In this podcast episode, John shares his transformative journey from clinical practice to becoming a Chief Medical Officer, offering valuable insights for physicians considering leadership roles in healthcare organizations.

His experience highlights how physicians can leverage their natural leadership qualities developed through medical training while acquiring essential new skills in management and organizational leadership.

The transition from clinical practice to executive roles requires strategic learning through professional organizations, advanced certifications, and continuous education in management principles. Most importantly, John emphasizes that successful physician executives must master three core attributes.

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The Art of Total Immersion in Healthcare Leadership

John's approach to leadership development centered on complete dedication to learning and growth. Like his earlier experiences in medical training, he found that total immersion was key to mastering healthcare administration. This meant joining professional organizations like the American Association for Physician Leadership, pursuing additional certifications, and continuously expanding his knowledge through various educational opportunities.

This commitment to learning helped him transition from a practicing physician to an effective healthcare executive while maintaining a better work-life balance than clinical practice often allows.

Building the Bridge from Clinical Excellence to Organizational Impact

The transition from clinical practice to leadership requires a fundamental shift in perspective and approach. John emphasizes how physicians must evolve from individual contributors to organizational leaders. This means developing new skills in strategic planning, team management, and organizational development.

The reward comes in the form of broader impact – while clinical practice allows physicians to help individual patients, leadership roles enable us to improve healthcare delivery systems that serve entire communities.

Core Attributes to Be a Better Physician Leader

Three essential qualities are key to succeed as a physician executive:

1. Accountability,
2. Optimism, and
3. Humility

John emphasizes that accountability means following through on commitments and addressing challenges directly. Optimism drives organizational change and inspires teams, while humility ensures leaders remain open to learning and value input from all levels of the organization. These attributes combined with physicians' natural leadership qualities create a foundation for effective healthcare leadership.

As healthcare continues to evolve, the need for physician leaders becomes increasingly important. John's journey demonstrates that while the transition from clinical practice to leadership presents challenges, it also offers remarkable opportunities for professional growth and a broader impact on healthcare delivery.

Summary

Physicians who are interested in transitioning to healthcare leadership roles can access the resources through the American Association for Physician Leadership (AAPL) and the American College of Healthcare Executives. These organizations provide essential certifications, educational opportunities, and networking opportunities for developing executive capabilities.

Success in this transition requires the same dedication that drives clinical excellence and a commitment to continuous learning and professional development.

Links for today's episode:

• American Association for Physician Leadership (AAPL)
• Medical College of Wisconsin's healthcare executive education programs
• American College of Healthcare Executives
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

Podcast Editing & Production Services are provided by Oscar Hamilton

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 381

To Be a Better Physician Leader

John: Now I spent many years in management and leadership roles in the hospital setting, which culminated by working as a chief medical officer or CMO. And while moving from part-time physician advisor and medical director to chief medical officer, I took advantage of educational opportunities at the Medical College of Wisconsin, the American College of Healthcare Executives, the American Association for Physician Leadership.

And I'm a certified physician executive and a fellow of the AAPL, and I hold a master's in public health. So today I want to revisit the issue of physician leadership, encourage you to consider moving in that direction, and offer some advice about how to get started. So let's get to it. I think that I'm going to be talking about being a physician leader today, and I'm going to start by sharing my story about total immersion.

What do I mean by that? You know, this is something we do when we're trying to learn something new. So all of us have gone through medical school and residency for the most part. And of course that was pretty traditional type of education. And I found that once I got into practice, everything was going well. I was building my practice. I was working at the hospital to see my patients, nursing homes and in the office. And eventually I started to free up a little bit of my free time and became interested in learning other things that are important, like things like protecting your income, how to invest, maybe trying to find some ways to stay healthy, physically fit. What I've tended to do when I began to get interested in something like that was to just to totally go in a hundred percent and bury myself in information to help me learn about that. So that's what I did after about five years in practice. I realized that I did not have in my little three-man practice, we didn't have an IRA, we didn't have a 401k or anything like that. So my partners and I got together and we started talking about how we could set that up. And then I thought, well, I need to learn about how I'm going to invest because all these concepts were kind of new to me, you know, investing in the stock market, mutual funds, individual stocks, dividends, non-dividends, paying stocks, money market accounts, things like that.

And so I just went all in. I mean, I read everything I could possibly read. I listened to podcasts about the topic. I bought books. I subscribed to certain magazines. And so it was kind of a total immersion into the concept of investing and planning for the future financially. And I even ended up starting investment club with some friends I got so interested in. And in fact, still over 30 years later, I'm still involved in that investment club. Well, as I started dabbling in being a physician advisor and then a medical director, similarly, I didn't really know what I was doing. I mean, basically I had learned a little bit earlier in my life by being the chief in my residency and participating in a bunch of committees at the hospital and becoming the chair of a committee. And then I learned about how meetings worked and how minutes worked and all that kind of thing. But it was a pretty superficial exposure. So I thought, well, I've got to get involved in learning more about physician leadership and management. So that's when I started joining these organizations.

