The need for physician leadership

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Today’s health care environment presents outstanding opportunities for physicians to develop lasting improvements in care delivery by demonstrating and providing leadership. The pandemic has demonstrated that physician leadership has never been needed more than it is currently.

Health care organizations have always needed the distinctive perspective of physicians among their leadership. Because of increased constraints on revenue and heightened review by payers, health system leaders of today are now more often in the position of making administrative decisions that ultimately affect clinical care.

WHY PHYSICIAN LEADERS?

At some level, it’s a societal expectation that all physicians are leaders. Shortly after passage and implementation of the Affordable Care Act, the American Association for Physician Leadership (AAPL) recognized a rapid increase in organizations seeking to employ physicians and educate physician leaders.

The trend has continued, though on a less-pronounced trajectory. Surveys conducted by large national organizations, including the Medical Group Management Association, the American Hospital Association, the American Medical Association, and the physician-recruiting firm Merritt Hawkins, continue to report increased consolidation and direct employment by hospitals.

Yet, independent practices (physician-owned) are certainly not moribund. The AMA study concluded that some 60% of practicing physicians were still working in physician-owned practices. By 2020, however, surveys conducted by some organizations, such as the AMA, agree that fewer than half of the practicing physicians in the U.S. remain independent.

Physician leaders have been described as “interface professionals” who bridge medicine and management. At the edge between other physicians and managers, physician leaders can be the catalyst that every successful organization needs, connecting the organization’s so-called sharp end (the front lines of care) with the blunt end (related management, leadership, and governance).

The AAPL believes that, with the right physicians on the C-suite leadership team, the organization will be able to relate to non-physician managers as well as clinicians of several disciplines. Through the orders they place and the management they provide physicians – and the physician/patient relationship -- are the primary drivers of care. For this reason, it’s natural for physicians to be in key leadership roles, shaping the decisions around what’s best for patients and the organization.

The Soul of the Business

This, however, does not necessarily mean that physician leadership is only demonstrated through titled leadership positions. Physicians of all types and in a variety of roles still provide leadership — albeit of a more informal kind. It is natural that formal and informal clinician leaders tend to have attributes that are especially useful for health care leadership, including the belief fundamental to the art of medicine: “First, do no harm.” That “creed” includes an appreciation for the value of solid data and a receptiveness to evidence-based decision-making and an inclination to do “what’s best for the patient.”

A shared history and a common language give physician leaders the credibility -- among their colleagues and other providers -- to garner critical support for clinical integration. This support allows them to drive the value agenda for initiatives such as reducing variations in care, reducing readmissions, developing a patient-centered medical home, implementing best practices, and other value-driven strategies.

The respect and authority traditionally conferred on physicians helps them win support for change, both within their organizations and from the communities they serve.

“Largescale organizational changes . . . require strong leaders and a cultural context in which they can lead. For obvious reasons, such leaders gain additional leverage if they are physicians,” according to Thomas Lee, MD, former president of Partners HealthCare System in Boston, Massachusetts, and chief medical officer at Press Ganey & Associates, in a Harvard Business Review article.

In an example of influence, the additional leverage provided by a physician leader enabled Rutland Regional Medical Center to win legislative and community support for the creation of a new acute care psychiatric unit.

The unit has helped fill the significant services gap for individuals with severe mental illness, created when floodwaters from Hurricane Irene destroyed the 52-bed Vermont State Psychiatric Hospital in Waterbury in 2011.

The leadership of W. Gordon Frankle, MD, chief of psychiatry at the time, helped the medical center obtain state resources to convert a portion of its inpatient psychiatric unit into a psychiatric ICU to care for some of the state’s most seriously ill patients. The unit is one of a handful opened across the state to improve geographic access to short-term psychiatric care.

According to RRMC’s Baxter Holland, Frankle served as an articulate and convincing spokesperson for the hospital and advocate for effective treatment for people with mental illness. His professional standing as a psychiatrist and knowledge of the medical needs of individuals with severe psychiatric conditions gave the medical center an entrée and a degree of credibility among legislators, community members, and other stakeholders that a non-physician may not have had.

“People will listen when a physician talks. They might not when someone else talks,” he says.

The credibility and trust engendered by a physician-led board and extensive physician committee structure have enabled the HealthTexas Provider Network to drive quality improvement since the multispecialty group’s data-driven work in this area began in 1999.

The need for physicians to serve as team builders, motivators, communicators, and change agents has grown exponentially in a system that now recognizes health care organizations more for their medical performance than their operational acumen.

It is important to acknowledge that CMOs and CFOs speak dif­ferent languages, have dif­ferent perspectives, and focus on dif­ferent goals. It is critical for clinical and financial leaders to recognize and understand the pain points of their colleagues on the other side of the C-suite.

Success in the value-based environment requires leaders who can bridge the gaps between the clinical and financial realms. It requires clinicians who can understand finances and can galvanize their peers around organizational or population health goals. Physician leaders speak the language and share the perspective of the care providers at the front lines of care.

Perhaps the best measure of physician leadership is that of hospital performance.

Year after year, U.S. News & World Report’s annual “Best Hospitals Honor Roll” supports a strong connection between high-quality ratings and physician leadership.

While the overall percentage of physician leaders in hospitals hasn’t changed (approximately 5% of hospital leaders are physicians), an overwhelming number of the top-ranked hospitals continue to be run by physician CEOs.

Peter Angood, MD, FRCS (C), FACS, MCCM, FAAPL(Hon), has provided senior executive leadership for all sizes and types of healthcare organizations. Since 2011, he has been chief executive officer and president of the American Association for Physician Leadership; the only professional organization solely focused on leadership education and management training for the physician workforce. The organization has members in more than 45 countries.