No longer a solo practice: how physician leaders lead

The authors conducted a national study to determine the factors associated with the success of physician leaders. They utilized the Leadership Practices Inventory (LPI) and a demographic survey followed by individual interviews with respondents. Data analysis revealed several implications for the selection, training, management, and career development of physician leaders. The results suggest that: Physician leadership training should have a strong focus on the "human side" of management, including negotiation, organizational "politics," conflict resolution, team building, and motivation. Data management and finance should be a focus represented in the curriculum. Mentoring relationships should be developed as an aspiring physician leader pursues a career shift. Self assessment, including an analysis of style, strengths, best potential organizational fit, and specific areas of strength and weakness should be an integral part of the development of an aspiring physician leader. Screening mechanisms to ascertain a physician's motivation to move toward a full-time leadership role should be developed to ensure appropriate intent. To facilitate this implication, more effective assessment tools need to be developed.     

Role stress among physician executives

On the one hand, physician executives are clinicians who place value on professional autonomy. As clinicians, the best interests of the patient drive their decision making and their value system. On the other hand, as managers, physician executives serve as agents of an organization. Because of the differences in the two cultures, some physicians have called the physician executive position a "no man's land" To address these issues and answer the questions that surround them, the authors developed a survey that was mailed to a random sample of the membership of the American College of Physician Executives. Parts of the survey served in other studies of role conflict and role ambiguity. Parts of the survey are new, developed specifically to analyze the physician executive role. The findings are reported in this article.     

Physician executive contracts: negotiating the future

Once viewed as a matter of standard protocol, physician executive contracts have become as complex as the health care industry itself. Historically, hospital administration and physicians negotiated a few key points, then sent the ideas to an attorney for insertion of standard legalize and boilerplate. Today, physician executive contracts are an important part of the changes in health care. They not only cover traditional hospital and physician relations, but increasingly apply to new types of relations (such as employment) between hospitals and physicians, physicians and physicians, and health plans and physicians. In this article, we will explore both the "content" and the "context" of physician executive contracts. Content will deal with the specific provisions typically included in contracts. Context will address issues associated with preparing for and negotiating a contract.     

A behavioral profile of physician executives

In late 1993, ACPE and Tyler & Company, a national health care executive and physician search firm based in Atlanta, Ga., jointly conducted a survey of physician executives to determine their most likely behavioral patterns. It is the first of a two-part survey that, when complete, will create a multifaceted profile of the "ideal" physician executive as seen through physician executives' eyes and through the eyes of hospital management. Questionnaires based on the DiSC method of behavioral analysis were mailed to 750 randomly selected members of ACPE. More than 170 responses were received. The survey results showed that the majority of physician executives have strong communications skills, are people-oriented, and are strong leaders. The majority of respondents are self-motivated and industrious and are driven by accomplishments. The second part of the survey, which will be conducted later this year, will poll hospital CEOs and boards of directors about their preferences for behavioral patterns in their executives. Comparisons and consistencies will be analyzed between the two surveys to develop a comprehensive profile of the "ideal" physician executive, and the results will be reported in Physician Executive.     

Global view offers good news for physician executives

Do all physician executives have much "catching up" to do in relation to their non-MD colleagues? A comparison of the role of the physician executive versus the non-MD executive/administrator provides a big picture view and signals new opportunities for physicians in the evolving health care system. Physician executives have only recently become invested in the health care executive suite and are less wedded to old methods and "classic" ideas. They are more likely to be able to adapt to new circumstances, jettisoning traditional approaches that have outlived their usefulness. But each group-physician executives and their MHA- or MBA-credentialed, non-MD colleagues- has much to offer to or learn from the other. By retaining those skills that are applicable, while also adapting the useful characteristics of the "traditional" health care administrator, a physician executive can increase the likelihood of success today.     

Revised antitrust guidelines. Forming physician network joint ventures

What do physician executives need to know about antitrust guidelines? This article presents an overview of the revised "Statements of Antitrust Enforcement Policy in the Health Care Area," released in late 1996. Antitrust concepts and implicated federal statutes are described, and implications for forming physician network joint ventures are explored. Requirements of the revised standards used by the agencies to determine a permissible integration are addressed, as well as the factors considered in antitrust scrutiny of physician ventures.     

Recommendations for new medical directors and physician advisors. Administrative clinical pearls

Presented here are "administrative pearls" that evolved out of a health plan's program to help new physician advisors and medical directors in their daily operations and decision-making process. The list of eight recommendations represents accumulated wisdom from experienced medical directors, physician advisors, and nurse managers.     