And reading about it, starting to subscribe to different podcasts, newsletters, magazines that told me a little bit about it. That's what I want to talk to you about today. Before getting into that, I would say that I really do promote the idea of getting into hospital management. If you're already in the hospital as a hospitalist or an ER doc or anesthesiologist or a surgeon or any of the other specialties that spend at least 20, 30% of their time or more in the hospital, I think it's a great place to work because you're providing very intense medical care. And in my opinion, we need more physician leaders in these settings. Most hospitals are run by people with an MBA or an MHA. They may have never done anything clinical.

There's some exceptions to that, like nurses who end up being in leadership positions. And they follow a path very similar to many physicians. In other words, they start out clinical and then they become a manager or they become a director. And actually there's a significant number of hospitals that are run by nurses, probably many more run by executive nurses than are run by executive physicians. And so again, I would encourage you to look at this path. The thing I like about it besides that it's intellectually stimulating and really it's something that any physician can do if they're interested is that it's a way to really help more patients. When I was seeing patients, I was dealing mostly with the healthy, worried well people came in with minor problems, really, that probably didn't really need a visit. Yes, you've got a lot of the screenings we're doing and health maintenance, but most things that come in are acute and they're relatively trivial, and then once in a while you see a really sick patient, get them admitted, and nowadays, if you're a family doctor, of course, you probably won't even be going to the hospital. The thing is, when I started getting into management, I found I was helping patients in new ways.

And at the same time, my lifestyle was better. The more I did in the hospital as a medical director and then ultimately as CMO, the less time I spent in the office, the less time I spent on call, and the more work-life balance I had. And it was something also where when you're in residency and early practice, you're challenged quite a bit because you're still learning and taking on new responsibilities, but then it becomes a little bit routine. And so when I started doing more and more in leadership, I really enjoyed learning more about how to manage, you know, learning about HR, learning about leadership and strategic planning and communication styles beyond those as a physician. And so there's a lot to it. And it is quite interesting. Let me talk a little bit about that. Is this right for you? Yeah, I don't think becoming a manager, director, or CMO in a hospital is necessary right for everybody. Because you have to be willing to take on some new skills, learn some new ways of doing things. I think there's some areas in particular that you really should try to strengthen and learn as you decide to do this. But let's think about how we should look at this and let's reflect in review some of the things that we should consider before making this move. So first of all, let's reflect about our motives.

You know, I have to admit that when I started getting into the physician advisory role, that was mainly to just make a little extra money. It was almost like moonlighting, but it was really non-clinical. But even as I became medical director, part of it was that I was really getting a little bit burnt out and I was trying to exchange hours of care as a medical director for hours of work as a primary care physician. So ultimately what that meant was I was getting paid on almost an equal basis for the medical director duties, but it didn't involve any call. And so over time I was cutting my call responsibilities back. And at some point later on, I actually hired my own hospitalist to start taking my in-house call. So if the motive is just because you're burnt out and fed up with medicine, that's probably not a good motive and it won't, you know, you'll end up a year or two later in the same situation, five years later, still burnt out and not happy. But if at least you have an interest in management and interest in learning new things, you have an interest in a specific area of management that might be fun, like when it's quality improvement or, um, CDI, clinical documentation integrity or informatics or, you know, one of the things we really normally get involved with as a medical director, then by all means, think about proceeding.

Reach out to your colleagues. If you've been out for a few years, you're bound to have some colleagues that are doing at least part-time work, and you may have even gone through residency and fellowship with someone who immediately went into a non-clinical role, although possibly related to their specialty.

Reach out and just talk to people, get their feedback and find out what it's like to make this transition, and also what it's like to be in a full-time management or leadership job. Read everything you can about it. Of course, when I say read, that includes online, that includes books. A lot of books written about this, a lot of articles written. When I say read, I also mean maybe listen to some podcasts like this one or others.

Go to websites and try and get a take on that. Then there are some formal places where you can go and you can register, meaning you should register or enroll with some of these professional societies. Of course, the one that I think is the best and probably most appropriate for those thinking about doing leadership roles and advanced management positions is the American Association for Physician Leadership. Now I've been a member of the APL for over 30 years, taking many of their courses. I've really been involved heavily in fact, that was the chair of the CCMM, which is a community that oversees the CPE designation and the requirements and the work that's done to apply for that recognition. So I've been heavily involved with it. I am not promoting it. I'm not paid, you know, but I got myself involved because I believe in what I did. It is always looking for new ways to expand and grow and provide more services to its physician members to become great leaders.

