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Physicians should assume leadership roles both inside and outside of their practices
Any major change in an industry requires strong leadership. In the U.S., healthcare has undergone a significant transformation in the last decade and the evolution is far from complete. That said, among all the stakeholders involved in the medical field, physicians are the most likely candidates to be agents of change.
While medical school teaches the skill set to heal, is it also preparing tomorrow’s doctors for this role?
Medical Economics recently convened a panel of leadership experts to help answer this question and others surrounding physician leadership. The panel consisted of:
Medical Economics:Why is physician leadership so important in healthcare today-first, with the advent of team-based care?
Maria Chandler, MD, MBAMaria Chandler: I think most physicians would agree that physician leadership is so important because we feel like we know what’s best for patients in most regards. We want to help patients. That’s our goal. That’s what we’re usually fighting for and so we want to be in the discussion about what is going to happen with patients, how we’re going to proceed with patients, how we’re going to treat patients and all the questions that come up when talking about treating patients.
Peter Angood: I think we’re in the early stages of team-based medicine and multi-professional approaches, so there’s still lots of room to learn and for the time being within the various clinical disciplines it is the physician population that’s still trained up to the highest level of education and provided the deepest level of experiences and those individuals, in addition to being smart and motivated, they’re altruistic. They’re idealistic. They really want to create change and in the current health care delivery systems. Ninety to 95% of the care is still directly delivered by or directly supervised by physicians. So it makes sense for the physicians to be in the leadership roles but certainly a part of a multi-professional team.
Next: What is the importance of physician leadership outside of practice?
Robert Juhasz, DORobert Juhasz: I would say that many of us are involved in education whether it’s directly involved, or indirectly involved-whether it’s with patients, their families or, with medical students and residents. I like to say you cannot not teach and the fact is that we’re all mentors and, as physicians, people are always watching what we do. And the fact is we have the opportunity to mentor others. And it’s a great privilege to be able to do that.
So it’s always thinking about, how are we helping the team members to know how they can actually engage their situational leadership within the team? How can we actually utilize all of their skills and advance their leadership as well?
Maria Chandler: I think over time, what’s happened is the physician always was the leader, let’s say in private practice many years ago, and now with the large medical groups, I think a lot of physicians don’t feel like leaders. They’re not in leadership roles in many cases and they’ve lost the helm so to speak with their own patients. They’re told what and how they need to treat patients, how many minutes they have, [and] what they’re allowed to do and not do-requests are denied in many cases.
So I think physicians are frustrated that they’ve lost that role about being able to say what’s best for patients. So I think we’re really feeling that frustration. And in the bigger groups, I think we need to regain control of leadership of the entire organizations. In many cases, physicians still run a lot of academic institutes …but they’re not necessarily leading the bigger groups. So I think that’s where a lot of the angst comes from that we’re feeling right now.
And the importance of physician leadership outside of practice?
Peter B. Angood, MDPeter Angood: The simple answer is that physicians need to be more proactive in their approaches to assuming these leadership roles, and proactive in the way of seeking them out so that they can get some experience and learn for themselves whether they truly have aptitudes or interests in leadership and management roles. And being proactive in terms of getting extra experience and extra education with the skills around becoming an effective manager and a successful leader.
Next: The 'physician perspective'
Historically, physicians got their MD and with the role they had in society and within healthcare delivery systems, often times assumed leadership roles through strength of character and strength of personality, but what we’re really recognizing now is that well-trained, well-educated physicians with leadership and management skills provide a far more effective delivery of change inside of a healthcare system and that now is beginning to translate out into non-healthcare delivery systems, other healthcare related industries.
So the physician perspective, the clinical acumen, the leadership and business skills, are all combining to provide effective change inside of a whole host of different types of organizations inside of healthcare. As they do that though, physicians need to make sure that they’re providing a proper balance for themselves and there will need to be some letting go of the clinical side in order to properly provide the focus on these leadership and management skills and experiences that they take on.
Robert Juhasz: It’s important-whether you’re in private practice for your colleagues or if you’re employed-for your organization to really have buy-in and willingness to accept the fact that a physician is moving forward with pursuits and leadership. I certainly have had that experience here at the Cleveland Clinic. I mean there is a need for physician leaders and it’s identified by many organizations about the need to enhance physician leadership.
I just completed being president of the American Osteopathic Association, which was a tremendous time commitment and a commitment on behalf of an organization for a physician to be able to take those kinds of leadership roles.
