Keith Marton, M.D., spent his career advancing in physician leadership positions. He began as a clinician educator, was a Robert Wood Johnson clinical scholar, worked as chief of education and research as well as vice president of academic medical affairs for St. Mary's Medical Center in San Francisco, and served on several hospital boards. So when a new position opened up at Legacy Health System, a four-hospital system based in Portland, Ore., he was ready to sign on as their chief medical officer and senior vice president.
But first he conducted an honest, and somewhat difficult, assessment of his management skills. And he concluded that he needed a coach to help him develop in certain areas.
"When you get to a certain level in your professional career," Marton says, "it's hard to find courses or books that give you what you need. I began to turn to colleagues, but the physician executive position is a relatively new phenomenon, and it's hard to find a colleague to turn to on a regular basis."
Most importantly, he says, "I found myself increasingly in situations where I came into conflict with physicians. I needed more tools in how I related to people."
Marton is not alone. Physician executives know they have relatively new positions and few colleagues in similar positions available as mentors. But consummate professionals that they are, they want to develop strong relationships with their co-workers and management teams. Smart executives also recognize the need to minimize conflict with CEOs and resolve confusion within their organizations (see related story, page 28). So some, like Marton, look outside their organizations for help.
Marton's first coach was a private consultant who did not have a medical background. During the six months they worked together, she helped him assess his relationships with others. She even attended meetings so that she could observe Marton in action. He introduced the consultant as his coach and received positive reaction, and even congratulations, about his personal development efforts.
His second coach was a former physician executive who Marton says "understood many of the situations I was facing, could compare them to other people he had worked with and had an astonishing insight into situations."
Both coaches helped Marton become a better listener and more clearly understand other people's needs. "I'd always prided myself on being a good listener, but I wasn't listening for what was really important to them and was (instead) filtering what they said through my background." Now he tries to determine Legacy's needs along with what's important to physicians and then find a way to optimize both.
Marton's supervisors initially allowed him use consulting dollars from his budget to pay for the coaches, though lately he has paid out of his own pocket because he uses them less frequently. His organization's monetary support for training is just one reason Marton has high praise for the mentoring skills of his boss, Robert Pallari, president and CEO of Legacy. "He gives me a lot of feedback, and he gives me assignments specifically designed to give me new skills." For example, Marton has become involved in the managed care contracting process, which helped him understand the managed care environment in Portland. "He does this with all members of our executive team, and he puts together educational opportunities for us. He makes it clear that the development of his team is part of his responsibility."
Marton advises other physician executives to not be shy about taking on new responsibilities. "On-the-job training is one of the key parts of becoming a physician leader," he says. And he suggests finding a mentor, which should get easier as more physicians take on administrative leadership roles. Finally, he stresses having a clear job description and understanding of how your efforts will be measured.
David Bachrach, president of The Physician Executive's Coach consulting company in Boulder, Colo., agrees that physician executives and administrators must work together. But Bachrach, who helps physicians develop leadership skills, emphasizes that administrators also must work to understand the physician's world as physicians hone their management skills.
"It's hard to have an equal relationship if the physician executive says, 'You don't know what happens in the operating room or what patients say at bedside, so you can't propose allocations of resources that are nonsensical to medicine."'
Bachrach encourages administrators to shadow a physician for a week, go on rounds, spend time in an office practice, attend medical society meetings and work with medical students or researchers to broaden their knowledge base. He also suggests that physician executives and administrators take classes together, suggest helpful management books to each other and spend time discussing business principles (such as budgeting) or important issues before attending meetings with senior management.
Because many physician leaders do not have management backgrounds, health systems and organizations are developing in-house programs to teach business basics such as finance, negotiation and human resources. Johns Hopkins Medicine in Baltimore instituted a leadership development program two years ago.
Twenty-five people last year and 38 this year are learning leadership style, interpersonal skills, group decisionmaking, organizational thinking and the basics of how Hopkins is run. They were nominated for the program by deans, vice deans and department chairman who saw leadership potential in them.
The class meets once a month from June through September, but program participants also attend two one-day retreats, work on team projects, attend senior management meetings, meet with advisors and have roundtable discussions with deans and senior leaders.
"When you have a chance to educate people," says Toby Gordon, vice president for planning and marketing at Johns Hopkins Medicine, who administers the program, "it helps build consensus and helps create and implement a strategy. It makes all of our jobs easier."
Gordon also teaches two classes in business and strategic planning at Johns Hopkins School of Professional Studies, where 25 to 30 physicians earn MBAs each year. And at Johns Hopkins School of Medicine, Gordon instructs medical students in the business of healthcare delivery and healthcare administration. There, she touches on everything from the rise of hospitals through the 19th century to the growth of the insurance industry and how large systems such as Hopkins are run.
She even shows them the cafeteria and how patient food trays are made. "They see what everyone does and how all these jobs keep the place going," Gordon explains. "Young people want to understand their role in the delivery system and the whole healthcare environment."
David Kirschman, president of the Physician Executive Management Center in Tampa, Fla., specializes in physician executive searches for hospitals, systems, group practices and managed care organizations. While he agrees that business skills are important for physician leaders, he says that most people he helps place already have developed leadership skills and are successful managers. What he looks for instead are physicians who will work well with administrators because they have common goals, are interested in the organization and are committed to excellence in healthcare services.
"Some of the best relationships tend to be between the chief medical officer and the CEO," Kirschman says. "Maybe it's because their fortunes are tied so closely together. And maybe it's because the CEO is at the top of his game and the physician is typically the senior physician at the top of his game, so there's a lot of respect for people who are at that level." He notes that neither person usually wants the other's job, so that tends to make the relationship less threatening as well.
Additionally, Kirschman finds that "the smart CEO understands that the only way ultimately that systems will work is if the physicians buy into the organization's vision. And the only way to get physicians to buy into it is through another physician. So a physician who is a chief medical officer and who has the respect of the medical staff will make an organization that can be successful achieve success." This philosophy means that CEOs want physician executives as allies and will work toward that goal.
Robin F. DeMattia is a freelance editor and writer in Fauquier County, Va.