Now, I do believe that physicians are natural leaders and I don't say that they're born leaders because I think a lot of the leadership skills that they develop come as a result of their medical training. There's a lot of characteristics that we have that we're either born with, nurtured while we're young, and then are nurtured further as we go through our training. I'm going to talk a little bit about that in a minute.

These are the kind of, I guess, attributes that I see that physicians have. Obviously, the intellect is there, very focused. Most physicians I know are quite accountable. They've got the ability to handle complexity, so they can think through problems well. Their communication skills are usually pretty darn good and are usually improved while they're going through training. Now, a lot of that is with communicating with small teams and with patients and with patients' families and so forth. So sometimes you've got to learn a different type of communication as you get into leadership, but very good perseverance and patience and keeping on problems, not easily distracted. Decisive is another good attribute that physicians generally have that's encouraged and grown during their training. They don't tend to be wishy-washy or indecisive. So that's good. And a lot of people are prone to that indecisive nature because they're not confident. Commitment, altruism, and a people orientation, now, doesn't mean that we're not sometimes introverts. In fact, I think probably the majority of physicians or at least a little more than 50% are somewhat introverted. So it's not like they feel comfortable in a large group giving a presentation necessarily, although most of us practice that during our training. But we went into medicine because it's a combination of science and also the health professions helping others, that kind of thing.

So it makes for fairly natural leader. A thing is though, physicians do have to evolve. They have to add new skills and new attitudes to really be an effective leader at the level of, an executive in a hospital, which is what I'm really promoting here today. So we need to, if we tend to be a little reactive, because we're in the mix of things, if something happens, we respond immediately, that's fine. But when you're in a business setting, when you're in an organizational setting, a big organization, whether it's a hospital, large pharmaceutical company, health insurance company, anything like that, you really need to be more proactive. So you need to kind of migrate from reactive to proactive when looking at things. When you're managing large groups of people and people in big organizations, you need to be proactive. So that's something you have to develop. You need to stop.

Or I would say add to being a performer or a doer to being a planner. You know, we don't necessarily go into our office seeing patients planning what we're going to do for each patient before they show up. A lot of times we wait till they show up and then they, we assess them and then we make a plan, but to run an organization and have two, three, four, five, 10 people reporting to you, running a budget of 1 million, 5 million, 20 million, 50 million then you need to plan and you need to be proactive. You need to kind of move from tactical to strategic thinking. So this is, again, you know, we're talking about annual goals, maybe a two or three year strategic plan. These are fairly common to do when you get to the VP level or higher in a big organization.

And we need to go from being deciders to delegators. We have to feel comfortable. If you're like, I'll tell you, when I was, I don't know, I'd say, I wouldn't say at my peak, but there were times when I had six or seven directors reporting to me. And my main goal was to help them develop their goals every year and maintain some kind of tool that we could track their performance.

And then encourage them and push them to meet their goals and exceed their goals. But I really wasn't there to tell them how to do their job. I was really there more to keep them honest and to make sure they were pitching in and to also coordinate with other senior leaders to make sure that all of our directors and managers were working together collaboratively.

And working for the benefit of the whole organization, not for just their department. So when you delegate, that means you can't really look over the shoulder and everything they are doing. But you have to feel comfortable with tracking their performance and their progress and meeting their ongoing goals and performing according to your expectations. We have to migrate from being independent, working independently to being more participative. So working on a team, not a team that we're necessarily always leading, we might actually be just the co-members of a team. For example, for the first few years that I was working as chief medical officer, I always thought my team was the directors and myself, the directors that reported to me and myself, area they had the utilization management, the quality, the medical staff office. And then at times I also had always had the pharmacy and then sometimes radiology and lab. And it was more about, like I said, quality and performance. And we were still responsible for budgets, of course. I came to find out later, or I came to realize later, that my real team wasn't all those people reporting to me.

Like I was the coach and they were my team. My actual team were my co-VPs, the people on the senior management team. There were 10 of us, if you include the CEO, usually the CFO, the COO, the CMO, CMIO we had for a while. We had the VPs for HR, VP for lab, VP for maintenance and facility and so on and so forth.

And that was really our team, but we spent a lot of time bringing that team together as a cohesive unit. And where at that point, the way we looked at it was, we are there to make sure that our departments, that level of team are actually working together to achieve the organizational goals, not to just make sure that their particular department looked good or had good numbers. So that was an interesting evolution that I observed. And we're usually practice focused. And in a hospital, if you have several hundred or a thousand physicians, depending on the size of the organization, of course, we're all focused on our own practices, our own groups. And once you move into the executive level of hospital management, then you really have to have this organizational focus. And basically you're trying to get everybody on the bus, you might say, or everybody rowing in the same direction on the boat. And it's a little different than just running a small business like a practice or even a large business is a multi-specialty practice or single specialty practice. Or even if you run your own surgery center, that's even there, you start to get a little different feel than running just to practice. And then you need to really go from, you know, patient accountability, which is important in terms of you're accountable for the healthcare of the patient, which even in a hospital executive position you still are, but it's organizational accountability and it's different. You're no longer a lone wolf. You're working as a unit with others at your level.