It really is a commitment, not only of the physician and colleagues, but also of the organization. And I must say I was blessed to have that support both at the Cleveland Clinic and at the American Osteopathic Association to be able to do that. But particularly as I transitioned through those roles to make sure that my colleagues were supportive and patients were understanding to allow me to make those transitions and make them successful.
Next: What are some qualities a good physician leader should possess?
Maria Chandler: I completely agree. I know there were studies done back in 1997 by U.S. News and World Report about how many physicians are actually forced into-many times against their will-leadership positions in groups. If [physicians] self-identify, I think it’s much less painful and there still are physicians who would much rather see patients full time and let another physician take the lead. I think they feel more comfortable under a physician. I think that you do need some business acumen if you’re going to take a leadership position and I include leadership and communication within what I’m calling business acumen.
Before I got my MBA, I really didn’t know what I didn’t know. I figured a physician would make a good leader no matter what from our medical training. But I really learned that that’s not particularly the case. In fact, some physicians are very poor leaders and have difficulty getting people to follow them.
Physicians think they have credibility everywhere but if you step into the business world, you really don’t have credibility just because you’re a physician. And I think there’s a reason for that. I think that business skills really give you the other half of the pie when you’re dealing with solving problems in health care. You need to be able to make a business case for what you want.
You know, unfortunately the way the payers reimburse right now, it’s sort of a disincentive to have your physicians be doing anything but seeing patients. And I know that as the chief medical officer of a system of health clinics in a Los Angeles County nonprofit. You know, if I gave all of my physicians time to learn leadership skills, I probably wouldn’t be able to stay in business. So I think something’s going to have to give where we put more priority on leadership training somehow for physicians.
What are some qualities a good physician leader should possess as well as instill in those they lead?
Robert Juhasz: I think it’s important to be a good listener. It’s really being attentive to those that you lead and the fact is we have tremendous people that we work with and so it’s really [about] bringing the best out of them.
I think it’s important to have a resilient attitude. The fact is, there’s a lot of concern and there’s a lot of change that goes on within healthcare and the fact is it’s been going on through most of our careers.
Next: 'The team player approach is good in almost every situation'
And so it’s understanding change and understanding change management but also being resilient and able to lead through that. And it is really the best of servant leadership. The first thing is really thinking about what impact that is going to have on the people that we lead and also on the caregivers that we lead and most importantly on the patients that we’re trying to improve care for.
I would say, lastly, just having a voracious appetite for learning because the fact is that we’re all learning something every day from each other and from our peers and it’s just important to continue to sharpen our tools to be able to be good leaders.
Maria Chandler: I agree with that and I think some of [those] qualities, if they’re not innate in someone, they are not taught in medical school. And I think it’s a real tragedy in fact, [when it comes to] listening and communication. We talk about it with patients in medical school, but we don’t really talk about it with the rest of the team. It’s taught that it’s very hierarchical. The physician is at the top of the totem pole, you tell the rest what to do, you’re the one shouting orders during a code.
I’ve talked to even surgeons with an MBA and I said I really think that the team player approach is good in almost every situation, but probably in a code or in the OR there needs to be one voice. And [one surgeon] said, “Absolutely not.” He said that he felt like you need to get input from the entire team and if one person on the team is afraid to speak up, it could cost a patient’s life and that he’s very much a team player even in a code and even in the OR because accidents happen. If everyone is afraid to tell the surgeon that he’s doing the wrong thing that’s how terrible errors occur. So I really think they teach that more in business school than they do in medical school and if we’re going to talk about what needs to be taught, some of it should come directly from the business school and their curriculum.
Peter Angood: I couldn’t agree more in terms of it needs to be a team-based approach at all levels inside of healthcare and certainly in clinical delivery regardless of the complexity because every individual, every discipline inside of a team has contributions to make, but they need to be functioning as a high-performing team. And that takes leadership. Management is about processes. Leadership is about managing the people. And over the course of time your processes can hold as a stabilizing factor but the people aspects are the critical ones and so we as an organization, have embraced a number of leadership competencies that are specific, we think, for the physician workforce …
Next: 'You're not the leaders of tomorrow. You're today's leaders'
Robert Juhasz: I’ve been really impressed as I visit our osteopathic medical schools over the last year of looking at young people. Obviously, you have more and more young people coming to our schools having had prior careers. So they already have some leadership training and development prior to coming to medical school. So that is something that is fascinating.
Oftentimes I’ll tell them, “Look, you’re not the leaders of tomorrow. You’re today’s leaders,” because they clearly are going to lead the next phase of medicine. The fact is that they are really looking to develop those skills and in a very selfish way. We’re all patients sooner or later and so as long as we’re focused on thinking about how are we developing those traits in our young physicians and in those coming behind us, it really serves us all well.
