evans says. Leadership classes can help them gain the skills they need.
But it's not just full-time physician administrators who are benefiting from such classes. Many courses also are aimed at practicing physicians who may have part-time leadership roles within their group practices or medical staffs, or who simply want to improve their office operations or participate in health system initiatives such as establishing clinical-care guidelines.
"These physicians are trying to create a bridge between two professions," says Hugh Gilmore, M.D., vice president of medical management for Memorial Hermann Healthcare System, Houston. "They already have an understanding of the clinical side, but it's necessary and important to begin to develop the knowledge and some of the skills of management."
Managed care is fueling the need for physician leaders and the programs that can help them become leaders, experts say, because physicians have been given an expanding role in caring for entire populations instead of focusing solely on independent episodes of care.
"Medical schools have socialized doctors to be independent contributors," says Steve Bloom, a psychologist with Somerville and Co., a Denver-based management consulting firm that works with physicians and other executives to enhance their leadership skills. "A physician in an operating room doesn't collaborate with nurses. It's much more of a command and control situation. They are the experts. The buck stops with them."
But outside the operating room physicians need to work with others as part of a team. Their contribution to decisionmaking within healthcare systems is imperative, so organizations are encouraging them to learn how to do it better, says Jim Roberts, senior vice president of clinical leadership at VHA, an Irving, Texas-based alliance of more than 1,500 healthcare organizations.
"Organizations see very clearly that physician leadership development is a core business strategy."
Most physician leadership classes are interactive and stress small-group work. For example, Evans built paper houses with other executives at a course offered by Premier and the J.L. Kellogg Graduate School of Management at Northwestern University in Evanston, Ill. The task taught participants how to think about and improve processes within a defined system, Evans says. "Everybody had to work together in order to get a larger number of houses produced in a quicker amount of time. It was fascinating."
Leadership classes usually cover some or all of these key issues:
Attending a leadership course helped David C. Pate, M.D., senior vice president at St. Luke's Episcopal Health System and medical director at St. Luke's Health Network in Houston, think about business issues in new ways.
In various administrative roles since 1993, Pate had relied on on-the-job training to make the transition from practicing clinician to executive before taking the leadership course offered by Premier and Kellogg. "There's a big demand and need for physician leaders, yet many of us are thrust into this without any formal training in medical management," he says.
In the program he learned how to apply a specific model to his strategic-planning efforts, use a framework to negotiate with others and approach marketing in different ways, he says. The lessons came from specific sessions and workshops as well as talking with other people taking the course.
Pate considered a number of factors when he began looking for a class that would fit into his schedule. His criteria: the reputation of the institution sponsoring the program, the credentials of the instructors, and whether the subject matter would directly apply to his responsibilities (see graphic this page).
The Premier/Kellogg program, which is offered in two one-week sessions, met Pate's needs. Another strong benefit of the class was that it included nurse executives and other healthcare administrators, Pate says. "That helped because I have to interact with physicians and nonphysicians (in my work)."
Joel Shalowitz, M.D., director of the Health Services Management Program at Kellogg, has trained hundreds of physician leaders in a variety of programs during the past 10 years. He says the number of participants has been growing in recent years.
Shalowitz says it's important that they take classes with nonphysician managers so they can understand the language of other executives and get different perspectives on issues, he says. "Physicians can work with others better if they understand how they think."
Kellogg puts together leadership development programs for several types of healthcare organizations. The Premier program is new. Other clients include healthcare systems, managed-care companies and insurers.
The ACPE also has been promoting business skills for physicians for years. That's the association's reason for being, and it's getting more important all of the time, says Howard Horwitz, director of professional development at the college. "As healthcare systems get larger and more complex, the stakes get pretty high, pretty fast."
Physicians, therefore, have to be prepared when they take on leadership roles, he says.
The organization sponsors about 65 education programs per year, including everything from entry-level seminars in communication to multiday classes on finance. Courses are held in all parts of the country.
VHA has recognized the need to help physicians strengthen their leadership skills as well. The alliance two years ago launched an education program that it brings to the sites of member organizations. Nearly 1,000 physicians across the country have taken the course, which is set up over a four-month time period, with classes held one weekend each month. The programs are tailored to what is happening within individual markets.
"We wanted to create a local program that is taught by national experts," VHA's Roberts says. "We believe that if we can bring relevant, practical, market-sensitive education to physicians where they work, they will become more knowledgeable and effective leaders, and that is our aim."
Covenant Health System in Knoxville, Tenn., twice has hosted the leadership program sponsored by VHA. The goal of the program is to equip physicians with an understanding of business processes and how to be a part of a team, says Les Hargrove, M.D., vice president of medical affairs at Covenant.
Kenneth R. O'Kelley, M.D., a partner with OB/GYN Consultants in Knoxville, is one of 55 people who have taken the class at Covenant. Because he had previously been involved in setting up clinical process guidelines for his group practice and for Covenant, the class reinforced why it is necessary to work with health systems and insurers to reduce practice variations and unnecessary costs, he says. "It made it clear that work on clinical guidelines, for example, is going to be very important. It helped enlighten me further about the things doctors need to be busy doing under managed care."
Some organizations offer their physicians in-house programs. For example, physician-network manager Vivra Specialty Partners of Plantation, Fla., has developed a training and mentoring program that matches those stepping into management roles in its networks with an experienced medical director. According to Jacob Lazarovic, M.D., vice president of business development and clinical quality, formal training consists of a half-day program that touches on such management issues as physician credentialing, clinical guidelines development and claims adjudication. Medical directors in the network spend 5% to 10% of their time on management duties, for which they are compensated. Lazarovic says balancing utilization issues and quality is the top priority for physicians who go through the training.
Vivra is a 2-year-old company that operates single-specialty networks and has $200 million in annualized revenues, 4,000 participating physicians and 11 million covered lives.
In another example, Sutter Health, Sacramento, Calif., runs a Leadership Lab three times a year for its physicians. Classes are kept small -- 10 students -- and, so far, 111 Sutter physicians have completed the course, about 25% of those for whom the course would be useful.
Physician leadership classes also are offered by universities and consulting firms that tailor programs to organizations' needs. Though he is not aware of any studies that track participation, Shalowitz says he personally has seen interest in the classes grow significantly in recent years. And despite the high cost of some of the programs, they are generally viewed as a good investment.
The Premier/Kellogg course costs $3,000 per participant. "That's fairly expensive," Evans says, "but worth every penny."
Covenant paid between $75,000 and $80,000 each time the VHA program was presented at the organization. Some physicians who have been through the course have been elected to medical staff office, Hargrove says.
Memorial Hermann soon will offer the VHA program to its physicians for the second time. "The better understanding our physicians have of what's happening in the healthcare market and the factors that are creating the changes we're experiencing, the more effective they can become as leaders," Gilmore says. "Those of us who have actually taken care of patients have the best understanding of how to offer efficient, effective care to the communities we serve. But we need to enhance and improve our knowledge of management, business and organizational dynamics to be more effective leaders."