And you have to learn to be accountable to one another and to the CEO. So let's focus on three of these aspects in a little more detail. So that accountability part is pretty darn important. And basically one way to define that is that you, you do what you said you would do when you said you would do it. And sometimes we'll add and the way you said you would do it. Now, in some things that you're saying you're going to do, you're gonna get done, you don't really care how it gets done. You know, if you're supervising some director, you say, look, you told me you're gonna do X, you're gonna meet this budget, and by six months from now, you're going to have this project halfway completed, fine. Just make sure you do what you said you would do when you said you would do it.

On occasion, you want to add the way you said you would do it. So sometimes the way you achieve something is important. Obviously, it has to be quite legitimate and honest and straightforward and not underhanded in any way. But as a leader, sometimes you don't want to worry so much about the way things are done. If they have a goal and the outcome is important, and as long as we're being authentic and we're being honest, then, you know, there are multiple ways to achieve the same goal. But again, if you want to quote this, do what you said you would do, when you said you would do it, the way you said you would do it, if you want to be accountable. And this could be to your team or to your boss. And when you don't achieve that, then you need to make amends.

So, the other thing that's really important is if you committed to something, if you promised to do something or just even agreed to some goal, you need to learn to apologize appropriately when it's not achieved. And that's what accountability is. And that means that, and this came up a lot in our senior management teams, we would meet and say, "Hey, you know, two weeks ago, this was what you said you were going to do. And you said it was going to be done by this meeting. So what have you got to show us?" And if one of us didn't have it, it meant that we had to say, "well, you know what I did, I committed to doing that two weeks ago. And I admit that I have not completed that. I don't have a reason or a good excuse was bad planning, timing and so forth on my part." So that's the first step is just admitting your mistake or your failure to comply with your own commitment, explain how you will rectify it. "I will get that done. In fact, I'll have that report that you needed by the end of the day tomorrow", commit to a deadline, which I did there.

That's basically it. Now, when you're being accountable and when you're stating that you did not meet the goal that you said you would meet, didn't complete what you said you would do, we never phrase it like this. Like, "I'm sorry" if, like, let's say that you were going to communicate with somebody and you ended up doing, you know, saying something that was not accurate.

You don't say, "well, I'm sorry if what I said bothered you. I didn't mean to bother you or to insult you." That's not really an apology because you're putting the if sentence in there, we're just putting it on them. Like if they took it the wrong way, you just say," I'm sorry, I offended you and I won't do that again," or in this case, to be accountable.

"Yes, I made a commitment. I did not meet that commitment. I'm sorry about that. And I make a recommit myself to completing this project by the end of the week. I will not fall behind in this project again." So you have to really commit to and not repeating your mistake. So accountability is a big thing. And a lot of physicians, I mean, we're accountable to our patients doing the right things and not doing something we're gonna get sued about or get reported about. That's one level of accountability. But when you're in a team for a large organization, you all have to make your commitments, stick to them and be ready to admit your mistake if you don't and move on. The other thing is it has to do with optimism. I think it's easy to become pessimistic and angry in healthcare.

You can, you know, you get, you feel like you're overwhelmed sometimes you're burnt out. And when you get that way, then you start to lash out, start to act negatively. You start to become resigned and that's not good for a leader. A leader cannot be depressed and resigned and feel like they have no control and they have to maintain a certain level of optimism that they and their team and the organization itself can solve important problems, can move forward successfully, and should not get that resigned feeling like nothing can change and we're not making any progress. Leaders with that attitude really don't last very long at all. So you have to avoid the negativity, defeatism, apathy, resignation, all those things I've mentioned.

You should embrace positivity, be kind of faithful, have faith, be inspired, be easy to encourage and encourage others. You know, always have hope and expectations that things will continue to get better because we're all working together to make things better and more successful and more responsive to our patients and to the community. So optimism is really important. If you can't...

If you can't be accountable and you cannot be optimistic, you really can't be a good leader. Then the other thing is humility in spite of all this. You're learning a lot, you're taking ever increasingly important levels of responsibility, working your way up to the C-suite, maybe even eventually become the COO or the CEO. But you have to have humility because again, you don't do anything by yourself. You should avoid being self-righteous if you'd fallen in that trap in the hospital and the operating room and the delivery room. If you become condescending, a part that goes back to being burned out or overwhelmed, but you have to stop that. You have to maintain some humility.

