50 Most Influential Physician Executives in Healthcare, 2012

The eighth annual Modern Healthcare/Modern Physician ranking of the 50 Most Influential Physician Executives in Healthcare is indicative of the transformation the healthcare industry is undergoing.

A number of the names that have appeared perennially on the list are gone or moved down in the rankings (particularly those with Washington addresses), and eight new names appear this year—including Dr. Eric Topol, who debuts at No. 1 on the strength of his book, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.

While others debate arcane legal points and the philosophical slippery slopes pertaining to the Patient Protection and Affordable Care Act, Topol instead writes about how “a propitious convergence of a maturing Internet, ever-increasing bandwidth, near-ubiquitous connectivity, and remarkable miniature pocket computers in the form of mobile phones” are taking physicians and patients where no one has gone before.

Topol throws down the gauntlet immediately by opening his book with this quote by Voltaire: “Doctors prescribe medicine of which they know little, to cure disease of which they know less, in human beings of which they know nothing.” He later quotes George Orwell, who called hospitals the “antechamber to the tomb.”

“We need a jailbreak,” Topol writes. “Medicine is about to go through its biggest shakeup in history.”

Among his biggest supporters is Dave deBronkart, better known in cyberspace as “e-Patient Dave,” a former stage-four kidney-cancer patient and now a board member of the Society for Participatory Medicine. He says he likes the use of the phrase “creative destruction,” a term popularized by Austrian economist Joseph Schumpeter's book Capitalism, Socialism and Democracy published in 1942.

“What Topol correctly identifies is that healthcare is not shattering or blowing up, but it's being unbundled and the pieces are recombining in different ways,” says deBronkart, who made waves recently by posting on his website a request for proposals to remove the skin cancer cells from his jaw.

“He sees more clearly and precisely what's happening—including the underlying mechanisms,” deBronkart adds. “The people who say, ‘No, no, hold back the tide' will have an unhappy outcome.”

Topol says, at least partially because “there isn't a pattern in medicine for acting quickly,” he structured his book more for public consumption rather than for his peers who have so far shown resistance to genomic medicine, using technology such as wearable body sensors and failing to recognize that “the most exciting time ever in the history of medicine and healthcare lies before us.”

“The idea was that, consumers—if they were educated about these possibilities—they would want them, they would drive this so much more,” Topol says. “It will be a joint partnership with physicians, healthcare systems, but hopefully, in many ways, the leading edge will be consumer because it's the patient that has the most vital interest in his or her future health.”

What patients will realize first, according to Topol, is that they will have access to information that they never had before. This will include data on their blood pressure, glucose levels, hearth rhythm, brain waves, even information on how aspects of their genome will interact with the drugs their physicians are prescribing—and this all will be available on their smartphones.

In his book, Topol talks about the resistance to allowing patients to have access to their own healthcare data, writing that “The American Medical Association has lobbied the government hard for consumers not to have direct access to their genomic data, that this must be mediated through physicians.”

According to the AMA, however, Topol has “mischaracterized the AMA's position on direct-to-consumer genetic testing.”

“This testing can be a valuable tool to aid in diagnostic and therapeutic decisions, and the AMA supports the rights of patients to obtain this information,” AMA President-elect Dr. Jeremy Lazarus says in an e-mail. “Because the results of genetic tests are seldom straightforward and the health conditions they address are complex, they should be done with the guidance of a physician, genetic counselor, or other genetics specialist.”

Without proper counseling, Lazarus says, patients may needlessly spend money or misinterpret test results, which could lead to making “unnecessary or unhealthy lifestyle changes.”

Others, though, are viewing Topol's book more positively, and its preface includes words of praise from former National Institutes of Health director Dr. Elias Zerhouni, who has made four appearances on the most influential physician executive list, and Dr. Reed Tuckson, executive vice president and chief of medical affairs for UnitedHealth Group, who has made three appearances on the list.

“Eric Topol has written an extraordinarily important book at just the right moment,” writes Tuckson, who is ninth on this year's list (his highest placement ever) and was formerly senior vice president of professional standards for the AMA. “Dr. Topol opens the door for an essential discussion of old challenges viewed through an innovative lens.”

Last year Topol, who is chief academic officer for Scripps Health, placed No. 69 on Modern Healthcare's 100 Most Influential People in Healthcare list. He also is director of the Scripps Translational Science Institute, whose stated mission is to replace “one-size-fits-all medicine with individualized healthcare” while accelerating innovation and the integration of research findings into medical practice.

