Brilliant, decisive and self-assured, the physician who served as chief executive officer of a thriving, 500-doctor medical group in the Midwest in the late 1990s appeared to have every tool necessary for success in management--everything, that is, except the capacity for collaboration and consensus-building. In the end, as support from his own medical staff collapsed, the doctor who ran his operation like a "dictator" ultimately lost his job.
"He so clearly knew what to do that he just did it, without bringing the other doctors along," says Sue Cejka, managing partner of the consulting company Grant Cooper & Associates, who provided the example without identifying the individual. "As a leader, you've got to be collaborative, no matter how right you are.
"He went down in flames."
The ill-fated career of the impersonal and autocratic CEO, fired after his bull-in-a-china-shop management approach alienated most of his colleagues, represents a case study of some of the contradictory traits that so often separate top-flight physicians from accomplished executives.
While they are supremely successful members of an exalted profession, physicians often do not possess the personal traits and leadership skills that translate to success in the corner office. The archetypal left-brain characteristics of so many successful clinicians--including a reliance on objective analysis, snap judgments and unwavering independence--can often lead to trouble when doctors trade white lab coats for a business suit, experts say.
The bottom line: Formal education and a curriculum vitae crammed with advanced degrees do not guarantee success as an executive or a leader.
"Advanced education is something I know physicians excel at," says Bill Westwood, managing director of executive search firm Korn/Ferry International. "But what we know is that the characteristics and qualities that distinguish the better leaders don't have much to do with academic degrees. It has to do with emotional intelligence and the intangibles that are, for the most part, not obtained through any formal training and advanced education."
"Of course, that's not to say that physicians can't make good leaders and executives," he adds.
In an effort to better identify those first-rate future physician executives, Korn/Ferry has tapped into a huge database of several hundred thousand searches nationwide to develop what officials at the firm say amounts to a profile in leadership. Westwood calls it one of the most comprehensive assessment tools of its kind, a survey that produces the kinds of metrics and bench-marking that help determine which physicians will succeed as executives--and why.
Unfortunately for physicians, the results thus far have not been particularly positive. Westwood says the experiences that shape physicians "don't always line up real well" with those of individuals who become successful executives. He says it's quite difficult to make the "leap from successful physician to successful physician executive."
Results of the assessment will not automatically disqualify a physician from a job as a healthcare executive during a search, Westwood says. Many other factors--including education and work history, of course--come into play when search firms review CEO candidates. But the assessment serves as an important tool in the increasingly difficult search for top executive talent in healthcare, especially when it comes to physicians, he says.
"Keep in mind that qualifications (for healthcare executives) range well beyond their leadership and decision-making style," Westwood says. "They have to have the right academic preparation, a track record at work and they might need to have turnaround experience. With this survey, we've tried to bring further attention to the behavioral and motivational side (of a search)."
In recent years, a trend appeared to be developing as some big hospitals and healthcare systems sought the services of doctors as top executives, reasoning that their knowledge of medicine and close rapport with fellow clinicians would produce positive results at a time of increasing friction between administrators and doctors. Some new hires were aimed directly at appeasing unhappy doctors--such as the appointment in late 2002 of family physician Mark Peters as CEO of 448-bed East Jefferson General Hospital in Metairie, La.
Since his elevation to the top job after several months as acting CEO, Peters says the once-tortured relationship between administrators and the medical staff has "made a 180-degree turn" for the better. At least part of that transformation, he says, can be attributed to his rapport with colleagues and his focus on what he considers to be the most vital trait of a leader: communication.
"I think doctors have a unique ability to lead hospitals," he says, "because they're such an integral part of the healthcare industry. They understand the system. And they understand other doctors."
Despite the elevation of Peters and several other doctors into high-profile executive posts in recent years, there has not been a sudden spurt in the number of top physician executives, observers say. Peters says that may result from entrenched decision-making by those who have grown to rely on a certain kind of leader.
"It's hard to deviate from the norm or change the way people have acted in the past," Peters says. "There is a certain comfort level with continuing with the status quo. But I think as more success stories (occur involving physician executives), it will open the door for more of my colleagues."
Officials with the American College of Healthcare Executives reported earlier this year that there are only 217 physicians among the 5,765 CEOs at its listed hospitals. Of the 4,706 acute-care hospitals, 145 CEOs, or about 3%, are physicians.
"Finding the combination of a great physician and a great leader is a very difficult thing," says Ed Mullen, another Korn/Ferry executive with lengthy experience recruiting physicians for top management roles.
Indeed, Westwood takes issue with the conventional wisdom suggesting that many organizations, particularly hospitals and health plans, view physicians as corporate saviors with just the right mixture of clinical skills, intellect and leadership ability.
