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    Rob Schreiner
    Rob Schreiner, MD
    Thomas Tami
    Thomas Tami, MD

    Once upon a time, roles were strictly defined and separated. Physicians were mainly responsible for transactional patient care and occasionally overseeing the clinical and behavioral practices of colleagues. Health system administrators, on the other hand, were responsible for everything else: service line revenue and expenses, management of staff, operational workflow effectiveness and the enterprise’s margin and market share. It was a simpler — if less-effective — age of parallel, siloed healthcare leadership.

    Then came the realization that team-based patient care produced superior clinical outcomes at lower total cost and a better experience for patients, families, staff and clinicians. So perhaps a model of shared leadership between physicians and administrators would also be superior to the parallel, siloed approach. Indeed, most health systems realize that the tempo of continuous improvement in quality, service and affordability is faster and more certain when both physicians (white coats) and administrators (suit coats) share the burden of designing, deploying and improving clinical and operational change.  

    Both parties have experienced surprises during that journey. Administrators now realize that some of the root causes of physician burnout (e.g., decline in relationships with patients and colleagues, decline in time to think and do one’s best work) are due to inadequate involvement of effective physician leaders when designing and deploying operational change. At the same time, physicians now realize the complexity of healthcare delivery beyond the doctor-patient relationship, its influence upon all other teammates and ultimately, the margin and market share of their beloved delivery system.

    Somewhere along the line, TriHealth Physician Partners, Cincinnati, realized that physicians needed to be in leadership roles, but the providers were brought in primarily for appearances, rather than for real leadership roles. The administration thought it would get buy-in from physicians, and physicians thought it would give them a voice. It didn’t exactly work that way for either party at first.

    Preparing physicians for leadership roles

    Every physician is a respected, if informal, leader in the clinical environment, but when asked to assume a formal physician leadership role, many are ill-prepared. The skillset for a successful physician leader extends beyond diagnostic and therapeutic talent. Physician leaders today are expected to design and deploy successful change management, conduct timely and effective performance management of colleagues, and know their way around a profit-and-loss statement. 

    While a growing number of physicians are seeking master’s degrees in public health or business administration, nothing takes the place of on-the-job experience in physician leadership. Competent physician leadership is necessary to expedite beneficial change in the delivery system (e.g., improvements in clinical quality, service and affordability), so the demand for these skills will continue to rise. 

    Physicians spend years in school learning to diagnose and treat patients, yet when we need them to step into an administrative role, we expect those skills to come naturally. Education is key, and advanced degrees are undoubtedly beneficial for anyone in a physician leadership role, but they aren’t essential. There are multiple methods to equip physician leaders with the skills to fulfill their new responsibilities. Often that means a formal leader development curriculum — accredited programs that offer continuing education credits. 

    The path forward for any organization isn’t through physicians, it’s with physicians. With the right selection, development and support, physician leaders will better equip the executive team to make positive changes for the future of the organization.

    The characteristics of great leaders are simple, yet can be difficult to hardwire. A good physician leader should demonstrate an ability to:

    • Communicate the vision of service and organizational excellence.
    • Articulate the connection between physician communication and patient perception of quality of care – the why.
    • Coordinate and conduct physician service excellence training. 
    • Recognize high-performing colleagues and coach low-performing colleagues. 
    • Develop and adhere to standards of behavior.
    • Develop relationships of influence with colleagues.
    • Run effective meetings.
    • Work effectively in cross-departmental teams.
    • Improve operational workflows to diminish burnout and improve resiliency of individual physicians. 

    If physician leaders are lacking in one or more of these areas, a competency-based professional development curriculum, using adult learning principles, can fill in the gaps.  

    Supporting physician leaders

    To position physician leaders for success and close the gap between the exam room and board room, they need unequivocal support from nonphysician executives. Senior leaders regularly checking in with front-line physicians will garner buy-in. 

    Other considerations when implementing a physician leadership program include:

    • Is there a formal contract (job description) that clarifies essential job responsibilities?
    • Does the physician leader have “protected time” outside of patient care hours to execute physician leader duties?
    • Will the physician leader be compensated for the additional responsibilities?
    • Have we invested in developing the physician leader’s skills?

    Taking that next step in leadership can be a challenge. It can be eye-opening to realize how hard healthcare executives work when moving from the chief medical officer of a multispecialty group of 150-plus physicians to the role of physician executive of a 600-physician group. Physicians tend to roll their eyes and think, “They don’t know what it takes to do my role,” and in some ways, that may be true. But administrators are incredibly smart and experienced; they understand the business and the psychology of activating a group of people. For physician leaders, it’s your job to help other providers understand what’s happening at the executive level and build that trust in senior leadership.

    The path forward for any organization isn’t through physicians, it’s with physicians. With the right selection, development and support, physician leaders will better equip the executive team to make positive changes for the future of the organization.

    Rob Schreiner

    Written By

    Rob Schreiner, MD


    Thomas Tami

    Written By

    Thomas Tami, MD



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