By Ted A James, MD, MHCM, FACS
September 6, 2018
“…leadership skills, like any other type of skill, can be learned and improved…. More challenging, however, is the development of the personal attributes that are necessary for effective leadership.”
-Charanjit S. Rihal, MD
Chair, Department of Cardiovascular Medicine, Mayo Clinic
Physicians as Administrative Leaders
Physicians possess a deep understanding of what is required to optimize the process of caring for people, and health care systems that are serious about transformation need to harness the power, talent, and creativity of clinicians as organizational leaders. Toward this end, a growing number of physicians are moving into executive leadership, and organizations are experiencing the benefit of having these physicians in key roles, providing input into what is best for patients and the organization as a whole.
However, health care is a complex business industry, and modern health care leadership requires additional skills that are not typically learned in medical school or even in practice. Many physicians are not familiar with the “business” of health care; including hospital finance, project management, or operational functions. Physicians have primarily yielded the governance of hospitals to nonclinician administrators. When physicians do end up in leadership roles, they often do so without much (or any) training or preparation. The lack of development can result in serious career failure, or a prolonged period of trial and error as the physician learns the ropes of administrative leadership.
This is not to say that physicians inherently lack leadership skills. That is far from true. Being successful in a busy clinical practice, operating room, or critical care unit, for example, requires excellent communication, teamwork, innovation, and vision. These are all requirements of effective administrative leadership as well. Furthermore; physicians, like any other group, comprise a diverse set of individuals with various personality traits, talents, and attitudes—including those of natural leadership. Nevertheless, there are fundamental differences between the nature of clinical medicine and clinical leadership.
|NATURE OF CLINICAL MEDICINE
||NATURE OF CLINICAL LEADERSHIP
|Prescribe and expect compliance||Lead, influence, collaborate|
|Immediate and short-term results||Short and long-term results|
|Procedures/episodes||Complex processes over time|
|Relatively well-defined problems||Ill-defined, messy problems|
|Individual or small-team focus||Large, integrated groups, crossing many boundaries|
|Expert carrying the responsibility||One of many sharing the responsibility|
|Receiving lots of thanks||Receiving lots of resistance|
|Clinical management||Operational management|
|Personal/practice finance||Hospital/health system finance|
Administrative leadership in our current health care environment requires more than excellent clinical skills. It also requires the ability to lead people, handle financial responsibilities, understand competitive strategy, and navigate organizational structures to advance the quality of health care delivery.
Do You Need an MBA to Be a Physician Leader?
Many physicians seeking leadership positions, or those who already find themselves in these roles, wonder if a formal MBA degree is necessary for their success. An MBA, or similar master’s programs (e.g., MHA, MMM, MHCM), can provide an excellent foundation and skill-set for a physician leader. These programs can be in-person, online, or some combination of the two. Having at least some in-person component provides an opportunity to engage with others and develop a rich network of colleagues. This was one of the most valuable experiences in my master’s degree program, and I continue to appreciate the relationships formed with my classmates to this day.
Programs can be full-time or part-time. Executive programs allow physicians to continue working while undergoing training. Some programs focus exclusively on the business of health care, while other programs are broader and focus on all business markets. An MBA program does come with substantial costs, both in the form of tuition as well as time away from practice and family.
Each program has a slightly different curriculum with different areas of focus; however, common topics generally include finance, communication, strategy, information systems, marketing, organizational behavior, operational management, and quality improvement.
Obtaining an MBA provides an excellent opportunity for career development and can open doors to new leadership opportunities within hospitals, other industries, or in entrepreneurship. It should be noted, however, that having an MBA or equivalent master’s degree has only recently become a prerequisite for certain senior leadership positions. Many physician leadership opportunities still rely heavily on a physician’s proven clinical and scientific accomplishments, rather than their business acumen. However, potential candidates are now more often expected to have at least some demonstrable leadership skills and practical experience.
