The best way to care for patients, many physicians are coming to believe, is to leave clinical practice and assume leadership positions in healthcare organizations. But that transition is easier said than done.
Accustomed to being in charge and making decisions quickly, physician executives must adjust to being team players who think long-term. And they must learn an entirely new skill set--the tools of the business world--before they can be effective.
For those making the transition to management, a mentor or access to other training resources can ease the process, but often such aids are not readily available.
"Physicians are trying to influence healthcare organizations in such a way that the bottom line is not the focus," says Roger Schenke, executive vice president of the American College of Physician Executives in Tampa, Fla. Membership in his organization began to grow in the mid-1980s, around the time managed care began to flourish, he says, then exploded last decade, leaping from 5,711 members in 1990 to 13,200 members in 1999.
Much of the organization's focus is on providing programs that offer business and management skills leading to certification as a medical executive.
As physicians expand their administrative roles, they are moving beyond traditional physician management positions, such as department chairman or medical director, Schenke says. These physicians are specializing in areas that require special competence--taking roles as the chief of medical informatics, clinical guidelines, health populations or electronic medical records, for example.
"The physician executive brings an understanding that the primary responsibility of management is to balance the financial health of the institution with the well-being of the patients, the welfare of its employees and (the need to be) a good neighbor in the community," Schenke says. When enough physicians achieve management positions, Schenke asserts that "they will make a significant difference" in the healthcare industry.
Greg Taylor, M.D., thinks he is making a difference in his position. Taylor practiced emergency medicine for 11 years before earning his master's in health administration and joining Cape Fear Valley Medical Center in Fayetteville, N.C., as the first medical director for the 800-bed regional referral center.
Taylor encourages physicians to get clinical experience before assuming management positions and to find a mentor to coach them through the transition because he benefited from having a mentor himself.
"What's wonderful about this job," Taylor says, "is I have the opportunity to have an impact on healthcare on a much more global level." He serves as the liaison between medical staff, senior management and the board of trustees, overseeing quality assurance, credentialing, discharge planning, utilization management, re-engineering, recruitment, contracting, conflict resolution, and much more.
"The reward systems are completely different," he continues. "In clinical medicine, you get immediate gratification and feedback. In management, the gratification is somewhat more delayed. But the opportunity to change strategically the direction of an organization and to provide healthcare to a community and a defined population is where the satisfaction comes from."
Taylor notes that physicians tend to be independent and enjoy working one-on-one with patients. But in management positions, they must learn to work as a group.
Conflict resolution, written and verbal communications, and knowledge of both financial and information systems are necessary skills.
Physician leaders also must balance their allegiances so neither clinicians nor administrators view them skeptically. "There is the real potential to be a split personality (where doctors ask themselves), 'Am I a clinician or administrator?' " Taylor says. "I focus on the patient, and whether that puts me on the side with the physicians or management is really secondary to me." Physicians fail to successfully make the transition to management positions, Taylor says, when they think their role is only to represent physicians.
V. Hugh Gilmore, M.D., vice president of clinical affairs for Memorial Hermann Healthcare System in Houston, says most physician executives "are still on the learning curve when we move into these roles, especially if we're the first one to accept a particular role in an organization.
"Mentoring is really challenging at this point because the pool of experienced physician executives is still relatively thin across the industry," Gilmore says.
"We (current physician executives) all have some mentors who are nonclinicians, but it really is special to have and find a mentor who is a physician executive because it's a different type of bonding and (you both have) an appreciation for the transition."
Gilmore's organization has provided some weekend physician leadership seminars to help doctors balance these roles and give them more insight into subjects such as healthcare finance, organizational dynamics and clinical quality improvement. He concedes that more could be done to prompt physician executive development, however.
"Organizations are a little bit puzzled about what to do with us," he says.
"They recognize the need for physicians in management and executive leadership roles. But because these are new and evolving roles, most physician executives, as they move higher up, end up with huge, broad sets of accountabilities. So there are very high expectations, which can sometimes be overwhelming. It's very important to have good communication and working relationship with the CEO or COO about your role."
