Vice president of medical affairs—moving on up to CEO? - The Evolving Role of the Physician Executive

Physician Executive, Sept-Oct, 1999 by J. Larry Tyler

THE CHANGES IN THE health care system have wreaked havoc on the careers of the traditional physician and hospital administrator. Physicians find themselves working harder for less money and satisfaction, and administrators have seen their careers collapse because of consolidations and hospital closures. Out of all of this turmoil, however, the vice president of medical affairs has seen possibilities arise that have not only enhanced their current positions, but have also opened doors for new career opportunities.

Historically, the role of the VPMA was a staff position--one that generally supported operations. The VPMA would supervise a small group of professionals and handle issues of quality assurance and protocol with the medical staff. Refereeing turf wars and keeping lines of communication open between management and physicians were also typical functions.

Staff jobs are important but often can be dead-ends, because they are limited in scope and account for only a small part of the organizations employees and budget. For many physician executives, the VPMA was the "be all to end all," and the lack of career progression suited them just fine. But there is an interesting evolution taking place.

Opportunities are arising for VPMAs to assume duties outside the scope of their established roles. As they have assumed and successfully performed new responsibilities, VPMAs are being charged with new and more varied duties. As a result, today some VPMAs have job titles and duties that resemble traditional hospital administrators more than they do physician executives.

Why the physician executive's role is changing

What accounts for physician executives being increasingly involved in management and operations? First, most of the fat seems to have been cut from the health care system. With operating margins approaching zero, the only way to continue to achieve significant cost savings is through changing physician practice patterns. It seems to me, and apparently to many hospital management teams, that a physician can have more of an impact on changing practice patterns than a non-clinician. Second, physician executives typically are quite bright. Brain power alone gives them an edge in most situations. Third, physicians tend to be respected by most of the population, including business executives. It appears that the same trust that executives feel with their personal physicians carries over into their interactions with physicians In a business setting. The implications of their growing roles in their organizations have not been lost on physician executives.

Suddenly a light bulb has come on--accompanied by trumpets. Increasingly, physician executives are reaching the conclusion that if they choose, they may be viable candidates for hospital CEO positions. Indeed, it seems that their conclusion has merit, but it must be tempered by marketplace realities.

Despite the reasons cited in this article and anecdotal evidence that they are prepared to assume these leadership positions, quantitative evidence suggests that physician CEOs remain the exception to the rule. The number of physician CEOs has fallen over the past decade according to the American College of Healthcare Executives, which tracks the AHA Annual Survey Data Base--about 100 physicians currently hold the top position today. Most of this group is employed at either academic medical centers or public entities. In 1992, there were 157 physician CEOs compared to 813 in 1972. What these statistics fail to illuminate, however, is the number of physicians moving into the chief operating officer role and being groomed for the CEO position. As a result, the number of physician CEOs is likely to grow dramatically over the next few years.

Critical success factors

That being said, it is important to consider the factors that can make or break the physician executive who aspires to become a CEO. We have seen some recent failures where physicians moved to the top but couldn't stay there. In some cases, their failure may be because they were unable to master the new set of skills that they needed to succeed--most notably a comfort level with teamwork. Their clinical training, which emphasizes the importance of self-reliance, often stands in the way of teamwork. While in their training to become doctors, they are taught to make decisions independently based on their knowledge and training, learning to subjugate the ego and take a more participatory approach will serve physicians trying to move into the top job well.

This brings us to a fundamental issue for VPMAs seeking to become CEOs--they have little formalized training or education for CEO roles. The American College of Physician Executives has done an outstanding job of training physicians for their roles as VPMAs, but it is only recently that the doors have opened for physician CEOs. Training for CEO positions tends to be on-the-job training. Even the American College of Healthcare Executives, the professional society for hospital executives, doesn't have CEO training per se. To the extent that these individuals can seek out professional development opportunities that enhance both their interpersonal/management skills and their "business' skills--accounting, finance, and planning--they are more likely to be attractive CEO candidates and succeed once they are in the position.