"Do physicians, by virtue of their unique position, make good leaders?" Westwood asks. "No. They make good leaders if they model the behavioral and emotional qualities of good leaders. It's like saying that someone who is 6-foot-4 and to some degree physically coordinated is going to make an excellent basketball player. Maybe. And maybe not."
But Jordan Hadelman, chairman and CEO of Witt/Kieffer, another executive search firm, says he sees an uptick in the national market for hospital executives with an M.D. after their names. In the past few weeks, physicians have been named CEOs at prominent hospital systems in Washington and Wisconsin (See News Makers, p. 33). Successful physician executives, Hadelman says, exhibit pretty much the same kinds of traits as their lay colleagues.
"We're seeing a trend where (hospitals) are going to physician executives who have gone back and gotten a (business) education, an MBA," Hadelman says. "And the ones who have made an effective transition have characteristics that are not dissimilar to what you look for in any CEO--vision, someone who can lead, who can build a following. When a CEO also brings a dimension of clinical knowledge, especially as the marketplace focuses on the importance of clinical outcomes, those qualities, coupled with strong financial skills, represent a pretty compelling background."
The American College of Physician Executives, meanwhile, tracks doctor executives only among its 10,000 members, making no attempt to chart industrywide figures. The association, which breaks down its membership into job titles, says about 14% of those individuals are CEOs of a wide range of healthcare organizations, including hospitals, medical group practices and managed-care companies.
"What we're seeing is definitely more recruiters showing interest in physician executives, and doctors realizing they need a business education to move ahead administratively," says Bill Steiger, editor of the ACPE's Physician Executive Journal. "We don't know how many hospitals have recently hired CEOs that were physician executives."
Says Mullen: "There is a market for physician executives. Is it growing? I don't know that it's necessarily growing. There's always been a market for physician executives. (But) hospitals are interested in finding good executives, whether they're physicians or not."
In search of people skills
One problem in recruiting doctors for these jobs, Westwood says, is a simple matter of personality. Masterful clinicians don't always possess the kinds of "people skills" required for success as an executive and a leader. That's where the assessment tool comes into play for Korn/Ferry, which compares the results of physician applicants with the huge database accumulated over the course of many thousands of executive searches.
The aggregate profiles in the database help recruiters ask the right questions, gain a better understanding of the candidate and help evaluate whether they are the right person for the job, Westwood says. It has been used on scores of medical director searches, but it is now being expanded for use in an increasing number of searches for other kinds of physician executives, including CEOs, Mullen says. Doctors who want to be executives, he says, "should be scoring closer to executives than the way medical directors might score" on the survey.
"They may be very good as doctors, and they may be very good as 'doctor leaders,' " Mullen says. "But they might not have some of the types of skills (needed for a top-level position)."
Indeed, doctors whose "interpersonally challenged" demeanor is tolerated because they are expert clinicians find the situation dramatically different when they become managers, notes Mary Frances Lyons, a former cardiologist who works with Hadelman at Witt/Kieffer and has conducted as many as 400 physician searches in the past 17 years.
"If they're unbelievably good doctors, the world is tolerant, even if they don't work that well with people," she says. "But there's no tolerance for that at a management level. In the world of management, it's your interpersonal skills that determine where you go and what you do."
Successful leaders, Westwood notes, have a number of common characteristics, including the ability to resolve conflict, foster teamwork and build consensus. These individuals are "active listeners," responsive to everyone from their subordinates to members of the board of directors. In other words, business leaders need people skills to succeed.
Shaped by their rigorous education and independence, doctors are far more logical and analytical, adopting a direct and often autocratic style that can alienate others, Westwood says.
"It's not as receptive to the needs of others," Westwood says of this management methodology. "It can also be kind of the 'my way or the highway' approach. It's not as tactful or listener-oriented."
He adds that doctors often are viewed as "brilliant tacticians" who can organize, adapt and make quick decisions--often involving matters of life and death. But those traits don't necessarily mean much for a top executive struggling with relatively long-term solutions for turning around a money-losing hospital.
"They aren't as thoughtful or creative, and they aren't likely to be as visionary in their thinking as their best-in-class counterparts," Westwood says. "Again, I see this largely shaped by their experience. They don't have the time or luxury in their practice to look at the bigger picture. And this is not to imply that they can't become effective leaders. But for the most part they are not ready for a job as a senior leader coming right out of their direct practice experience."
In most cases, of course, physicians who want to move into management "pay their dues," as East Jefferson's Peters says, by moving into some kind of elected medical-staff leadership position. Like many of his physician executive colleagues, Peters served in positions ranging from medical director to vice president of medical affairs, blending clinical work with administrative posts for about a dozen years before moving into management on a full-time basis in the mid-1990s.
