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."
The ill-fated career of the impersonal and autocratic CEO, fired after his bull-in-a-china-shop management 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.
The bottom line: Formal education and 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 the firm says 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.
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, 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)."
Appeasing unhappy docs
In recent years, 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 late 2002 appointment of family physician Mark Peters, M.D., 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.
Officials at 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. At 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.
But Jordan Hadelman, chairman and CEO of Witt/Kieffer, a healthcare executive search firm, says he sees an uptick in the national market for hospital executives with M.D. after their names. 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 (business) education, an MBA," Hadelman says.
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."
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 Korn/Ferry assessment tool comes into play. The aggregate profiles in the database help recruiters ask the right questions, gain a better understanding of the candidate and help evaluate whether he or she is 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)."
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.
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."
Case in point: Glenn Steele, M.D., 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)."
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.
"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."
More business degrees
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, Cejka, Westwood and ACPE officials say. 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 (April 2004, p. 20).
The ACPE recently launched 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.
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 ACPE's educational programs.
"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 as "the smartest person in the room."
Taking the M.D. plungeDespite the view that physicians may not have the right skill set to be successful hospital administrators, a number of hospitals and systems have gone with docs as their new top execs in recent months.
- In April, Providence Health System, Seattle, named John Koster, M.D., as president and chief executive officer of the 19-hospital system.
- In April, St. Marys Hospital Medical Center, Madison, Wis., named Frank Byrne, M.D., as president.
- In May, three-hospital Duke University Health System, Durham, N.C., named Victor Dzau, M.D., as president and CEO.
- In May, six-hospital Caritas Christi Health Care, Boston, named Robert Haddad, M.D., as president and CEO.
- In May, Regional Health, Rapid City, S.D., named Charles Hart, M.D., as president and CEO of the rural healthcare system.