Alternatives to an MBA
Not all physicians will have the ability or desire to devote two or more years of their life to obtaining an MBA degree. And in reality, an MBA is not the only option for developing leadership skills. You can gain several of the necessary skills through online courses or live workshops offered by professional organizations and specialty societies. The length and focus of these programs vary from one-day seminars on a specific topic (e.g., communication, finance, quality improvement), to week-long programs going more in-depth into a particular subject, or covering a broader aspect of leadership development. Some examples of organizations offering training include:
- American Association for Physician Leadership
- American College of Medical Quality
- Institute for Health Care Improvement
- HMS Leadership Development for Physicians and Scientists
- American College of Surgeons: Surgeons as Leaders program
- Drexel’s Executive Leadership in Academic Medicine program for women
With these programs, you can seek out specific competencies to supplement your skills and help address particular needs, or you can obtain a more comprehensive, broad-based foundation in leadership. Many programs provide certificates of completion and offer CME credits. The cost is often far less than the tuition for a master’s degree program, and courses can be spread out and completed over time as needed.
Another alternative is seeking training from within your organization. Some institutions offer internal physician leadership development programs (mini-MBAs). These programs provide the advantage of no travel, little or no tuition cost, and the ability to directly apply the training to current organizational challenges and priorities. Many organizations also employ a ‘dyad model’ that pairs physicians and nonphysician administrators as co-leaders of services and programs. The dyad model allows these partners to balance each other’s skills and weaknesses, and work together as a cohesive team toward a common organizational goal.
No Substitute for Experience
Whether you choose to pursue a formal MBA or an alternative program (or both), the benefit of real-world experience cannot be understated. I suggest timing your training for when you will be able to use it directly in a current or upcoming role. Obtaining an MBA ten years before taking on a leadership role only gives you the credentials, but lacks any practical demonstration of how you have applied the skills or gained relevant experience as a leader.
The lessons learned in a leadership role are undeniably powerful, practical and relevant. Physicians interested in administrative leadership should volunteer to serve on committees within their hospital or state medical association. Not only does this provide exposure to the domain of organizational leadership, but also helps you to establish a track record as a leader with identifiable accomplishments. Ultimately, results are more important than pedigree. As you take on leadership roles, ensure that you receive feedback, mentoring, and coaching. Doing so can help to accelerate your learning curve, avoid common pitfalls, and enable you to be productive in your role.
“Leadership defines what the future should look like, aligns people with that vision, and inspires them to make it happen despite the obstacles.”
– Kotter JP., Leading Change
The capability to lead does not come solely with a degree; however, a degree can broaden your perspective and provide you with a greater array of skills and resources to be an effective leader. Combining the unique perspective of physicians working at the point of patient care, together with a keen knowledge of administrative leadership, is a powerful force that can effect change and meet the demands of an evolving health care system.
True physician leaders see the bigger picture and have the ability to inspire others toward a greater purpose. They step-up to challenges, are willing to roll up their sleeves to get the job done, and do not shy away from difficult tasks. They are not self-seeking, but instead, seek to improve the status quo for their patients and colleagues.
These characteristics are not simply taught in a classroom but are also developed through life experience, mentorship, and an internal conviction to higher values. Physicians who receive the combination of formal training, real-world experience, and expert feedback/coaching can become the type of leaders that we need to bring about the best in health care.
The transformation of US health care into a reliable, effective, patient-centric system will require a large pool of true physician leaders equipped to carry out the mission and willing to engage at all levels from the bedside to the boardroom.
Just as physicians need business education to work in executive positions, business executives in the health care industry also need insights into the medical field:
- Rihal CS, MD. The Importance of Leadership to Organizational Success. NEJM Catalyst, Dec 2017.
- Angood P, Birk S. The Value of Physician Leadership. Physician Exec. 2014 May-Jun;40(3):6-20.
- Frich JC, Brewster AL, Cherlin EJ, Bradley EH. Leadership Development Programs for Physicians: A Systematic Review. J Gen Intern Med. 2015 May; 30(5): 656–674.
Dr. Ted James is a medical director and vice chair at BIDMC/Harvard Medical School. He is an alumnus of the Harvard Health Care Management program and is involved internationally in leadership development and health care transformation. Follow Dr. James: LinkedIn / Twitter
Dr. James blogs about health care transformation. To see more of his posts, click on his name in the tags below.
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