Confronting the disruptive physician

Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.     

Diagnosis and therapy for the disruptive physician.

A disruptive physician can alienate staff, drive away patients, and even land your organization in a lawsuit. Consider some practical advice on how to identify and deal with disruptive physicians.     

The disruptive physician. A quality of professional life factor.

Medical leaders need to understand that attending to quality of professional life issues includes dealing with the insidious costs and stress associated with disruptive physician behavior. The disruptive physician or professional undermines practice morale, heightens turnover in the organization, steals from productive activities, increases the risks for ineffective or substandard practice, and causes distress among colleagues. Physician executives need to help reduce or prevent this behavior and develop accepted systems in which to manage, confront, and rehabilitate the person labeled "disruptive." Suggested strategies to consider in developing a system include: (1) Defining reasonable and competent interpersonal behavior; (2) educating in interpersonal skills; (3) evaluating interpersonal skills; (4) developing disruptive policy; and (5) assessing, confronting, and rehabilitating.     

Poll results: doctors' disruptive behavior disturbs physician leaders

Results of ACPE's 2004 Physician Behavior Survey show that physician executives face deep frustrations when forced to tackle the thorny issue of disruptive behavior by fellow physicians.     

Professionalism is judged by appearances ... like it or not

Exploring the larger subject of executive professionalism should include the whole range of behavior issues that affect others' perceptions of you. In this competitive environment, with limited time to manage relationships, physician executives must take control of all aspects affecting their credibility and communications. This is not to suggest that you become the stereotyped, air-brushed news anchor, all style and little substance, but that you create a total package, one in which the "inside" and the "outside" of your presentation are complementary. Focus your attention on how well you have developed these factors as a physician executive: Appearance; demeanor; professionalism; and integrity. To create a "total package," it is helpful to consider the following recommendations: Write "commercials" for yourself and your organization; use every interaction as a selling opportunity; make every context a platform; don't hide from criticism--seek it out; and use every opportunity that comes your way to listen.     

Satisfaction higher for physician executives who treat patients,survey finds

If you're satisfied with your physician executive job, one factor contributing to your happiness may be that you're still seeing some patients. Check out the results of a national survey that examines why some physician executives are more satisfied with their jobs.     

A process for objective review of physician performance

How do you objectively evaluate physicians at reappointment. How do you establish a common ground for the evaluation process that still acknowledges acceptable differences in performance? Perhaps one physician has some difficulty with documentation and attendance at meetings, but has no quality problems clinically. Another physician may have good documentation and meeting attendance, but has some quality problems. Another physician has a behavior pattern that is disruptive, a few documentation problems, but excellent quality. Yet another physician is a marginal practitioner with major problems in several areas, including quality. Reappointment of these physicians might be extremely difficult, especially if the credentials committee is recently appointed and not familiar with the details of the performance data.     

Do you demonstrate leadership skills when you speak?

Nervous about your next big presentation? Don't be. There are proven ways to polish your presentation, spice up your speech and capture your audience's attention. Find out how experienced physician executives deliver dynamic presentations and learn tips for avoiding common mistakes.     

Thriving in change

The turbulent state of health care and the rapid changes that show no sign of abating point to many career-related challenges for physician executives. How can you predict the impact of these changes on your career? What measures can be taken to prevent any negative impact of change? And how can you prevail when dealt a negative blow like job loss? The signs that foreshadow the unraveling of a physician executive's career are described. The warning signs are: Not keeping up with change, losing your influence; getting negative feedback; turning your "concerns" into complaints; the economy working against you; and being blindsided because we think leaders operate logically. Being proactive puts more control in your hands and leaves less to chance. You can prevent being blindsided if you: develop your people skills; get comfortable and involved with e-business; stay abreast of health care trends; pick up the pace; and develop "You, Inc." There is a final component to prevailing over adverse circumstances--find your work-related passion and apply it to your career.     

Diagnosis of a stalled career

What should physician executives do to prepare for a career move? This is not a list of items to improve technical skills and knowledge, but information on how to accurately and clearly present your experience and gain credibility. A few of the basic career preparations that physician executives must make include: (1) Get your paperwork in order, both a resume and a curriculum vitae; (2) seek feedback and critical input; (3) refresh or establish your interviewing skills; and (4) focus on your communications techniques. Physicians executives cannot rest on their deserved laurels as strong practitioners when aspiring to a senior management role. It is critical to emphasize other skills--decisiveness, communication, and management experience in a range of health care organizations.     

Skills needed by physician CEOs. Interview by Barbara J. Linney

How do you transition from physician executive to physician CEO? Three physician CEOs were interviewed to explore the skills they needed to land in the top position. They share their views on what it takes to be a successful CEO. They describe the skills that they needed when they moved into the CEO role and how they acquired them. Some of the qualities it takes to be a CEO include the ability to: Articulate your values; use your people skills; describe a vision; solve problems; listen; walk around; and use analytical skills.     

