The adage that physicians can manage patients but little else has been blasted by a survey of hospital and health system CEOs. The survey, conducted by Witt/Kieffer, a nationwide executive search firm, indicates that physician executives are key advisers, care enhancers, resource managers and clinical motivators.
As they grow in status during the coming years, physician executives will be major influencers throughout all aspects of healthcare decisionmaking, according to the survey. The Witt/Kieffer survey of 90 executives shows that physician executives are highly marketable and in demand, with compensation levels among the highest in healthcare--between $150,000 and $300,000 or more.
Physician executives earn praise from CEOs for their effectiveness in forging strong ties between physicians and administration, enhancing quality care and monitoring utilization outcomes. Thirty-seven percent say the executives' single most significant responsibility is aligning system and physician incentives. The top physicians develop, implement and monitor best practices, the CEOs say. And they advance the interests of patients and the organization before other constituencies.
"The take-away message is that physician executives' contributions are held in high regard by the highest levels of leadership in healthcare systems, including both management and the board," says Mary Frances Lyons, M.D., vice president and co-director of Witt/Kieffer's Physician Search Practice, a recruitment and placement operation.
Chuie Yuen, M.D., northeast regional medical director for Cigna, says physician leaders are valued in his organization for their contributions to improving care and addressing resource allocation and operational issues. "We sit at the table really as equals at the executive level. We are also ambassadors to clients, talk in public venues . . . and work very much with the public in terms of driving change to improve healthcare."
But more important than demonstrating value within the organization, Yuen suggests, is demonstrating value within the community. "Part of my work is to create those bridges to really deliver quality care . . . by working closely with physician directors practicing within the community."
Hospital and system CEOs ranked on a five-point scale their agreement with 13 statements relating to common functional responsibilities of physician executives. The top five in which CEOs believe physician executives are most effective were:
- Advising the CEO, COO and governing board (80%);
- Forging stronger relationships between physicians and administration (78%);
- Enhancing quality care (76%);
- Developing, implementing and monitoring utilization outcomes (72%);
- Influencing resource utilization (68%).
"Physician executives, in many instances, are in charge of ideas and influence . . . To the degree that they can show that they can form teams that deal with all areas--operational, fiscal, care management, strategy--they will be able to leverage themselves professionally higher and higher in healthcare delivery systems."
This strategy has worked for Newton McCollough III, M.D., medical director of the 22 Shriners Hospitals for Children, which provide free care to those with orthopedic problems, severe burns or spinal cord injuries. The system is funded by the Shrine of North America, an international fraternity of approximately 525,000 members who support the network hospitals.
McCollough, whose background is in academic medicine, says he learned on the job from businesspeople. He has done what Lyons suggests--teamed up with a counterpart in hospital administration in order to fuse the medical perspective with financial and operational realities. "Generally there are more and more decisions that have to be made on a priority basis that relate to budget," McCollough says. "If there are qualified people working with the medical director, the idea of the team approach is very workable."
Determined to speak the same language as those in operations and finance, Robert Lipson, M.D., president of Atlanta-based WellStar Health System, earned his MBA degree. WellStar is the largest integrated delivery network in the southeast with 1,250 hospital beds and 300 physician practices. Lipson holds significant accountability for the bottom line of the system and for contracting issues.
"If you want to get involved in an IDN, the language of business is very different from the language of medicine," Lipson says. "Unless you're bilingual, you're going to have a problem." This belief led him to approach Kennesaw State University in Kennesaw, Ga., about starting an MBA program designed specifically for physicians. Ten physicians signed up immediately, and since then, many more have followed suit.
John Klimek, M.D., chief of medicine at Hartford (Conn.) Hospital, where he oversees 300 physicians, says he believes physician executives can learn the business lexicon because most are "quick studies." "It's much easier for a physician to learn the fundamentals and jargon of business than the converse."
Klimek took an intensive two-week Effective Executive Management seminar sponsored by the University of Pennsylvania where he rubbed elbows with executives from General Electric, Coca-Cola and IBM. Although it took a couple of weeks, Klimek claims now he can read a profit and loss sheet with the best of them (see related story, page 56).
While physician executives may win high grades for effectiveness within their systems, for many it has come at the expense of their own clinical practice. Just over half of the CEOs who responded to the survey say that the physician executive continues to practice medicine at least some of the time, but 44% report their physician executive no longer practices medicine.
For some, the move away from clinical practice has created a schism with peers still in practice. "Medicine has been corporatized, and (being) a corporate executive is the way I am perceived, in part," says Klimek. "My job, instead of deciding which antibiotic to give someone with pneumonia, is where am I going to get $5 million to build an electrophysiology program and where will I put it. The change that has had to occur in me in the way I look at the world . . . is that now I have to be responsible for the care of thousands of people (as opposed to an individual patient)."
The opportunity to take better care of more people is precisely what led Robert Roy, M.D., northeast regional medical director for AetnaUSHealthcare, to leave 20 years of private practice behind him in 1990 to assume a management role within the managed care industry. Far-reaching disease management programs in areas such as asthma and diabetes have led to better care for thousands, Roy suggests.
The company has 160 full-time medical directors, Roy says. Medical directors play a significant role--not only in the obvious areas of quality control, but also in developing coverage policies, bringing back to the company some of the problems that may be perceived in the community and developing legislation.
Although executive roles can at times usurp a physician's time and move him further and further away from clinical practice, most still need "a clinical fix," Klimek says. He turns off his computer an hour a day and walks the wards, talking to doctors and individual patients "to get a face on the individual person instead of just the big organization that only talks about money," he says. "I like building things. I'm building programs that take care of lots of patients."