Ideal Physician Executive, The

Medicine and Health Rhode Island, Jul 2006 by Recupero, Patricia R, Rainey, Samara E

Historically, physicians have performed management functions crucial to the successful operation of a clinical practice, whether in solo practice or in managing a team of professionals. In the past, hospitals were often owned and managed by doctors, but growth and a changing healthcare sector saw decreasing numbers of physicians in management and increasing numbers of managers from non-medical backgrounds. Recently this trend has begun to reverse. Today, growing numbers of physicians are found in graduate MBA programs. Since its inception in 1975, the American College of Physician Executives has grown from the inaugural 64 to current estimates of around 10,000 members.1 Increasingly, many hospitals have physicians as their CEOs or presidents.2 In Rhode Island, four of the thirteen acute care community hospitals are under the leadership of physician presidents or CEOs: Butler, Kent, Miriam, and Rhode Island Hospitals.

THE IDEAL CHARACTER OF THE PHYSICIAN EXECUTIVE

In 1873, at a conference of superintendents of psychiatric hospitals, Dr. Isaac Ray, Butler Hospital's first "CEO," presented a paper, "Ideal Characters of the Officers of a Hospital for the Insane,"3 where he described "The Good Superintendent" and "The Good Director." The paragons displayed: a) respect for other physicians and for patients; b) non-judgmental listening skills; c) a willingness to subordinate one's ego to the service of humanity; d) personal accountability; e) immersion in and knowledge of the day-to-day workings of the hospital and its staff; and f) support and encouragement of physicians. The qualities one must strive to avoid were those often found in poor managers: condescending or authoritarian attitudes; scapegoating subordinates; micromanaging employees; false promises; poor time management; judgmental or emotional reactions; excessive pride; and prejudice.

Today, most of Dr. Ray's lessons ring true for physician executives at all levels: CEOs or hospital presidents, medical directors, operations administrators, staff association managers, even doctors in private practice. Successful physician executives have relied on their listening skills to build consensus and show respect for their colleagues. The field of medical management has strong-voiced opponents and proponents. This article will present an overview of physician executives: who they are, why more doctors are choosing management, the pros and cons of physician executives, challenges facing physicians in management, qualities of the ideal physician executive, and implications for future leadership.

WHO ARE THE PHYSICIAN EXECUTIVES?

Physician executives come from varied backgrounds, but most combine training in medicine with management experience. Only one-third have obtained or are working toward advanced management degrees, such as business administration (MBA), medical management (MMM), healthcare administration (MHA), public health (MPH), and law (JD).4,5 95% of physician executives are board certified, and 62% come from primary care practice.4 Some physician executives belong to the American College of Physician Executives (ACPE; formerly the American Academy of Medical Directors) and may hold CPE (certified physician executive) certification from the ACPE or board certification from specialist organizations. Most physician executives are male, but growing numbers are female.6

WHY WOULD AN MD WANT TO BE A CEO?

Commentators believe that managed care, which has left many doctors feeling micromanaged and frustrated, has spurred interest in executive positions. As health maintenance organizations (HMOs) and managed care organizations (MCOs) grow more powerful, many physicians understandably resent this shift, objecting to non-medical administrators regulating medical practice. Seeking more autonomy and authority and a more active role in the decisionmaking process, many physicians see management as an opportunity to regain control of the most important medical decisions facing patients.7

For some, money may be a factor. From 2000 to 2002, the overall median compensation for physician executives rose 7.1% from $210,000 to $225,000. During the same period, the median compensation for those who were CEOs and presidents of hospitals jumped from $221,000 to $313,000.5

WHAT THE PROPONENTS HAVE TO SAY

Doctors' education and knowledge make them attractive candidates for executive management positions in healthcare organizations. Physicians can relate to medical staff in a way that nonmedically-trained MBAs cannot; physician executives can speak their language and grasp the difficulties and dilemmas faced by doctors. Furthermore, a medical background qualifies physician executives to set standards for acceptable and unacceptable practice; if someone must tell doctors how to do their jobs, should it not be another doctor? The Institute of Medicine's report, Crossing the Quality Chasm, notes that defining quality is a medical role.8 A successful physician executive can function as a bridge between healthcare providers and board members. Even when venturing into executive-level management, physician executives remain physicians, and they can relate to other physicians' frustration with cost-containment measures, managed care, and the practical realities in the day-to-day maintenance of a practice.