Physician support groups in a multispecialty group practice setting

With a moderate expenditure of time and energy on the part of a physician executive, the group support concept can be used in any organization to help physicians overcome social obstacles and learn to cope with the disturbing changes that are occurring in medicine. By selecting the most suitable candidates, anticipating obstacles, and simply beginning an effort, one can bring about optimal change for physician members of an organization despite their apparent reluctance. The optimal time for suggesting help in this group support manner is when the problem is acute and significant, i.e., "a crisis."     

The telephone encounter: the cast of characters encountered by the physician executive

Volumes have been written about telephone productivity, decorum, behavior, and economic impact. Although every physician is skilled in telephone communication, medical directors must approach this communications modality from a different vantage point. The attending physician uses it as an information receiver and transmittal station. The medical director uses it as a negotiation platform. It is estimated that 50 to 90 percent of the medical director's time is spent on the phone. "Working smarter" can increase productivity to save time and stress. This article identifies and categorizes many of the problems that the medical director deals with on a daily basis. It pertains to phone conversations in which there is a question about a procedure, appropriateness of care, medical necessity, or quality of care.     

Physician report cards: now and in the future

The six methods used to create physician performance reports-a less pejorative term than physician report cards-are seriously flawed. These current approaches are peer review, essay-style reports, raw data, statistical reports, outcome analysis, and aggregate variation from guidelines. We must deliver what we promise in information designed to confirm dependable practitioner performance. Otherwise, we risk confirming, instead, the public's suspicion that the emphasis in "managed care" is too much on managing profit and too little on patient care. This article explores a plan for how to proceed with evaluating physician performance.     

Resource allocation. The cost of care: two troublesome cases in health care ethics.

With the cost of health care rising rapidly, both physicians and administrators regularly face resource allocation decisions. Under these conditions of relative scarcity, the equitable and appropriate distribution of limited resources becomes an ethical as well as a financial issue. Through ethical analysis, physician executives can assist their physician colleagues and fellow administrators to find rationally defensible answers to questions regarding the distribution of limited resources. Six criteria are frequently "weighted in the balance" by ethicists when analyzing whether justice is served in the distribution of a limited resource: need, equality, contribution, ability to pay, effort, and merit. The authors argue that, from an ethical standpoint, the best single criterion upon which one can base an allocation decision is that of merit, defined as the potential to benefit from the investment of additional resources.     

An approach to the impaired physician

The 1988 California Administrative Code requiring all acute care medical staffs to provide assistance to impaired physicians has not resulted in an increase in the annual census in the Medical Board of California Diversion Program. In part, this lack of an increase is due to the failure of some hospitals to form physician aid committees and to the poor functioning of such committees in other hospitals. The common reasons for these deficiencies are that the medical staff leadership does not think there are any impaired physicians on staff and that they don't know what the committee would do if it were formed. This attitude demonstrates a lack of appreciation for the prevalence of impaired physicians and the tremendous amount of work required (establishing policies and procedures) to identify and help them. This article discusses the prevalence of the impaired physician, the types of impaired physicians, a "cookbook" approach to managing these physicians, and the success of intervention.     

Becoming a company person.

Physicians face a management challenge in adjusting to being part of a larger organization. By nature, physicians are not "company people." For physician executives, whose instincts can still lean toward being ferociously independent and individualistic--therein lies the struggle. Here are a few suggestions to help physician executives make the adjustments that are required of a "company person": (1) Be in the right place; (2) abandon critical/negative thinking; (3) focus on the issues; (4) maintain solidarity; and (5) make your boss look good.     

Persuasion strategies for physician executives: Part I--Influencing superiors

Little is known about the way physicians function as managers in influence situations. In an effort to fill this gap in the literature and to illuminate how a "target's" communication style affects "agents" strategic decisions, this study examined 222 physician executives' choices of compliance-gaining strategies when seeking to influence superiors who communicate with them in attractive and unattractive styles.     