How to shape positive relationships in medical practices and hospitals

Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's medical leaders. Poorly managed workplace conflict can alienate patients, demoralize staff, increase turnover, damage relationships with valued referral sources and third party carriers concerned about patient satisfaction, and lead medical practices to costly "corporate divorces." Physician executives cannot solve the problems caused by disruptive doctors simply by bolstering their own conflict management skills or by policing offenders. The larger contexts within which inappropriate workplace behavior occurs must also be assessed and addressed. The true leadership challenge is to intervene in ways that help to foster a "culture" of appropriate interpersonal dynamics throughout your organization. This requires learning to think and to intervene systematically.     

Physician leader, be careful not to let arrogance stand in for competence

At various points in your physician leadership career you may feel such a sense of mastery that you delude yourself into believing that you are better than you are. Depending on the size of your ego, that time may come sooner or later than in your peers, but, be mindful, it could come.     

The art and science of starting a new job.

To be successful in a new job out-of-town, physician executives need to develop a plan for a smooth transition into the organization. A checklist to prepare yourself for the new position should include: Updating your research; (2) staying in close contact with your new boss; (3) visiting the office; (4) hiring your own support person; (5) planning the first week; (6) telling the troops how to manage you; (7) making early decisions; and (8) meeting your peers. The focus should be on the job and connecting with your new boss, medical staff, and coworkers--and not exclusively on the environment of your home-to-be.     

Common denominators of success

There is no mystery to the success stories described in this column. In addition to a lot of hard work, a few basic principles have been applied to widely differing scenarios. These common denominators provide the philosophies and dynamics that can lead to your breakthroughs in quality health care delivery: (1) Trust--among the physicians and then between them and management and the board of directors; (2) positive physician culture and attitudes; (3) effective physician leadership; (4) patient care focus; (5) strong team orientation; and (6) true accountability by all stakeholders. Your job is to help your physicians feel they are major stakeholders in your health care delivery system and be their voice in clinical and financial decision-making at the highest level.     

Coping with bad news: the physician executive's role in a lawsuit

In these days of doctors, lawyers and lawsuits, chances of an American physician finishing his or her career without a malpractice claim are growing more remote. Every physician executive overseeing the activities of a group of peers knows this and should be prepared to assist the physician who is sued. Examine four key ways to help your physicians deal with the stress of a lawsuit.     

Delegation can make (or break) your career

Delegation is not a soft skill. Physician executives who do not delegate well and strategically cannot expect to achieve the top jobs now or in the future. It's not enough to have great communications skills to convey your vision. You won't achieve that vision alone; you must have a great team to bring that vision to fruition. However, you can't delegate your first and most important step--self-assessment. To maximize your strengths and minimize your weaknesses, you'll need a clear view of what makes you tick. Then start thinking about your executive role in these terms: Conceptualize work mandates as projects; choose people who are better than you for your team; and try to work yourself out of a job. By learning to delegate, physician executives can make their own careers (as well as those on their team) richer and more fulfilled.     

Health care is sales

Health care is all about sales--everyone today in the competitive arena of health care is a salesperson. Your selling days began when you applied to medical school. Your product was yourself, and you worked hard to sell it. That was only the beginning. In your daily work as physician executives, you are selling yourself and your ideas-your ideas about relationships, management structures, partnership issues, merger questions, etc. It's a complicated world, and the concepts are often abstract and difficult. But it is your job to communicate with others to get things done. It is the most important part of your job. It is selling, in fact, at a sophisticated level. How do you communicate and sell yourself and your ideas effectively? Here, some ideas on how to listen and communicate.     

Hired, fired, and not retired: an interview with a physician executive who has run the career gauntlet. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Robert J. Hudson, MD, on April 24, 2000 to discuss his experiences as a physician executive who has made the career transition from practicing physician to managed care executive to biotech entrepreneur. Along the way, he's hired and fired others, and been fired himself. Painful as it is, many physician executives' career realities include being fired. Organizations, after all, are living organizations--they grow, wither, and molt. And as they molt, organizations shed and regrow new skin. What do physician executives do when they've been fired? They go through their own cycle and retreat, reflect, and re-emerge, often reinventing themselves as they go. An essential part of this process is looking within to plumb likes and dislikes, strengths and weaknesses, nightmares and dreams, and positive and negative experiences. For most executives, out of these experiences has come a circle of friends and a Rolodex. Start by reaching out to the circle, by going through your Rolodex, and you can broadcast the news of your rebirth.     

Opportunities? Barriers? It's up to you.

This career advice column is usually directed toward those in transition--physician executives who are actively pursuing job opportunities or preparing to do so. But most of your career is actually spent in a position and on the job. So it seems appropriate to focus on the great majority of physician executives who are not currently in the job market. Take a look at opportunities to learn and grow in your present position.