“Where people end up is somewhat arbitrary,” Straube says. “I think that physicians bring a special skill or background that relates to having spent at least part—if not most—of their careers with people who receive healthcare and dealing with people who deliver it on the front lines of healthcare service. Having that perspective is especially valuable when decisions are being made.”
Straube's multifaceted job involves providing senior executive input on Medicare, Medicaid and the State Children's Health Insurance Program; representing the CMS before the OMB, Congress, the White House and “numerous outside stakeholders”; serving as director of the CMS clinical standards and quality office, what he describes as the nation's “No. 1 decisionmaking agency”; heading the federal government's health information services group, which works on collecting clinical quality data; and collaborating with quality-improvement organizations.
Straube says these efforts are channeled into focus areas such as reforming the payment system to promote better quality; promoting IT adoption and use; reducing healthcare disparities; and addressing complaints. “That's my day in a nutshell,” Straube says.
When Hamburg was nominated to lead the FDA, the choice was cheered by Sidney Wolfe, a physician who's director of Public Citizen's Health Research Group, a consumer advocacy group. But now Wolfe is becoming one of her sharpest critics.
Wolfe says Hamburg and the FDA are doing a good job enhancing food safety, “getting better” in the regulation of medical devices, but have been “reckless” in decisions to allow continued use of certain drugs whose risks, he says, outweigh their benefits.
“It's a disaster,” says Wolfe, who has appeared on the most powerful physician-executive list four times—but not this year— with his highest position being No. 8 in 2005.
The top female executive on the list who doesn't work for the federal government is Cassel, leader of the American Board of Internal Medicine, a credentialing organization, and its foundation.
“About one in every three physicians is an internist of some sort. It seems to indicate that it is not so much about me, but the work I'm privileged to do,” Cassel says, noting that her board certifies more than 200,000 physicians across 18 subspecialties.
Reed Tuckson never made the list when he was senior vice president of professional standards at the AMA, but he's made it two years in a row since becoming executive vice president and chief of medical affairs for Minnetonka, Minn.-based UnitedHealth Group, finishing No. 28 this year, up from No. 35 last year. Tuckson joined UnitedHealth in November 2000 as senior vice president of consumer health and medical-care advancement, and his profile has steadily risen.
“I have a sense of being energized and engaged to gain a much greater appreciation of the causes of cost escalation in the healthcare delivery system,” Tuckson says. “The underlying challenges of getting after cost escalation and the related issues of improving quality and safety and preventing illness, these are the things we have to get at. That is the work that is so exciting for a person in a position like mine.”
This year tied with 2007 for having the most women on the list: eight. Along with Hamburg, Clancy, Benjamin, Cassel and Lavizzo-Mourey, other women on the list were Patricia Gabow, CEO of Denver Health, at No. 23; Barbara Paul, senior vice president and chief medical officer, Community Health Systems, Franklin, Tenn, No. 43; and Dexanne Clohan, chief medical officer at HealthSouth Corp., Birmingham, Ala., No. 47.
Cassel notes that, although they were “separated by a few years,” she attended medical school at the University of Massachusetts the same time as Clancy. “It is true that when Dr. Clancy and I were in medical school, we were in a small minority,” she recalls. “But I'm certainly seeing a number of women coming up through the ranks.”
More female physicians are holding executive positions in government and policymaking roles, but Cassel says the “academic world tends to lag behind” on this issue.
Next on the list behind Cassel is Oschner's Quinlan, at No. 14, who says the lack of gender balance on the most powerful physician-executive lists reflects “the rather lengthy period of time it takes to move up in a large organization.” He predicts the numbers will get progressively more balanced each year.
For Quinlan, it was not only his sixth time on the list, but his fourth time in the top 20.
“The bribes work,” jokes Quinlan, who claimed first place in 2007. “I think it really is recognition of what an institution does, what a team does, and I've been part of a great team in a great institution in a difficult environment.”
Quinlan says the seven-hospital Ochsner system differs from other hospital systems that employ physicians in that the New Orleans organization is “basically a medical group that happens to own and operate hospitals and a system.
“We're a group practice,” Quinlan says, calling his selection to the 50 most powerful list “an endorsement of our program, but—since it's a one-person award—I got it.”
Another regional healthcare leader with national recognition is Gary Kaplan, chairman and CEO of 289-bed Virginia Mason Medical Center, Seattle, who finished at No. 16 for his fifth appearance on the list and his fourth-straight showing in the top 20. Kaplan has gained recognition for applying the manufacturing industry's defect-reduction methods to healthcare. “It isn't impossible to get zero defects,” he says.
Earlier this year, Kaplan was honored with the MGMA's lifetime achievement award, and Jessee, the group's president and CEO, says Kaplan is an example of how local and regional healthcare leaders with vision can have national influence.
“He's obviously very well-known in Seattle, but he's also well-known on a national level,” Jessee says. “His vision on safety and efficiency has created a national reputation even though his work is on a regional level.”
Jessee, who has announced that he will retire in fall 2011, deflected any credit from himself for being one of the few individuals to make the most powerful list in all six years of its existence, and explains it has to do with how the MGMA's 22,500 members manage or lead 13,700 medical practices.
“In all candor, people don't really vote for me, they vote for the CEO of MGMA,” Jessee says, adding that it also reflects the trend toward larger medical practices. “Physicians are learning how important experienced practice managers are to their enterprise, and I'm the visible symbol of that. Most everyone on the list is on there by virtue of the position they hold.”