The purpose of a job interview is a job offer

Perhaps empathy has been overdone in recent years. Most of us would admit to some cynicism or disbelief when we hear the words, "I know how you feel." Having said that, however, I actually do know how you feel. If I can't identify exactly where you are coming from, I do know where you are likely to be going and how bumpy the ride is likely to be. I'm a physician and a physician executive. I am also an executive search consultant who is daily in the field interviewing physicians who may or may not be the right individuals for a client's situation. If I don't exactly feel your pain, at least I know its sources. I know how difficult it is to make the move from challenging clinical work to an administrative role in health care. While, as a group, physicians are multiskilled and multitalented, it's an unfortunate fact that some of the skills and talents that made you an excellent physician may be blocking you from succeeding in an executive capacity. My hope is that, through an occasional entry in this column, I can share my experiences and relate the remarkable wisdom of the impressive physician executives whom I meet every day. The first issue I'm opening up for discussion is employment interviewing: Why the interview is so important, what the interviewing process is, and how you can become more adept in this critical skill area.     

Reinventing my medical career

The author found himself in a surprising situation in the Fall of 1998. For the first time in his life, he was looking for a job. Kent Bottles, MD, shares his experience of reinventing himself from academic chairman in an integrated delivery system to health care consultant. He stresses that physician executives need to package their experiences in terms of transferable skills that are easily understood by potential employers. He also emphasizes that acquaintances are more important than friends in obtaining employment; one needs to network with acquaintances and rely on the sympathy of relative strangers. A lot of hard work, networking, and "selling" his reinvented self resulted in a CEO hiring him. With all the changes brought on by the global economy and the uncertainties of the health care marketplace, other physician executives may be faced with the need to reinvent themselves.     

Physician anger, Part 2. More on the dance of anger.

This article is a follow-up to an interview with Charles Dwyer, PhD, which appeared in the 1999 March/April issue of The Physician Executive. He described how physician executives can change the perceptions of today's beleaguered physicians and help them cope with change. We then asked him for some hands-on strategies to deal with physician anger, fear, and resentment. After much contemplation on providing a list of "fixes" that will restore each of us to a state of greater satisfaction, Dr. Dwyer concludes that there are no generalizable solutions because there are too many variables that come into play in each organization, individual, or group. Attending to the self can provide both individual rescue from these turbulent times and the best hope for changes in the system from which patients and health care providers can benefit. If physicians are to regain their power and maintain, or even improve, their quality of life, clearly changes are called for. And these are changes that require persistent effort and uncomfortable adjustments.     

From primary care physician employment to private practice: easing the transition

In most cases, the practice acquisition and employment strategy of the 1990s has backfired, with acquired physician practices losing in the range of $50,000 to $100,000 or more per physician annually. There are two alternatives for addressing the operating deficits incurred from practice ownership and physician employment: (1) restructuring through the implementation of network-wide and practice-specific initiatives to improve financial performance; or (2) wholesale (i.e., all practices) or selective practice divestiture, depending on the individual practice financial performance and "fit" with the physician network strategic priorities. Unraveling a decade's worth of physician-health system relationships that are grounded by the notion of acquisition and employment is going to be a complex process for both parties. But given the magnitude of financial losses on acquired practices and the inability of health care providers to sustain future losses, there simply are not options beyond restructuring or divesting these relationships.     

Leading beyond the bottom line

Do physician executives approach managing and leading health care organizations like a CEO of a Fortune 100 company? Or does their training as physicians first give them a unique perspective, leading them to view organizational issues differently? The authors suggest that to be a physician executive is to be the practitioner, teacher, coach, and mentor for a new philosophy of leadership and management called Leading Beyond the Bottom Line. While the financial health of an organization is critical to its survival and its ability to fulfill its purpose, the trap is to focus on maximizing the bottom line. This new philosophy leads an organization to attend in equal measure to the (1) welfare of its patients, (2) its financial health, (3) the well-being of its employees, and (4) the building of its community. "The Optimal Organization" is one in which these four objectives are seen not only as related, but interconnected, and the goal is to maximize all of them. The legitimate role of the physician executive is to manage in search of Pareto Optimum, or the maximum benefit for all four organizational objectives. Clearly, this is a tougher job than maximizing profits or just optimizing profits and patient care.     

High expectations mirror high stakes for physician executives

Because the stakes in health care are high, physician executives are challenged to meet high expectations set by their CEOs and boards. These may be unrealistic--for example, demanding that physician executives possess expertise in finance or strategic planning. Job stresses for physician executives are specific to the role, but are not unlike those faced by other senior executives. It's a fact that professionals leave jobs for any number of reasons; sometimes, not through their own choice or fault. Thus, every time a physician executive leaves a job, it should not be characterized as "being fired," and not every job-leaving should be taken as a failure. Accept that you may make mistakes while doing the best job you can. Rely on your own value system and integrity to see you through.