Continue to always be curious, meaning welcoming other people's opinion. When you're in a leadership role, it's not that you're making all the decisions without input from your peers and from the people that are reporting to you. You should focus on listening more than talking. You know, just because you're the chief medical officer doesn't mean when you're with your directors or with your teams, it's so-called that report up to you, they have the frontline observations. They have the frontline knowledge of what's actually going on day to day. You have to remain curious, you have to listen first. And then if there's a sort of a solution that's self-evident and a decision has to be made about, are we gonna invest money here? Are we gonna share personnel?

Are we going to try and find other ways to meet a goal? Then you might have to make that decision, but you need all the information first and that means being humble. I guess what I want you to just realize is that leading is a skill that builds on what you learned during your medical training, but it involves listening and inviting others to embrace your vision. And you know, you think about when you're a leader, you're always on stage and your patience, dedication, and integrity become a role model that are key to recruiting others to join your organizational journey as a leader. You're trying, like I said earlier, to get everybody on the bus that's going to debut. I mean, it's a metaphor, but it's one that one of my CEOs used all the time. It's like, we're all going to get on this bus and we're going together.

We're all going to hop in the boat and row in the same way, in the same direction. There's no sense us all being in the boat. We're all rowing in a different direction because then we're not going to move. And so really one of the core responsibilities for a leader is to inspire your team and to get them to want to join, not be forced to join.

Bottom line is if you are successful and you get 90, 95% of people to row in the same direction and hop on the bus that you're taking to debut, then if there's five or 10% that can't do it, won't do it for whatever reason, then they should be left behind. That means they should go find a job where they're going to be happier and more productive. So if those are the kinds of things when you're listening what I just talked about sound like fun. Well, then by all means, that's an indication that you should consider strongly to start your leadership journey. You've probably already been on it. If you're a physician and you're probably asked to do things and take on responsibilities where you're not just pitching in as a member of the team, but you're leading part of the team or leading the entire team.

Maybe you're working on temporary committees to solve a problem. Maybe you're chairing a committee that's really important. Or maybe you're on the board of a hospital or a public health organization, hospice, something like that. If you like that and what I've talked about today sounds like a fun, like I said, then go ahead and take off and continue your leadership journey.

I'll be coming back to talk about more issues related to management leadership in coming podcasts in addition to interviews with more that are also doing non-clinical jobs outside of leadership.

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Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career. 

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The post To Be a Better Physician Leader appeared first on NonClinical Physicians.

In this week's Classic Podcast Episode from 2020, Dr. Jennifer Spector describes how to become a medical editor. Unlike other medical editors who spent years as a paid medical writer, Jennifer parlayed her involvement in a professional society and unpaid writing to land her new editor position.

Jennifer is a Board-Certified Podiatric Physician and Surgeon with 14 years of clinical experience. She spent over 5 years in national leadership positions at the American Association for Women Podiatrists (AAWP). She’s had a long-term interest in education, writing, and consulting. She is passionate about educating others. In June 2019, she became the Associate Editor for Podiatry Today.

She received her DPM degree from the Temple University School of Podiatric Medicine. Then she completed a three-year residency in podiatric medicine at Christian Care Health System.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career you love. To learn more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

For Podcast Listeners

• John hosts a short Weekly Q&A Session on any topic related to physician careers and leadership. Each discussion is posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 a month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

How to Become a Medical Editor

Medical writing and editing are great careers. They come in various arrangements: freelancing or employment; working remotely or in an office; technical, journalistic, or educational. And there are positions open to physicians of all backgrounds.

After completing her residency, Jennifer spent several years building her practice. She later volunteered at the American Association for Women Podiatrists. She chaired several committees. Then she held several leadership positions, becoming President of the organization in 2018.

There are so many things that we might have dipped our toes into in clinical practice without realizing how they can apply outside of actual practice. – Dr. Jennifer Spector

While at the AAWP she was responsible for writing and editing the newsletter and other documents. That experience enabled her to land her position as Associate Editor for Podiatry Today.

After working in that position for about 20 months, Jennifer was promoted to Senior Editor followed by Managing Editor at Podiatry Today. In July of 2022, she became one of the Assistant Editorial Directors at HMP Global, the parent company of Podiatry Today and a market leader in international healthcare education and clinician engagement.

Finding Editing Jobs

Today’s conversation with Jennifer clarified her process to become a medical editor for a news journal like Podiatry Today. Jennifer reminds us to develop a portfolio of writing and editing samples to share with prospective employers. She was able to do this while volunteering with the AAWP.

If you’re looking for freelance writing opportunities, you should look at the portfolio of journals published by the parent company of Podiatry Today, HMP Global. There are 12 journals and over 100 Online Digital and Learning Networks under its umbrella.