Korn/Ferry isn't alone in crafting semi-scientific ways to measure the potential success of executive-level job applicants. Though Westwood describes the firm's tailored assessment tool as unique, search firms across the country employ a wide variety of similar methods to measure job applicants--including personality tests such as the Myers-Briggs approach and the Birkman Method, a widely used assessment tool that helps measure leadership skills, behavioral styles and suitability of applicants to certain positions.
That assessment exam, which has been developed and refined over nearly five decades, is especially useful for individuals who seek a career change, including physicians hoping to bridge the gap from clinical work to management, says Lorne Weeks, a physician who is the executive in charge of PhysicianCareerNetwork, a search firm that he says has worked with more than 500 doctors in the past five years.
"It's tailored to the midcareer individual," Weeks says. "It determines a number of characteristics, including psychological needs, areas of interest, as well as delineating stress behavior. It ranks 125 alternative career paths from the best fit to the worst for that particular physician. For us, it's an EKG, chest X-ray and MRI all rolled into one--our principal diagnostic tool."
Cejka, a longtime physician recruiter, says she is working with officials from the American Medical Group Association, which represents most of the large medical groups in the nation, on a project to help define "the competencies and characteristics of the successful physician CEO." A key part of that project, she says, will be examining some of the characteristics of successful leaders within the AMGA.
Although the project won't involve anywhere near the huge sampling available to Korn/Ferry, Cejka says she hopes it will help refine and improve the personal checklist she has developed over more than a quarter-century in the physician-recruitment business. She says she believes it also will lead to better results for her clients as she focuses on "best-practice" personality traits.
Cejka dismisses the widely held notion that many doctors have a "God complex." "I don't see that. But what I do see, particularly among surgeons, (are individuals) who have a natural tendency for rapid decision-making. It's a necessity in their work. It's a critical thing for a surgeon--a bad thing in a CEO. On the other hand, the one positive transferable skill is that ability to make decisions based on limited information. You're never going to have all the information--not as a doctor--or as a CEO."
A success story
Case in point: Glenn Steele, a surgeon who three years ago made the transition from dean of the University of Chicago's Pritzker School of Medicine to CEO of 8,500-employee Geisinger Health System in Danville, Pa. Steele, who specialized in cancer surgery for more than two decades, almost mirrors the parallel cited by Cejka.
"One of the great advantages of my 'surgical personality,' " Steele says, "is that I can make decisions with inadequate data. You always end up coming to a point where you have to make a decision, take a chance--go for it. That's a very positive thing (for a doctor and an executive)."
For his part, Steele says there are several indispensable attributes of a good executive. Among them: the ability to listen, communicate and collaborate. He says he spent four months talking with employees across the far-flung system, developing a common vision for the future. In the end, he says, "It wasn't me coming from the mountain with a tablet--but me bringing back to all the employees what I had heard. It wasn't my vision; it was their vision.
"If you know the answers to something, even if it is the right answer and you haven't gone through the process of involving all the stakeholders, you don't end up getting the result you want," Steele says.
Steele is a rarity, a physician executive at the top of a large, complex, integrated delivery system who never received an advanced business degree.
Says Cejka: "Physicians can make good CEOs, but two things have to happen. One: They have got to get operating experience. An MBA and operating experience are not the same thing. Two: They've got to make the transfer from task orientation to collaboration."
Still, doctors who want to make the leap into the ranks of management these days are more often than not preparing for the transition with advanced business degrees, says Cejka, Westwood and ACPE officials. Dozens of schools across the nation offer a variety of business degrees aimed at physician executives.
Almost one-third of the 126 medical schools in the U.S. offer some form of business degree to their graduates. (The April 2004 issue of Modern Physician, Modern Healthcare's sister publication, ranks the top MBA programs for physicians.)
ACPE spokesman Steiger says he sees a spike in the number of doctors taking courses offered by his association--about 2,000 physicians now participate in the group's joint MBA program with the University of Massachusetts and a similar course that offers a "master's in medical management." The latter program is a collaboration with three other schools: the University of Southern California, Tulane University and Carnegie Mellon University.
The ACPE also is launching a new program called the Physician Leadership Academy, which officials describe as a "training ground" for doctors who want to move from senior medical positions to a top executive post. It debuts at the association's annual Spring Institute this week in Las Vegas.
The invitation-only program, limited to 45 physicians likely to make that transition, will focus on "what it takes in terms of both education, background and internal makeup to be a success as a CEO," says Howard Horwitz, who directs the educational programs for the ACPE.
Like Westwood and other physician recruiters, Horwitz points out that some of the best-known traits of a physician--particularly their self-assurance and perceived arrogance--aren't exactly the ingredients for success as an executive.
"I think a lot more physicians aspire to be executives than can be (executives)," Horwitz says. "Then again, a number of those who are offered these positions find that it isn't exactly what they want to do. Many times, being at the top is not easy."
Westwood offers one other piece of practical advice for would-be physician executives: Do not look at yourself, he says, as "the smartest person in the room."
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