Who will lead?

A recent survey conducted by the UCLA Center for Health Services Management and the Physician Executive Practice of Heidrick & Struggles, an executive search firm, sheds light on the emerging physician executive's role. The goal of the research was to identify success factors as a means of evaluating and developing effective industry leaders. Respondents were asked to look at specific skills in relation to nine categories: Communication, leadership, interpersonal skills, self-motivation/management, organizational knowledge, organizational strategy, administrative skills, and thinking. Communication, leadership, and self-motivation/management emerged, in that order, as the three most important success factors for physician executives. An individual's general competencies, work styles, and ability to lead others through organizational restructuring defines his or her appropriateness for managerial positions in the health care industry.     

What skills do physician leaders need now and in the future?

The role of the physician leader is moving beyond traditional medical staff issues. A recent national survey of physician leaders shows a growing need for education on specific technical, leadership, and practical skills. The results reveal the medical leadership skills that physician executives consider important today, and provide a window to the future about the skills that will be important tomorrow. Physicians say they need training now in quality assurance, clinical benchmarking, decision-making, and strategic planning. And when they gaze into the future and see the rapid changes throughout health care, they say they'll need more training in communication, organizational change, effective listening, and systems thinking.     

Influence by learning how people process information

To have a successful career in management, you have to pay more attention to refining your communication skills than you ever thought was necessary. In a survey of 100 physician executives, 94 percent felt training was needed in communication skills if you are thinking about becoming a physician executive. When recruiters talk to us about the basic requirements for physician executives, one of the things they say the person needs to have is excellent communication skills. Most people have good communication skills, but what can move you into the category of excellent is paying careful attention to how the person you are talking to processes information. You can only do this if you listen before you do much talking. What do I mean by processing information? When we get up in the morning, the world is out there separate from us. We have to take in information about that world and make decisions all day long. We don't all do this in the same way. In this article, I am going to discuss four ways to process information.     

Building physician managers and leaders: a model

A needs assessment identified leadership, management, and interpersonal skills as training and development areas for hospital's physician executives. Training sessions were developed and occurred quarterly over a two-year period. Development strategies were designed to enhance transfer of learning from the classroom setting and incorporated personalized coaching sessions, development of a peer mentoring program, group redesign of the performance appraisal process, strategic planning, and performance feedback sessions. The comprehensiveness of the approaches taken in this program is critical to successful training and development efforts of physician executives.     

Care management challenge is the toughest yet.

The newest health care trend involves changing the core business--health care delivery and the resources involved--through better care management. This impacts every practitioner all day, every day. This issue truly belongs to the physicians, and thus to physician executives. Care management is the latest frontier, the place where the delivery of quality care, in the most efficient way, at the best possible cost, all come together. And physician executives are being challenged to make it happen, to change the way medicine is practiced and health care is delivered across the country, to move from treating episodes of care to a true preventive mindset and population-based methodologies. This column outlines the skills in care management that systems-based physician executives will need to develop or enhance to remain competitive--effective communication skills and team-building capabilities are critical attributes for those who hope for success.     

Physician executives and communication.

This article presents the results of a pioneering survey of American College of Physician Executives members' perceptions of just how skilled they are as communicators and where they feel the need for further training. Listening skills were rated most important and most in need of enhancement, but physician executives agree that managerial communication skills across the board are vital to the success of a health care organization.     

You have the job you wanted--now what?

We've had calls from physicians who finally have the medical management job they always wanted and then a month later they wondered why they wanted it. I asked seven physician executives to come together as a group and talk to me about this issue. I also asked them what skills they needed most when they first got the job and, as time passed, which skills continued to be most useful. I have not used their names because they were open enough to talk about some very sensitive issues.     

Why an MBA?

As physicians move into medical management, leaving clinical practice behind to play a major role in managing physician performance and clinical processes, they are having to deal in the business world. Physician executives are donning the pinstripe suit instead of the white coat, and adding a business acumen to their clinical skills. Many have opted to pursue executive MBA programs to learn the business competencies they need to manage health care organizations. This article summarizes the educational opportunities available in executive MBA programs and discusses the value of business training for aspiring physician executives.     

Physician leadership. Physician executives share insights

Senior physician executives were asked to share their insights about how the medical management field has evolved. The Physician Executive Management Center, a Tampa, Florida-based search firm, has been surveying senior physician executives each year for the past decade. This year's report on physician executive compensation and duties in hospitals, managed care organizations, and group practices provides an excellent picture of the growth of the profession, as well as a broad perspective of anticipated changes for the future of medical management. The respondents addressed the following questions: What are the skills necessary for success? How have their jobs changed over the years? Have they made the right choice in pursuing medical management careers?     

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.     

What physician executives and health care organizations should expect from each other

Today, interest in defining the role of the physician executive and ensuring this individual is effectively integrated into the organization is high for good reason--the ranks of physician executives are growing. What attributes should health care organizations look for when hiring physician executives and what should they should expect of them once they are on the job? Physician executives should: (1) have demonstrated clinical and management skills; (2) have a comfort level with participatory decision-making; (3) have superb interpersonal skills; and (4) be a champion of the patient. Physician executives should expect the following support from their organizations: (1) varied roles and responsibilities; (2) mentoring by other senior executives; (3) lifelong learning opportunities; and (4) complete support of the management team.     