David Bachrach, president of the Physician Executive's Coach, a Boulder, Colo.-based company providing leadership advisory services, says the time crunch faced by medical managers limits more physicians from getting or giving expanded management training.
"Those who have gone before and are actively practicing the art and science of medical leadership really don't have time to spend mentoring large numbers of people," Bachrach says. And while a few larger healthcare systems offer physician leadership training, most organizations don't have those resources, he says.
Parkview Hospital in Fort Wayne, Ind., devotes resources to promoting physician leadership.
"We feel that it's better for everybody involved, and especially our patients, if the medical staff and the hospital administration are working very closely and collaboratively," says President Frank Byrne, M.D.
Parkview uses a percentage of medical staff dues for leadership training programs. For example, two years ago the hospital spent $80,000 for a VHA physician leadership course held one weekend a month for four months and attended by 24 physicians. Fifteen physicians recently committed to a two-day retreat titled "Reasserting Physician Influence," which stressed new ways to involve physicians in leadership and to improve the interactions between physicians and management.
Two or three times a year, the hospital offers educational seminars on healthcare trends, information technology or other issues, with 150 to 200 physicians usually attending. Parkview sponsors off-site programs such as those offered by the ACPE.
And three physicians--Byrne, the senior vice president of medical affairs and the health system medical director for the community hospital division--sit on the Parkview board of directors.
Byrne emphasizes that the hospital "doesn't believe in physician leadership by chance." Quarterly, the senior staff makes a list of physicians who have demonstrated aptitude and interest in leadership. Those physicians are encouraged to attend programs like the VHA course and to take committee assignments or other leadership positions at Parkview.
Making the switch to a leadership position often is not an easy decision for physicians to make, says Bill Braun, principal with The Health Systems Group, a physician leadership training company in Cleveland Heights, Ohio. "When you talk to physicians privately, they ask 'What does it mean to be a leader?' 'What are the competencies you need to know?' The way they have learned to think in a clinical setting is quite a bit different in a business."
Braun, who also serves as an adjunct professor at Baldwin Wallace College in Berea, Ohio, helped the school and Northeast Ohio University's College of Medicine develop a healthcare executive MBA program three years ago. "If you're going to help shape an industry, you have to do more than provide front-line services," he says. "We're preparing people to be the leaders in the healthcare industry in the future." The first class at Baldwin Wallace had 32 students, graduating in December 1999. The second class has 13 students, and the third class has 22.
The Foundation of the Pennsylvania Medical Society in Harrisburg, Pa., developed a distance learning program that leads to a Certificate in Medical Leadership and Management. The program kicked off last September with 19 students, who participate with instructors and each other in real-time chats, teleconferences and bulletin board systems.
"Physicians need additional skills other than what they were given in medical school," says Matthew Tornambe, the foundation's executive director. "They find that by the time they're moving into practice, there's an awful lot they don't know about the environment they're going to have to practice in." He says physicians have benefited most from the program's modules in marketing, strategic planning, communication, leadership theory and computers.
Tornambe says a physician satisfied in private practice may benefit from a certificate program most, while a physician hoping to move into a management position in a healthcare organization should consider an advanced degree. Either way, a certificate program is one way to learn about management theories and practices without a drastic investment or career change.
Once physicians get some management training, they still need to be flexible because leadership positions are still evolving, advises Gilmore. "It's real curious and most humorous to see the variety of titles that are attached to roles in organizations and the big basket of accountabilities that go along with that," he says.
"The industry is in such a state of flux that you're going to see a lot of shakeout and some fundamental restructuring in how we do healthcare and even possibly how you practice medicine," he continues. "Ultimately, much of our role as the clinical leaders in hospitals or systems is to represent the clinical conscience of the organization. It's not that our nonclinical colleagues don't have the interest of patients at heart, but their context for dealing with that is different from a clinician."
Taylor from Cape Fear believes that the future for physician executives is positive. "I think we are near the bottom of a bad economic cycle in healthcare," he says. "Over the next 48 to 72 months we will see Congress and insurance companies increasing payments to health systems. And with economics looking brighter, there will be ever increasing opportunities for physician executives."
Robin F. DeMattia is a freelance editor and writer based in Fauquier County, Va.