Others joining him in making their first appearance on this year's 50 Most Influential ranking are Dr. Farzad Mostashari, the U.S. national coordinator for healthcare information technology, No. 4; Dr. Kelvin Baggett, senior vice president and chief medical officer at Tenet Healthcare Corp., Dallas, No. 6; Dr. Susan Turney, president and CEO, MGMA-ACMPE (formerly the Medical Group Management Association), No. 11; Dr. Larry Wellikson, CEO, Society of Hospital Medicine, Philadelphia, No. 17; Dr. Wiley “Chip” Souba, acting director, Dartmouth Institute for Health Policy & Clinical Practice and vice president of health affairs and dean of the Geisel School of Medicine at Dartmouth, Lebanon, N.H., No. 22; Dr. James Madara, executive vice president and CEO of the AMA, Chicago, No. 44; and Dr. Dan Stultz, president and CEO of the Texas Hospital Association, Austin, No. 45.

Reflective of the tumultuous time in healthcare is the fact that 22 physicians who made the list in 2011 don't appear in 2012, including familiar names such as Dr. Donald Berwick (No. 3 last year, six appearances in all); Dr. David Blumenthal, (five appearances, including No. 1 in 2010); Dr. William Bria, (four appearances); Dr. Patricia Gabow, (four appearances); Dr. Edward Murphy, (seven appearances); Dr. Emad Rizk (four appearances), and Dr. Paul Tang, (five appearances).

Maybe more telling is how some of the mighty have fallen—especially those in last year's top 10. Dr. Carolyn Clancy, director of HHS' Agency for Healthcare Research and Quality (who finished first in 2009) fell from No. 3 in 2011 to No. 28 this year in her seventh appearance on the list; Dr. Regina Benjamin, U.S. surgeon general, went from No. 4 to No. 16; Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, went from No. 5 to No. 47; Dr. Francis Collins, director of the National Institutes of Health, fell from No. 6 to No. 42; Dr. Margaret Hamburg, commissioner of the Food and Drug Administration, fell from No. 7 to No. 48; Dr. Harvey Fineberg, president of the Institute of Medicine, fell from No. 8 to No. 43; Dr. Mark Chassin, president of the Joint Commission, fell from No. 9 to No. 37; and Dr. Delos “Toby” Cosgrove, president and CEO of the Cleveland Clinic, fell from No. 10 to No. 33.

In addition, Dr. Glenn Steele Jr., president and CEO of Geisinger Health System, fell from No. 13 to No. 31; and Dr. Nicholas Wolter, CEO of the Billings (Mont.) Clinic—and said to have the ear of Senate Finance Committee Chairman Max Baucus (D-Mont.)—fell from No. 14 to No. 41.

One constant on the ranking remains Dr. Gary Gottlieb, president and CEO of Partners Healthcare in Boston, who finished No. 34 (down from No. 18 last year). He is the only person to make the 50 Most Influential in all eight years of its existence.

“I think it's because I've had the privilege of working for a wonderful organization,” Gottlieb says. He adds that some of the influential physician executives he's worked with include his predecessors Dr. Samuel Thier and the late Dr. James Mongan, as well as former New York-Presbyterian Hospital President and CEO Dr. Herbert Pardes and Berwick, who Gottlieb says influenced change in the field of medicine by “focusing on the human experience of healthcare.”

Gottlieb says his recognition also reflects Partners' role in healthcare reform at the state level in Massachusetts and also at the national level by taking part in the Pioneer accountable care organization program. He adds that, in an environment where there are fewer economic resources for healthcare, physician executives need to lead in moving the healthcare system toward alternative payment models and away from fee-for-service while staying focused on the mission of helping patients and reducing “horrifying” racial and ethnic disparities in healthcare.

“If we blow it by saying, ‘This is all about the bottom line,' we'll lose so much of what we've gained,” Gottlieb says.

Dr. Gary Kaplan's seventh time on the list (he didn't make it in 2006) marks his highest spot yet: second place. Kaplan's focus on reducing costs while improving quality—which includes applying the Toyota Production System to healthcare—has led to Virginia Mason Medical Center in Seattle being named the Top Hospital of the 2001-2010 Decade by the Leapfrog Group coalition of large employers and, last month, winning its second Medical Group Preeminence Award from the American Medical Group Association, which it previously won in 2007.

“It's really recognition of the physician leadership team,” says Donald Fisher , AMGA president and CEO, who says that, as Virginia Mason receives national recognition, Kaplan's leadership—which has produced “a shift in culture and a re-engineering of core practices”—is being recognized as well.

“His experiences and outcomes—reductions in waste and improvement in quality—has been noticed,” Fisher says, adding that, as a result, other organizations across the country are now looking at how they can adopt Virginia Mason's methods at their own institutions.