Wanted--seasoned veterans. Diamonds in the rough need not apply

Health care organizations looking for physician executives prefer seasoned veterans--doctors who have already done the job. They want job-specific experience. Most organizations do not provide training grounds and orderly career ladders for aspiring physician executives. The Permanente Medical Groups, Family Health Plans, and some very large group practices are exceptions, but, for the most part, rising medical directors in these organizations stay with them. Most hospitals are not large enough to have associate or assistant medical directors or an environment that could provide a training ground for rising physician executives. On the other hand, hospitals, larger group practices, health insurance companies, and managed care organizations provide ample opportunities for nonphysician managers to train, gain experience, and climb the ladders. How can the novice physician executive break into the world of management and begin establishing management credentials? The author provides some key steps that can lead to success.     

Getting the third degree.

The main finding of the just released results of the 1987 Physician Executive Compensation Report is that compensation increases in 1987 for physician executives continued to outpace inflation by considerable margins. There were variations by type of health care organization and by geographic region, of course, and bonuses seem to have fallen out of favor in most cases. A side result of the survey deals with the degree to which physician executives have opted for formal management education to improve their management skills and their chances of success in medical management. These survey educational findings are described in the following article.     

Why become a certified physician executive?

What is the CPE Tutorial and how can it help advance the careers of physician executives? This five-day program teaches executive skills that make physician executives more valued in the marketplace. When candidates successfully pass an evaluation judged by a panel of health care CEOs, recruiters, and Fellows of the College, they become Certified Physician Executives (CPEs). This certification provides recognition to potential employers that CPEs have: stature as a physician; been successfully tested in all disciplines of medical management; demonstrated management experience; and successfully completed the Tutorial with a five minute presentation describing skills and competencies on the last day. As CPEs become widely known in the marketplace, the designation will be a valued credential that helps physician executives get and keep desirable positions, as well as advance to the next level in their careers.     

Physician leadership. How do physician executives view themselves?

Most physician executives today have acquired substantial management training and experience, and many have worked with and relied on the expertise of mentors for their career guidance and development. Physician executives are actually becoming executives who happen to be physicians. They view themselves first as leaders, then as physicians, and finally as managers. That is a remarkable transformation in perception. To chronicle this process, Witt/Kieffer, Ford, Hadelman & Lloyd conducted a national survey this spring among senior physician executives in both payer and provider organizations. The data provide a "snapshot" of their role, and may also suggest some future scenarios for the industry. The primary reasons for choosing to pursue a management role noted by most participants include a desire to be part of the health care solution and an interest in management and leadership challenges.     

The MBA mystique

Is an MBA the solution for you? Do physician executives need to have a business degree to compete in today's competitive marketplace? What are clients looking for when they make hiring decisions? The answers may surprise you. This column is an attempt to dispel myths about physician executives and the MBA degree. Clients want to attract and hire physician executives who possess sometimes intangible skills--with or without the MBA credential. These intangible skills include the ability to educate other physicians to the new health care realities, a sales orientation emphasizing effective communication that focuses on patients and payers as customers, comfort with ambiguity, flexibility, and tact and sensitivity in negotiations.     

Elements of effective corporate planning

This paper focuses on several specific areas in corporate planning which heretofore have received limited attention in the literature. These areas include perception of a need for planning, analysis of planning from a process viewpoint with particular emphasis on organizational structure, and elements of effective planning. Data on which conclusions are based were developed through structured in-depth interviews with key planning executives of 14 large corporations in the Pittsburgh Metropolitan area.The study determined that the most prevalent event associated with perception of a need for more formalized planning was a change in top management. The emphasis on planning usually arose from three sets of factors—organizational, external, and performance. The typical planning process involves establishing corporate goals and objectives, setting environmental premises, collecting information and forecasting, establishing divisional goals and objectives, developing divisional plans, and revising objectives and plans if objectives are not met. The major participants in the planning process are top management, the corporate planning department, divisional general management, divisional staff groups, and intermediary planning groups.The study identified necessary conditions for effective planning which included planning knowledge and skills, planning climate, psychological commitment, and effective group behavior. The study also includes a discussion of planning weaknesses, current trends, and recommendations.     

Physician executives report high job satisfaction. Summary of findings from a survey of senior physician executives

The role of the senior physician executive is well established in American hospitals and health systems. There is little research, however, on overall physician executive job satisfaction, their perceptions of their organizational role and job performance, or their views of the medical staffs with which they work. A recent survey of physician executives examined these and other areas. It found physician executives to be quite satisfied with their jobs. What follows is a summary of the findings. An article based on the survey will be featured in a future issue of The Physician Executive.     

The physician executive and the future.

In summary, physician managers have a bright future. They are working on one of the most exciting professional interfaces--medicine and management. The future of medicine is both high-tech and low-tech. It will challenge all physician executives. For a few years, health care organizations will experience turbulence and stress. The name of the game for physician managers will be organizational survival. The nation will then move into an era of abundance in medical care, and the management game will switch from survival to thrival. Managers are key players in the world of tomorrow. The physician executive is a manager and therefore a key player. One of the best things about the future of the physician is that he has one.     

Leadership is the key to chief medical officer success

Senior physician executives were surveyed in 1998/99 to ascertain that they see as their greatest value to their organizations. They believe that their most significant contribution is their accumulated knowledge and experience--both in medicine and management. This medical management perspective is considered the key advantage of serving on the senior management team and helping to shape the organization's decisions and direction. Additionally, they rated their relationships with physicians as a critical aspect of their position. They were also asked what activities they most enjoyed. The number one response was working with the physicians on the medical staff and in the community. This includes the day-to-day involvement as a leader, as a mentor and educator, and overall as a liasion to the organization's practitioners. The activities that they found most rewarding were also those they perceived to be of greatest value. If these physicians are correct about what is valued in their organizations, they are the right people in the right jobs--and they enjoy what they do.