In the Physician Executive Management Center's 2004 survey of physician executives, we questioned physician leaders about their professional development and satisfaction with their management careers. We also asked their opinions on a number of matters related to the profession. Exactly 500 respondents completed the opinion question portion of the survey.
When reviewing the responses for each of the organizations represented by these physician executives (mostly hospitals, systems, managed care and group practice), we found few differences among the groups. In fact, we found the pattern of responses to be virtually alike in all major findings. Therefore, we chose to analyze the data from the opinion section as a whole, rather than by organizational type.
The majority of participants in the survey are physicians serving in senior physician management positions such as the chief medical officer. These are physicians who typically have had 15 years of clinical practice, have been in their current positions for five years and have a history of other management positions. Therefore, their responses represent the opinions of a mature, experienced subset of the physician executive profession.
The following information includes the original question from the survey, a statement of the findings from our analysis, and our comments and reactions to the findings.
QUESTION: When did you first consider an eventual career as a physician executive?
The majority of the respondents said that they initially thought about a change from a clinical to a management career after about 10 years of clinical practice, post-residency training, and more than 85% said that they considered the change during a period of two to 10 years or so of clinical practice.
A career as a physician executive is rarely pursued as a physician approaches retirement from a long clinical career, or at least few end up in chief medical officer roles at that time. We suspect that this statistic may very well have been different 20 years ago, when many chief medical officers of hospitals were end-of-career clinicians. Another conclusion of these findings suggests that few physicians who progress to senior leadership positions were thinking of a management career while in medical training.
QUESTION: Why did you decide to make a move into management?
Seventy percent of the physicians in this survey responded that they made the decision to move from clinical practice into management primarily to "have a greater impact on medicine" and to "seek new challenges." Some physicians additionally found enjoyment with committee and part time management work, while engaged as a clinician, and were influenced by those experiences.
It appears that few physicians who transition to management do so because they are bored with medicine or are looking for an alternative from clinical activities. It has been our experience that the successful physician executives are drawn to management in the same way that they were drawn to medicine, by an opportunity to make a difference. Those who are successful make the decision to change careers seeking the rewards, not hoping to escape from medicine.
QUESTION: How did you prepare for a management career?
The most common responses from this group included their participation with management courses, presumably with organized medical management groups, and gaining on-the-job experience serving in leadership positions in their local organizations. Twenty percent pointed to both methods as their preparation. Pursuing an advanced management degree was another popular option, but less so than the other choices of preparation.
It is interesting that about 60% of this group either have or are currently pursuing an advanced management degree such as an MMM or MBA. Yet, only about 25% cited the degree as a specific preparation for a management career in this instance. Perhaps the decision to pursue a degree came after the physician had already decided to embark on the path to an executive career. Clearly, the preparation for a management career requires a commitment to learning through education.
QUESTION: When you took your first management position, what was the reaction of your friends and colleagues?
The colleagues of 40% of the respondents were enthusiastic about the respondent's decision to move into a new career direction, while friends of another 36% wondered, "What is a physician executive anyway?" Only about a quarter of the respondents were met with concerns about their sanity.
We imagine that it would come as quite a shock for friends and family of physicians to learn that they had made a decision to leave the practice of medicine (and all of society's respect and admiration for practitioners). It also would be quite disconcerting to see your personal physician now become a manager, even in a healthcare-oriented organization, which was the case with these physician executives.
QUESTION: In hindsight, was the decision to take your first management position and move into management a good one for you?
A management career was the "best decision I ever made" said a majority of the respondents and was a "bad decision" for only a few physicians. Also, only a few of the respondents said that they did not enjoy their current position.
This reaction to a career as a physician executive is not a surprise to those associated with this profession over the years. By the time physicians have progressed to senior-level positions such as chief medical officer, they will have seen a wide variety of issues and challenges and, if they remain in the profession, will thoroughly enjoy their involvement. This is good news for the upcoming group of clinicians who are considering a similar career move but are uncertain of the wisdom of such a change.
QUESTION: Did you have a mentor to help you learn the business? If you could work it out, would you mentor an upcoming physician executive?
Approximately 50% of the respondents did have the help of a mentor while they were in their initial stages of learning the business. Of that group, two-thirds felt it was of value to them, while the remaining one-third felt that it was not that much help to them. As to their interest in serving as a mentor, 98% would like to participate as a mentor if it could be worked out.
It is clear that physician executives serving in CMO-level positions would embrace the opportunity to become mentors to other physicians who are learning to become competent managers. Beginning a formal program to develop leadership through education and mentoring could be a good idea for a large and influential professional organization or association.
QUESTION: What advice would you give to a physician who wants to make a career move into management?
The principal response was the admonition that "this job is not as easy as it may seem to you," presumably warning prospective physician executives of the significant work involved to be successful as a chief medical officer. Thereafter, the vote was split on the second piece of advice, which was to either obtain a management degree or to take management courses.
With 60% of this group having or working on an advanced management degree, we would have expected a greater emphasis on the pursuit of a degree. Perhaps those with a degree were not as convinced of its ultimate value in a senior physician executive position. In any event, the pursuit of learning is considered important to success for physician executives.
QUESTION: What is your ultimate career goal as a physician executive?