Summary

In today's interview, we learned what it takes to become a medical editor. This is often a natural step for established writers to pursue.

Links for Today's Episode:

• Dr. Jennifer Spector's LinkedIn Page
• Podiatry Today
• HMP GLOBAL
• AAWP
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)
• The Nonclinical Career Academy

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The post How to Become a Medical Editor – A PNC Classic from 2020 appeared first on NonClinical Physicians.

Interview with Dr. Mark Olsyzk – 356

In today's interview, outstanding CMO Dr. Mark Olszyk provides his advice and that of his co-authors from The Chief Medical Officer's Essential Guidebook. 

He discusses the critical skills required for effective medical leadership and practical tips for navigating complex healthcare challenges. And he emphasizes the importance of continuous learning and collaboration among healthcare professionals to be successful.

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The Journey to Becoming an Outstanding CMO: Insights and Experiences

John leveraged resources from the American Association for Physician Leadership (AAPL), including its Certified Physician Executive (CPE) program, to enhance his leadership skills. That is where he met Dr. Mark Olszyk, a seasoned physician leader with a rich background in military service and medical administration.

Dr. Olszyk, co-author and editor of “The Chief Medical Officer's Essential Guidebook,” shares his extensive experience in medical leadership. From his early days in the Navy to his decade-long tenure as a Chief Medical Officer (CMO), he highlights the importance of learning from successes and mistakes. The book serves as a comprehensive guide for aspiring CMOs, offering practical advice and lessons distilled from the experiences of various medical leaders.

The Role of a Chief Medical Officer: Responsibilities and Challenges

Dr. Olszyk outlines the multifaceted role of a Chief Medical Officer, emphasizing the importance of building bridges between various stakeholders in a hospital. He describes the evolution of the CMO role from the Vice President of Medical Affairs, focusing on credentialing, privileging, quality reviews, and regulatory compliance.

A CMO is a liaison between the medical staff, hospital administration, and the board of directors, ensuring effective collaboration. Dr. Olszyk also discusses his journey in medical leadership and the fulfillment he has experienced during his career.

Advice for Aspiring Medical Leaders: Steps to Take and Skills to Develop

Mark offers practical advice and steps to gain relevant experience for those considering a career in medical leadership. He encourages involvement in leadership roles within hospitals and joining professional organizations like the AAPL and the American College of Healthcare Executives (ACHE).

He also emphasizes the value of networking, seeking mentorship from current medical leaders, and continuously developing leadership skills through education and practical experience. By engaging in paid and volunteer leadership opportunities, physicians can significantly influence the future of healthcare while developing new skills, on their journeys to outstanding CMO.

Summary

In this interview, Dr. Mark Olszyk shares his extensive experience as an outstanding CMO and co-author of “The Chief Medical Officer's Essential Guidebook.” For those interested in purchasing the book, it is available on Amazon or through the American Association for Physician Leadership (AAPL) website, where volume discounts are also offered.  You can reach Mark directly via LinkedIn.

NOTE: Look below for a transcript of today's episode. 

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Links for Today's Episode:

• Dr. Mark Olszyk's LinkedIn Page 
• The Chief Medical Officer's Essential Guidebook
• AAPL: The Chief Medical Officer's Essential Guidebook
• 4 Things the CMO Should Never Say to the CEO – 251
• 6 Important Assignments of a Hospital CMO – 218
• What Makes a Great Health System Chief Medical Officer?
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 356

The Essential Guidebook to Being An Outstanding CMO

- Interview with Dr. Mark Olszyk

John: During my efforts to improve my skills as a physician leader, I naturally took advantage of the AAPL, the American Association for Physician Leadership, including its CPE program. And it was during the final week of that CPE program that I met today's guest. He's a consummate physician leader, starting with way back when he was in the military. He may still be in the military, I'll ask him about that. But anyway, he's held numerous leadership and executive positions, and he's also the co-author and editor of a new book, well, it came out last year, The Chief Medical Officer's Essential Guidebook. Let's welcome Dr. Mark Olszyk to the show. Good to see you again, Mark.

Dr. Mark Olszyk: Good to see you, John. It's been too long, but thanks for having me and inviting me to your podcast. I'm really excited to be here.

John: Excellent. I have brought up the issue of physician leadership, and especially in the hospital setting, many times over the years on the podcast. And as far as I know, there are books written about the job and different aspects. But really, when I saw this book, with excellent collaboration with the AAPL and yourself with all your experience, this is just perfect for those in my audience who are thinking about moving along those lines, and actually a "how to" to get there. I really appreciate you putting this book out there.

