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.”