In the 1950’s, one-third of hospitals were run by a physician leader. By 1982, less than 3% were physician-led. That number is running about 6% now. And the healthcare industry has been in the throes of major changes.

old hospital physician leader

One of the consequences has been the growing employment of physicians. The expansion of this employment model is having serious negative effects on our profession.

Physicians have become commoditized. Today, we seem to be treated more like run of the mill laborers than highly trained professionals expected to provide ideal patient care.

Historically, the medical staff was an independent, self-governing organization within the hospital. Under this legacy model, a hospital CEO and board had to collaborate with the medical staff to create new service lines and implement new policies and procedures.

Loss of Autonomy

That independence and control have vanished, leaving medical staff members feeling powerless. Whether due to this loss of autonomy, the ever-growing number of regulations, or the relentless need to see more patients, it is easy to feel overwhelmed.

These feelings are magnified when working in environments that lack transparency and shared decision-making. Physicians become resentful and withdrawn in this kind of environment. Trust diminishes. Burn-out follows.

isolation physician leader

Sociologists call this withdrawal a lack of engagement. Physician engagement sounds like a nebulous term, but it is a very important aspect of our professional lives.


Engagement can be thought of as presence. It reflects the degree to which physicians are inspired by their work; how loyal they are to their organizations; and how much pride they have in what they do.

Engagement appears to be at an all time low.

This was confirmed by a recent survey by Athenahealth (Engagement Survey). Only 20% of physicians demonstrated characteristics of engagement.

We’ve all seen, and maybe even felt ourselves, this lack of engagement. When we’re not engaged, we become complacent. We lose our vitality. We just go through the motions. This lack of enthusiasm for our work can affect our relationship with our patients and our co-workers. The quality of our work, patient outcomes and success of our organizations are jeopardized.

dead physician leader

Solution: More Physician Leaders

But the same survey also provided insight into improving the level of engagement. Because it  showed that…

  • Physicians working in physician-owned, independent medical groups were almost twice as engaged as those in hospital- or health system-owned groups, AND
  • Physicians employed by organizations run by a physician leader (even if hospital-owned) showed engagement levels four times the levels reported in non-physician-led organizations (8% vs. 32%).

partners physician leader

Working physicians respond better to a physician leader. They share similar backgrounds and experience, which creates more credibility. There is a higher level of trust among such physicians.

Skilled physician leaders can help healthcare organizations to better understand and communicate with their physicians. Such executives can build trust, loyalty and engagement.

Appropriately trained physician executives know how to integrate clinical care, leadership and business skills. Many of the top hospitals in the country, including Mayo Clinic, Mass General, UCLA Medical Center, Johns Hopkins and Cleveland Clinic, are run by physician CEOs. There is evidence that quality metrics are better in health systems led by physician CEOs.

I believe the survival of our profession depends on more of us becoming involved. Physicians should step up to lead our hospitals, medical groups and other healthcare organizations. We’re the best hope for maintaining the focus on the patient, while engaging and motivating our colleagues. By doing so, we can help to ensure the fulfilment of the healthcare industry's promise – and the survival of our profession.

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