As I grew into my role as physician executive, it became apparent that there were several new sets that I needed to learn that were not part of my medical training. As a physician, I was trained to obtain a thorough history and perform a physical exam, to formulate a problem list and differential diagnosis, and develop a treatment plan. In so doing, like other physicians, I learned to:

  • Communicate clearly with the patient and/or her family
  • Quickly consider the pertinent information and prescribe a course of action
  • Direct the rest of the medical team by writing appropriate orders (act as quarterback)

new skills

In a role as manager or administrator, in contrast, my role was to:

  • Coordinate and collaborate with other team members, including peers and subordinates
  • Approach decision-making more deliberately, with more time to collect and review important information and discuss with colleagues and direct reports*
  • Function more as a coach than a quarterback – not writing orders, but developing and implementing plans, accomplishing agreed-upon goals, and guiding direct reports to do the same
  • Involve my CEO in all major decisions

I found that there are at least 4 new skills that an effective physician executive needs to master.

Four Essential Skills

  1. Working effectively with your direct reports.
    • As a physician executive, you will be given increasing responsibilities. This translates into increasing numbers of direct reports, or of departments of increasing size (as measured by number of employees) and budget (as measured by revenues or expenses).
    • For example, as a new administrator, you might be asked to be administratively responsible for Physician Services Department (Medical Staff Office) and the Quality Improvement Department. Effectively, that means that the Directors for those two areas will report directly to you. Therefore, you become indirectly responsible for the effectiveness and success of those departments. In a typical community hospital, those departments could have staffing of 8 to 20 each, depending how they are structured. And their total budgets might be between $500,000 and $2 million. As your skills develop, new departments/direct reports will be assigned to you.
    • Motivating and maintaining accountability of your direct reports is a major component of management and will be thoroughly discussed in a future post.
  2. Building consensus.
    • When moving forward with new initiatives, choosing new goals, and prioritizing action steps, the physician executive must learn to consult with colleagues, engage physicians, seek input from department leaders and promote alignment. Unlike the physician that quickly decides on a course of action for a medical illness, the executive must be cognizant of the impact of her decisions on staffing, budgets, morale and public relations.
    • This consensus building can occur in several ways: through one-on-one meetings, formal presentations to groups, publishing a “white paper”, or email blasts or blog posts. But skipping this step can lead to “blowback” and time wasted defending your decisions and rebuilding trust later.
  3. Reporting up.
    • Communication with your superior, whether the COO, CEO or another senior executive, must be regular and pro-active. You can occasionally get away with “asking for forgiveness rather than permission.” But making your CEO or COO look bad in the eyes of a medical staff or system board because of insufficient involvement and alignment will undermine your standing.
    • This can be a difficult habit to adopt, because autonomy is a very important value to many physicians. And it sometimes feels like a lack of trust when your CEO insists on regular detailed updates. But it is no different from you wanting to remain aware and in control of your practice or academic department. A discussion of trust will the topic of a future post.
    • new skills
  4. Redefine your team.
    • At first, I defined my team as the directors and managers that reported to me. After all, this is where the most time and energy were devoted. We worked together daily to produce great outcomes for patients served by those departments, providing good service to our physicians, and meeting budgetary and strategic goals. But over time, my primary team became the other senior executives and CEO.
    • The CEO, COO, CFO and division VPs work together to set strategic direction. We develop and implement new service lines, and ensure that each of division is working together to achieve organizational goals, rather than optimizing individual departmental silos. This often means forgoing staff or budget dollars in one of area in order to enable another area to expand or hire new talent, all for the overall good of the organization.

There is a lot more to becoming an effective physician executive, but honing the skills mentioned above will go a long way toward making that a reality.

Next Steps

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See you in the next post!

*”Direct report” is a term used for any person that reports up to another person in the organization. You will generally make decisions about your  direct report's performance evaluation, salary adjustments, approval of goal setting and hiring and firing.