Five Steps for the Physician Executve

It always seemed to me that my classmates in medical school and residency were more intentional than me regarding their life choices. I generally just rode the wave of the “path of least resistance.” During my first year of medical school, many of my classmates were enrolled in the “Med Scholars” program, which meant they were simultaneously working on their M.D. degrees AND a Ph.D., M.B.A. or J.D. They obviously had a plan.

I had chosen to go to medical school as a default, because I had gotten good grades, enjoyed studying science and that’s what smart kids were doing. I didn’t really have a master plan. I didn’t know which specialty I wanted to pursue or where I wanted to practice. And initially I was quite fearful of interacting with patients. But I made it through, and selected the speciality of Family Medicine, mostly because it was generic and matched my internalized concept of a physician that had been formed by watching TV shows like Dr. Kildare and Marcus Welby, MD.

Curious Realization

I made an unexpected discovery as I reached the end of my second year of residency: I liked working with colleagues, staff and the faculty to try to fix things. So, one of my classmates and I threw our hats into the ring for the position of chief resident for the following year. My colleagues selected me for the job!

I found that I enjoyed meeting with staff and residency leadership, providing my insights and observations, and solving problems in the clinic. I also liked taking on projects, such as updating and expanding our list of elective rotations, coordinating grand rounds and bringing teams together to plan special events.

The New Practice

I joined two family physicians and the medical staffs of the two local hospitals and began to build my patient panel. I found myself attending the OB/Gyne, Surgery, Pediatrics, Internal Medicine and Emergency Medicine Department meetings in addition to my own Family Medicine Department meetings. I wanted to keep up with clinical issues in those fields, and get to know the persons that I would be referring my patients to. I personally wanted more CME opportunities than were available, so I coordinated a weekly CME series for my Family Medicine colleagues for the next several years.

At the time, hospital medical staff were encouraged to participate in one of the many medical staff committees (Quality, Bylaws, Credentialing, etc.). I was generally an introvert and non-political, so I avoided controversial issues. I was drawn to being involved with coordinating CME, because it seemed so politically neutral. I started attending CME Committee meetings and became chair of the committee by default when the previous chair retired from practice.

Chairing that committee really started to introduce me to the non-clinical side of working in a healthcare organization. And it led to being appointed to the Illinois State Medical Society’s Committee on CME Accreditation, which I later chaired. And that led to being recruited to the Accreditation Council on CME (ACCME), which exposed me to another level of management and administrative activities.

Becoming Intentional

Up to that point I had been riding a wave of opportunity and the fact that these organizations often had difficulty finding volunteers. But I enjoyed the work. Meanwhile, in order to generate some additional income, I began “moonlighting” at the local “STD Clinic”, the hospital-owned family planning clinic and an occupational medicine clinic. Because of a “vacuum” of interested physicians, I found myself serving as part-time medical director for both the family planning clinic and the occupational medicine clinic. I discovered through these various activities that I was learning on the job how to plan, communicate, lead, delegate, collaborate and manage in ways that were different from the skills applied in the realm of the practicing physician.

That's when I became much more intentional. I began thinking about formally evolving from practicing physician and part-time volunteer leader to exclusive full-time physician executive. Here are suggestions for starting the process, based on what I did.

Five Steps for the Budding Physician Executive

  • Read anything pertaining to your new interest (key words: physician, leader, leadership, executive, manager, business)
    • Blogs
    • Books
    • Articles
  • Join associations like the American Association of Physician Leaders (AAPL) (formerly the American College of Physician Executives) and the American College of Healthcare Executives (ACHE)
  • Learn – consider seeking additional formal training
    • MBA
    • MHA
    • MPH
    • MMM
  • Seek part-time roles
    • Part time medical director
      • Clinics
      • Hospital units (ICU, Observation Unit, Dialysis, etc.)
      • County Health Department
    • Hospital committees
    • Local and state medical society and specialty society committees
  • Attend conferences devoted to physician leadership and issues of interest to physician managers and executives (provided by a variety of organizations including the Greeley  Company, the Healthcare Advisory Board, the American Hospital Association, the ACHE, the Studor Group, the AAPL).

Back to My Story…

Let me summarize what I did in a little more detail. I opened my schedule and my thinking to consider serving as medical director for a variety of clinical areas. Since I was working as an occupational medicine physician and medical director, I enrolled in a Master's Degree Program in Occupational Medicine through the Medical College of Wisconsin. I read everything I could, joined the AAPL and began attending their physician leadership meetings.

Since the local hospital that had helped to recruit me to the community did NOT have a formal physician leader (other than those in the volunteer medical staff structure), I began a conversation with the hospital CEO to create a new position. He ultimately hired me as its first vice president for medical affairs (VPMA). I continued to practice medicine, but gradually reduced those hours and increased my management duties as I took on more responsibilities as an executive. Later, I transferred all of patients to my partner and became a full-time Senior VP and Chief Medical Officer.

That's the path I took. Yours will surely be different. I don't think having a business degree is absolutely necessary (after all mine is in public health), but focused study of business practices and management  in the healthcare setting will be very helpful. In my case, I also went on to become a Certified Physician Executive through the Certifying Commission in Medical Management, which can be obtained without having a business degree by completing formal coursework and an intensive one week tutorial.

In a future post, I will describe some of the specific new skills used as a healthcare executive, and some of the biggest lessons I needed to learn as I progressed in my career.