Dr. Mark Olszyk: Oh, well, thanks. To answer your previous question, I'm not still in the military. I got out in 2003, kind of hard to believe, but I'm a proud Navy veteran, and my son is an Army ROTC. So, get that out of the way.

John: Nice.

Dr. Mark Olszyk: Yeah, yeah. The book, I think everybody at some point in their lives, reflecting on their experiences, and their travels and their journey, say, "Yeah, I should write a book about that." And I'm no different. But I've been a CMO, chief medical officer for about 10 and a half years. But I've been in medical leadership since the first year after finishing residency, I went into the US Navy. And the military, unlike almost any other sector, will put you in to leadership positions as soon as possible. And you find a way to get the skills and find the maturity and the leadership is thrust upon you and you have to rise to the occasion. I've always been grateful for that.

But I had gone to conferences at AAPL, others where I met other chief medical officers, and we would share stories. And I thought, boy, it'd be great to write this stuff down and distill this because these are some really valuable lessons, not just the things that we had done correctly, but all of the mistakes that we had made. And wouldn't it be better for other people to learn from our mistakes rather than repeat them themselves.

I guess it came to a head in our system. Physician was made chief medical officer of another hospital. And I just kind of casually passed along here's 10 things to do, like the 10 commandments, but not nearly as inspired, but just 10 things. And about six to eight months later, I guess he lost it. It was that impactful. But he lost it and said, hey, can you send it to me again? I just didn't have it. And I thought, "You know what? If I'm going to write some stuff down, let me make it into something." And it just kind of grew. And I talked to some of my colleagues and contacts. And I said, would you guys be interested in collaborating on a book? Because I think it'll be enormously boring if it's just me telling the stories. But if we have a whole chorus of voices, I think that might really strike a note.

I just had no idea how to publish a book. I just didn't want to do it on my own. I approached AAPL. And Nancy Collins was very gracious. We actually met in a Starbucks in Maryland. And she showed me some of her other publications that came out recently, one of which was a collaborative effort. And it just kind of grew from there.

I reached out to everybody I knew in my life who was a CMO or medical leader. And there was a lot of enthusiasm. I learned a lot in trying to shepherd people together for a collective effort where I was not their boss. They were not getting paid. And there was no way I could really enforce any sort of deadlines or standards. That in itself could be a book, a book about how to write a book. But it was a fun journey. I'm glad it's out there and I've received some excellent feedback.

John: Yeah, when I look through it, of course, most physicians, actually, most clinicians, of course, they like teaching, like helping their peers and so forth. And I think many, if not all, not all of the section writers or physicians, of course, you tapped into other expertise, which I like. There's a lot covered there.

And when I think about the CMO role, it's in my mind is like this iconic what does a CMO do? But everyone does it differently. Everyone does different aspects, more depending on each job. It's unique. But yet, I think you covered everything that I could think of in terms of what questions would I have if I was thinking about being a CMO or I was and I was missing something. So tell me a little bit more about the process. How did you herd all these cats and get this thing done? How long did it take you to do?

Dr. Mark Olszyk: From start to finish, it took about a year. Some of the author contributors returned their submissions in two weeks. Others took about eight months. Some needed multiple revisions, some needed none. I did recruit two co-editors, Aaron Dupree and Rex Hoffman. They helped out a lot.

I learned a lot about copy editing and all of the back office productions and placing it and formatting it. From what had existed only as a series of, I'll say, not too well organized Word documents on my desktop, to see that transform into an actual written book was pretty fascinating and eye-opening. But originally I had an idea for a structure and like all initial ideas, it went away pretty quickly.

And so I just asked people to write about what they felt that they were knowledgeable about or passionate. And the outlines of a puzzle began to come together. And then after about 75% of the submissions were in, at least an outline form, then I could actually target what was missing.

As a frustrated or wannabe classicist, I used the model of the medieval concept of the human being. The first set of chapters, the first section is about the anatomy of the CMO, the basics, the blocking and tackling, metrics and patient experience and all the quotidian day-to-day activities that were going to be the guts and the sinews and the bones.

And then we would move on to the heart, which is all about relationships and how the CMO relates to the chief nursing officer, the chief executive officer, to the board of directors, to departmental chiefs or chairs, and also their perspectives, what they think a CMO should be, or how a CMO should act to be successful in their eyes.

And then we moved on to the brain, the strategic thinking, extra hospital relationships, like how do you deal with third-party rating agencies and auditors and joint commission and dealing with the media, especially when the memories refresh from the pandemic, what if you're asked to appear on TV, on live TV, on the radio and newspaper articles how do you prepare for that?

