The C-suite spot: More physicians step in as hospital leaders

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As healthcare evolves into a more value-based system, physicians are increasingly taking the reins as leaders within healthcare systems, using their clinical background to direct stronger patient-centric care.

Hospitals already were starting to consider different approaches to financial and care delivery models, and then the Affordable Care Act (ACA) put a stronger emphasis on value and population health, Peter Angood, MD, told Cardiovascular Business. Angood is president and CEO of the American Association of Physician Leadership (AAPL) in Tampa, Fla., and lead author of a white paper about the value of physician leadership.

The ACA “has helped to really move this trend along much more quickly than we were originally seeing,” Angood said. “The combination of those trends has precipitately found physicians in leadership roles of different types.”

About 5 percent of hospital CEOs and presidents are physicians—including cardiologist Delos Cosgrove, MD, at the Cleveland Clinic and leaders at the other top five hospitals in the 2013 U.S. News and World Report’s best hospitals “honor roll”—a number that is expected to increase rapidly, according to Angood. The reasons are simple, he said. Physicians bring extensive knowledge about the “core business” of caring for human beings, and they’ve been there on the frontlines dealing with problems in hospitals.

“Physicians are the ones who are trained and educated clinically to the highest level, and the expectation in society is that they make the highest levels of clinical decision-making,” he said.

The white paper listed aspiring physician leaders’ attributes and limitations. Doctors are fast learners and outcome-driven with high expectations and an unparalleled work ethic. They may be well-respected by peers, but they also tend to be autonomous in their problem-solving approach, which can create barriers to forming, leading or participating in successful teams. They typically need to develop business skills related to financial management, human resources management, interacting with different vendor communities and dealing with purchasing strategies.

That transition in mindset is beginning, Angood said. AAPL includes physician leadership as one of its nine essential elements required to provide optimal patient-centered care. And more physicians are leading quality initiatives in their institutions, being relied on to manage major projects.

“By the time their residences are complete, they will have demonstrated their ability to create cohesion and lead others to where their organization needs to go,” said Rebekah Apple, senior manager of physician services and support at AAPL.

Angood is conducting a survey to determine if hospitals are doing a good job of training physicians to become leaders. “Some of our preliminary data is showing that healthcare organizations are beginning to pay attention to how better to educate physicians in their workforce around leadership as well as management principals,” he said.

The new model doesn’t exclude nonphysicians from leadership roles, Angood noted. They still may be suited to such roles as CFO, or partnered up in a dyad with a physician. And it’s not just physicians who are recognizing the importance of having management skills. Nurses, pharmacists and other disciplines are also looking for ways to acquire skill sets and experience related to leadership and management.

“The future is going to be interesting because not only do physicians at the student and trainee levels recognize the need to have these leadership and management skills, but other clinical disciplines are also recognizing the importance of having the management skills,” Angood said. “You've got this constellation of forces coming together where everybody thinks there needs to be a stronger input of their discipline in leadership and management circles of any type of healthcare system.”