Secrets of a chief medical officer: what they didn't teach you in medical school but you wish they had

Physician Executive, July-August, 2004 by Robert W. Chappell, Jr.

IN THIS ARTICLE ...

An experienced chief medical officer shares pearls of wisdom on ways to maintain the delicate balance between the medical staff and the administration.

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"No margin, no mission," "physician satisfaction," "patient satisfaction," "high quality at low costs" are frequent topics of discussion occurring in the administrative "C suites" of today's for-profit and not-for-profit hospitals.

As the challenges facing health care grow in scope and complexity, the role of the physician executive has evolved beyond the traditional duties of a medical director. Today's vice presidents of medical affairs and chief medical officers are often positioned as major decision makers for hospital budgeting, operations and strategic planning.

Like a double-edged sword, the expanded responsibilities are coupled to higher expectations of performance as negotiator, facilitator, change agent and disciplinarian. Expecting Camelot, many new physician executives find ruling the hospital medical kingdom a daunting task for even the most politically astute.

Tom Dolan, president of the American College of Healthcare Executives, once described the physician executive "as a minister of state without portfolio." Your physician colleagues believe you have gone to the dark side and your administrative associates consider you an enigma.

As a previous hospital chief of staff and current CMO of a two-hospital system composed of nearly 600 medical staff, I am often faced with decisions that must be made in times of crisis. I consult the works of Aristotle, Sun Tzu, and Machiavelli and then debate which one offers the appropriate advice.

The job life expectancy of a CMO is five years or less: therefore the physician executive today is often hired with expectations of immediate results with a short--if any--honeymoon period.

I find the adage "experience comes from doing many things and wisdom comes from doing many things badly" applicable to the physician executive. Here are some pearls of wisdom--or secrets--offered not from the perspective of a perfect CMO, but from one who has learned his lessons in harm's way.

Tell no lies

Your personality may get the door open, but only your integrity can keep it open. Each day the busy physician executive has 10 to 20 conversations with members of the medical staff, very few of which are discussions of the weather. A staff member is often inquiring about the hospital's strategic plans, the status of a future partner's privileges or the purchase of the latest medicated, coated cardiac stent.

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Telling the truth is always the best practice, even if the message is not the most pleasant. The CMO is frequently the messenger of bad news in the form of new policies concerning medical records or surgical equipment that will not be purchased. Physicians are bright people and will see through your lies. Remember the old cliche "say what you mean and do what you say." It will serve you well.

Relativity matters

When most of us think of the subject of relativity, we think of Albert Einstein's famous theory about time. You probably do not realize that relativity is also important to your success as CMO.

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The time references used by hospital administrators differ from the time references of physicians. A physician will make numerous decisions each day regarding treatments and patient care, many of which really are a matter of life and death. The medical staff member cannot begin to fathom why it takes six weeks and four committees to approve a new foley catheter.

Occasionally, the physician executive may reduce the endless red tape of hospital policy; he/she must always acknowledge the physician's frustration with the system. Return all physician phone calls on the day received and make it a habit to follow up on the progress of a project with your medical staff member either in writing, by phone or in person Remember, time is relative.

Be principled, but not inflexible

If this is your first physician executive position, you may believe many issues are black and white; after all, managing a hospital is not brain surgery. Unfortunately, after a short period of time, the wise CMO will discover multiple shades of gray. Compromise and negotiation are part of the job. Knowing which hills to charge and die on and those to carefully climb will distinguish the average physician executive from the exceptional one. Remember, do not let perfect stand in the way of possible.

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Go to the problem

Japanese business executives do not tolerate their young associates who try to describe problems they have not seen firsthand. If the surgeon tells you the OR is a disorganized mess, put some scrubs on and make your own assessment. It will more often than not be an enlightening experience. Remember, a picture is worth a thousand words.

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Never forget why you are there

Even if you are one of the 18 percent of physician executives with management degrees, the letters behind your name that got you the job were MD or DO. You were not hired because of your business skills: the woods are full of hotshot MBAs.