Maria Chandler: I get asked a lot why do you think that you should teach medical students business and not wait until later when they can “really use it in practice.” I think it has a lot to do with what we’re talking about. Medical school, I feel, beats some of the qualities out of the medical students that might be helpful later like we’ve talked about. So if they’re getting an MBA at the same time they’re learning both cultures and they’re learning to be a team player in the business school and then they’re going over to the medical school and learning how to run codes, etc., as the dominating person in the room.
So I find that they’re seeing both, they’re weighing both, they’re questioning more what they see in medicine and how it, how it works right now and how it could work better and how they could be a better leader. I find that they’re more creative because I think medical school tends to stomp out some of the creativity of people and when you’re searching for problems to processes and inefficiencies in medicine I think you do need to think out of the box and not just continue doing it the same way that it’s always been done.
Robert Juhasz: I always say you can only give away what you have and so we have to be really mindful of that as mentors because often times we say young people do what you do, not what you say. And so it’s just really critical from that perspective that as we’re leaders to be thinking about how we are mentoring those next generations. If we want better leaders, we’re going to have to be thinking about that as we go out.
Peter Angood: I totally agree that we need to be providing them their skills beginning in medical school and through residency. And many of them are seeking it out already regardless if there’s any formalized curriculum in their environments. But the difficulty we have is that there’s always four generations in the work force.
Next: How do you change the future and the present at the same time?
So how do you change the future and the present at the same time?
Maria Chandler: As the director of our MD/MBA program, this comes up all the time: How do we teach the faculty what the medical school students are learning in business school? And that’s really hard to do; some of it is so traditional and some of the faculty are so traditional and have been around for a long time. It’s a really hard thing to change. I’ve been really helping to recruit for our executive healthcare MBA as well out of our faculty and I think as more and more of the faculty start learning all of this, it will spread, but it takes a long time.
Peter Angood: There are about 900,000 licensed physicians in the U.S. and so it’s a long-term project. When you look at any industry that’s gone through a significant large-scale change, it’s a multiple generation time period that you look at. So you’re looking at 30 to 40 years. We don’t have the luxury of that in healthcare but we do have significant changes beginning to occur. There are various attributions to this catch phrase but it gets back to the point: You educate the young and you regulate or mandate the old.
I think the physician workforce as a whole is beginning to recognize that their attitudes [and] their approaches need to shift if they’re going to be able to do better in the shifting healthcare environment over all. The old style stuff is not going to cut it much longer, over the next five years or so, and I think physicians are starting to appreciate that and making their own changes regardless of their age demographic.
Robert Juhasz: Simon Sinek speaks about “start with why,” and it’s really ultimately what we’re trying to achieve. We’re trying to improve health, and thinking about how do we achieve that as organizations, as physicians, as healthcare organizations, and as a public and so it helps especially if we have physicians who have been in practice that’s thinking about our neuroplasticity and how do we change that and how do we decide we’re going to learn something new to change the way we do things?
Next: 'Choosing wisely' and decreasing costs
We’ve done several things at the Cleveland Clinic to look at this. One is a physician communication course now that we’ve put 1,500 physicians through. It’s an eight-hour course so it’s a tremendous investment. But it’s really thinking about patients and our communication and thinking about how are we better at really making sure we’re listening to people and taking care of patients as people. Especially as we’re thinking about decreasing the costs of care and thinking about “Choosing Wisely” and initiatives of making sure we’re doing the best things that we can, the highest quality of care, while reducing costs. It’s thinking about how we communicate better.
Peter Angood: A lot of our conversation the last few moments has been around the academic environments and certainly a place like Cleveland Clinic is very well recognized, but a lot of healthcare is not delivered in those types of environments. We’ve got a lot of merger and acquisition activity going on in health systems, in the physician groups, etc., and so, those that review this discussion need to take seriously the fact that, in their local environments, they need to look for ways to introduce and provide the exposures to a lot of these skills that are needed in terms of leadership and management. And that’s for all types of healthcare delivery regardless of the geographic location or the type of institution involved.
To hear the full discussion, visit bit.ly/MEleadership
Next: 10 ways physicians can become better leaders
Most physicians were never trained on how to become effective leaders, it can still be learned,
In a recent talk, Robert Taylor, MD, provided 10 ways to help physicians cultivate their leadership skills, including:
Source: Robert Taylor, MD, FAAFP, professor emeritus of the Department of Family Medicine, Oregon Health and Science University’s School of Medicine.