While 37% of the respondents are happy in their current positions and hope to remain for a while, the remaining 63% are interested in either a career move to another, larger organization to again serve as a chief medical officer, or they aspire to a position as a chief executive officer or a chief operating officer in their current or another organization.
It has always been a dream for physician executives to assume a senior operational role, especially early in their careers and as they trained for more managerial responsibility. Perhaps as they gain actual experience in a variety of organizational settings, the prospect of a CEO role is less attractive or less attainable. It is interesting that the majority of these mid-50-year-old physicians who have been mostly in stable positions for on average of five years hope to make at least another move to a position with more complex responsibilities.
QUESTION: How do you like your current management position?
Ninety percent of the respondents said they think their current positions are either great or that they love them or at least think they are good jobs. Virtually no one replied that they hate the job, which was an optional response.
So, for the overriding majority of chief medical officers and other senior physician executives, the job satisfaction is considerable. It certainly suggests that the move to management was a good choice for this group of physicians. And it reinforces the prospect for other physicians who will make this career decision in the future.
QUESTION: Do you consider yourself to have had a significant positive impact on your organization?s quality of care?
Ninety-eight percent of the respondents said they either have a large degree of positive impact on their organization's quality of care or at least some level of improvement. Negative-impact replies from this group of chief medical officers were less than 2%.
It appears that the chief medical officers of this study are meeting their goals of having greater impact on patient care as managers than they could as practitioners when they decided to leave clinical medicine in favor of careers as medical managers.
QUESTION: Which personal style works best for you in your current management role?
Of the choices offered, 40% of the respondents stated that they are either "hard chargers" and another 40% described themselves as "steady as she goes" type of managers. Less than 5% described themselves as "low key" managers, and about 15% percent of all respondents thought the style that works for them sometimes depended on the day!
If the "hard charger" designation relates to what is known as a "Type A" personality, then it appears that a wide variety of personal styles are effective in management at a senior level in these organizations, both high-energy and low-energy. We imagine that the style that works best depends on the culture of the organization.
QUESTION: What is the best part of being a physician executive?
The majority of the participants (60%) said the best part of serving as a physician executive is having an impact on the quality of patient care. About a quarter of these physicians responded that they enjoy working with physicians, helping them to be successful. In the unstructured answer section, these physicians often provided additional comments to reinforce their satisfaction with having an impact on patient care and either educating or working with the medical community. They also mentioned two principal "best parts" of their profession, and presumably their current position, which were "the satisfaction of accomplishment" and "working with a management team and influencing organizational decisions." Another "best thing" that received mention was the variety of duties, which is deemed to be a good part of their jobs.
It should come as no surprise that these professionals, who have a history of accomplishments in education and clinical careers, are now especially happy with their ability to have a significant impact in their current careers and positions. They also seem to like a lot of work and responsibilities, which works out well in most organizations where there is much to do.
QUESTION: What is the worst part of being a physician executive?
A rousing 57% said the thing they thought was not good about their positions and the environment was that there were too many meetings. The second most frequent response was the lack of enough clinical, patient contact. When one reviews the entries in the optional answer section, these physicians feel the worst part of the job is the culture of their organizations in which there is too much bureaucracy, decisions and change take too long, and much of the slow movement makes growth very difficult. It was also a common theme that "there is too much work and too little time to do the work that they have." Another oft-mentioned negative was the feeling of lack of respect from others, both other physicians as well as lay managers, and that they are not always taken seriously in their roles as senior managers. Other issues of concern were physician behavior problems, and the ambiguity of goals.
Physicians who are successful in this business are often frustrated with the necessity to work within their organizations' systems, the bureaucracy of decisions, the prevalence of meeting after meeting and the consensus decision-making that takes place in order for anything to be accomplished. This certainly is in contradiction with their medical training and initial years as clinicians and was probably unexpected when they made the move to a full-time position as a physician executive.
QUESTION: The most important skill that you bring to this job is . . .?
The response to this question of skills resulted in their highlighting communication skills (both talking and listening) as the most important competency that they provide in their role as a physician executive. There was also significant support for their skills as analytical problem-solvers, which received almost as many responses as the communication skills response.
This group of physician executives again emphasizes the importance of excellent communication, as we have seen in previous surveys of the profession. There are perhaps no greater skills that can be brought to a senior position than the ability to communicate ideas, listen carefully to one's constituency and serve as a credible intermediary in the exchange of information.
QUESTION: Why do physicians trust you?
The most frequent response to the question of trust was that they were trusted because "they always do what they promise," therefore it is reliability that generates trust among the medical staff and its members. In the optional answer section to this question, the respondents most often mentioned "their experience as a physician executive and their record of accomplishments" as a key to gaining trust of physicians in their organizations.
While honesty and reliability are the obvious criteria for trust on the part of physicians, it is also important that the physician serving in an executive capacity be able to gain trust by building a record of accomplishments in issues of interest and value to physicians.
QUESTION: What is your biggest challenge over the next year?
Overwhelmingly, the most frequent response was to "identify change and growth" as the challenge of most importance. There were only a few responses that mentioned the challenge of financial issues (which was the second most frequent response at less than 10% of the total).
Clearly, any physician considering a career change to management should understand that it is a profession that must be comfortable with change and the challenges of being effective in a constantly dynamic environment.
David Kirschman is president of the Tampa, Fla.-based Physician Executive Management Center, which conducted the survey.