Besides Topol and Mostashari, the other newcomer in the Top 10 is Tenet's Dr. Kelvin Baggett, who holds the No. 6 spot and was also recently named to Modern Healthcare's 2012 list of the Top 25 Minority Executives in Healthcare. With 51 hospitals—including rural, urban and critical-access hospitals as well as academic medical centers in 11 states—Baggett says Tenet creates a knowledge base that is relevant to institutions across the country.

He notes that more than half of Tenet's hospitals are participating in the HHS Partnership for Patients quality-improvement and cost-control initiative and that Tenet's own Clinical Innovation Awards also helps create “a ripple effect.”

“We want to encourage and recognize innovation in care delivery in our organization, and encourage and capture things that have tremendous benefit for our local hospitals and the national enterprise,” Baggett says.

A physician executive who's had a big influence on him, he says, is Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, who has appeared on the 50 Most Influential list seven times, including this year where she ranks No. 35 . “I'm a RWJ Clinical Scholar,” Baggett says. “So, at an early stage in my career, I spent a fair amount of time talking to her.”

Lavizzo-Mourey says she's humbled by her seven appearances on the list and says it's attributable to the work of her colleagues who study healthcare transformation demonstrations and work to present objective information for “weaving the science of outcomes” into practice.

“We are living in interesting times,” says Lavizzo-Mourey, who cites as influences Baggett, Clancy, Gottlieb and another fellow seven-timer, Dr. Darrell Kirch, president and CEO of the Association of American Medical Colleges, who is No. 40 on this year's ranking.

She says physicians are often the bridge between the different sectors that have an interest in healthcare, and—as “discoverers and seekers of knowledge,” they have to use their influence with business and policymaking factions to protect patient needs and create a healthcare system “that is closer to the one we all seek.”

Only eight women made this year's 50 Most Influential list, with Dr. Barbara Paul, senior vice president and CMO of Community Health Systems in Franklin, Tenn., finishing the highest at No. 7. It was her fifth and highest appearance on the list, and it marks a return after an absence in 2011. The only woman making a debut appearance is the MGMA-ACMPE's Dr. Susan Turney, who holds the No. 11 spot.

She says her placement reflects the solid foundation and national presence the organization has built and the grass-roots advocacy efforts it engages in.

“They have a collective, powerful voice,” Turney says of her group's members. “When we speak on policy issues, we're carrying their voice forward and telling their stories.”

Turney replaced Dr. William Jessee, who made six appearances on the 50 Most Influential annual rankings. At another member association, Dr. James Madara, who holds No. 44 on this year's list, replaced six-timer Dr. Michael Maves last June as chief executive of the AMA.

“It's just great fun,” Madara, a former CEO of the University of Chicago Medical Center, says of his first year on the job. He notes that this includes the recent AMA board-approved multiyear strategic plan that he describes as a “positive force by and for physicians” to improve patient outcomes and the wellness of the U.S. population as a whole, reduce disparities in public health, strengthen research ethics, develop more team- and competency-based medical school curriculums, and define the elements that lead to physician satisfaction.

Evidence suggests that “physician satisfaction, not surprisingly, corresponds to patient satisfaction,” Madara says, and the aim is to “encourage the future best and brightest to go into medicine.”

Similar efforts are going on at the Geisel School of Medicine at Dartmouth, whose dean—Dr. Wiley “Chip” Souba—made the 50 Most Influential ranking for the first time. “Some of the things we're up to at Dartmouth are getting people's attention,” he says. These include incorporating leadership training into the medical school curriculum and launching an 18-month master's degree program in healthcare delivery science. Souba notes that the average age of that program's participants is 43.

“I think that physicians have to be a key player at the table of healthcare reform,” Souba says. “Are they the only player at the table? No. But they understand the hydraulics, if you will, of how systems operate and what patients need.” Returning to the ranking after a two-year absence is Dr. Robert Wah, whose influence cuts across public and private sectors as well as associations and academia. The chairman of the AMA board of trustees, Wah is also the CMO of Computer Sciences Corp. in Falls Church, Va., and is a former deputy national coordinator for health IT at HHS.

“I think this is a critical time for physicians to be involved,” Wah says. “We're in the implementation phase of health-system reform, and we're filling in all those ‘to be determined' blanks.”

Wah says he still sees patients and it's very gratifying to see one patient at a time get better, but that his roles at the AMA, CSC and previously with the military health service and HHS extend his ability to reach more patients than he ever could by providing direct care. As technology becomes a more integral part of providing healthcare, he says it's important for physicians to speak up.

“One of the things physicians can bring to IT is to make sure it's anchored in the right goal,” Wah says. “When you get involved in information technology, the discussion very rapidly gets into bits and bytes and boxes, cables and schedules. People have to be reminded we're not just doing another IT project, we're doing something that will help physicians take care of their patients.”