And then finally, the soul or the spirit, which would be the transformational values and ethics and diversity, inclusion, aspirational type things. It was kind of a journey from the very basic things that a CMO would do day-to-day to the more long-range aspirational goals or values. And I think the way it's written, you can skip around. You can say, gee, I want to learn more about how to prepare for a media interview or how to relate to the board of directors. And you can go right to that section. So it doesn't have to be read in order. It can be used as a reference or it could be read as a story in itself.

John: I think it's pretty comprehensive. And probably in anyone who serves as CMO may not even be exposed to all the things that are covered. There's so much and again, because each role is slightly different. So it's awesome. One of the things I like to do when I'm bringing on an editor and author is pick their brain. So I have an ulterior motive for having you here other than just to talk about the book, although again, it's fairly comprehensive.

But just to keep what our audience's appetite here for this job because some are a little reluctant maybe they have a negative feeling about working in hospitals being abused by somebody or another, but there are good systems out there. And the other thing is being the CMO, you can make a big difference in how that organization is run. Tell me what you would say, if you were to boil it down, what are the most common areas that a chief medical officer is sort of responsible for? Maybe another way to look at it is like who reports to them, because it kind of makes me think about, okay, well, I do this because this person reports me. So however you want to answer that question in terms of the core roles of a CMO.

Dr. Mark Olszyk: I think the CMO role evolved from what was previously and still exists, usually in a hyphenated title, Vice President of Medical Affairs. That being the mechanics and the support staff for the organized medical staff. And every hospital per joint commission guidelines and through history, has had an independent organized medical staff who are largely responsible to establish their own standards for credentialing and privileging. And that was made ever more important back in the 1960s, when there were landmark cases, lawsuits, where patients began to sue hospitals. And the hospital said, hey, we have to really have some quality standards, and we're going to ask the medical staff, almost as a guild to police itself. But the medical staff have full-time jobs taking care of patients, and it's hard for them to keep the files and the minutes and the records and organize the meetings and stay abreast of all of the regulatory changes.

There is an Office of Medical Affairs in every hospital. And the Vice President of Medical Affairs, now the CMO, is largely responsible for ensuring the quality of the medical staff, making sure the medical staff leaders understand what they're supposed to do, making sure that they do it. And it's challenging in that the medical staff can be employees of the hospital or healthcare system. They can be contractors or vendors, or they can be completely independent. And when I started out at this hospital, it was about one-third of each.

To get all those different folks with their different interests aligned in a common effort proved to be a challenge, but one I thought was very fun because I had to look at their world through their eyes and also convince them that what we were doing was necessary and important and create a team not of rivals or competitors, but of people who didn't necessarily all fall into the same silo.

We're largely responsible for the credentialing, privileging, presenting those applications to the medical executive committee and to the governing body, which is usually the board of directors, making sure everyone is completing their FPPEs, their OPPEs, the ongoing professional performance assessments, making sure they're up to standards with joint commission, reviewing and knowing the bylaws. I probably know the bylaws better than anybody in the hospital. We've rewritten them 10 times since I've been here. Quality review, and then making sure that the medical staff were involved in all of the various intra-hospital, extra-hospital committees radiation safety, prescribing, that sort of thing.

What I'd like to say is that the chief medical officer is a bridge builder between the hospital administration and the medical staff, but also between the medical staff and the board of directors, between the hospital and the community. Sometimes the CMO, I found myself as the spokesperson during the pandemic especially. It was on local radio, on TV trying to break down in very understandable terms what was happening, but also bring back to the hospital and tell them, hey, this is what the community is concerned about. Here are the questions they have.

We have to be mindful of that, responsible for that. Also within the hospital, being a bridge builder between the various departments translating the needs of the hospitalist team to nursing or between medicine and surgery and sometimes refereeing, sometimes being just the host getting folks together.

But I always come back to bridge building. And again, if you look through history, through cinema, through literature, bridges always figure prominently in history, battles of the Milvian Bridge with Constantine changing the nature of the Roman Empire, Stamford Bridge, which ended the Viking Age in England. All these great events happen on bridges. Even if you've seen Saving Private Ryan, which came out, in 1998. The last ultimate scene, Tom Hanks losing his life is actually on a bridge. And if you're a fan of The Lord of the Rings, that's where Gandalf the Grey transforms into Gandalf the White. And again, Jimmy Stewart, It's a Wonderful Life. The transformational scenes occur on a bridge.

I was a scoutmaster. When the Cub Scouts become Boy Scouts, they cross over this bridge and they don't really pay much attention to it. But I gave a little speech to the parents, like, look, this is a special time, you're going from one part of your life to another. And this is punctuated by going over a bridge. Bridges represent liminal spaces, liminal time, when you're not here, or there. Bridges are a great metaphor, because they're very narrow. And they're very risky, because if you fall off one way or another, if you don't keep a straight path, if you don't keep your eyes on the goal, tragedy can ensue. And sometimes it's foggy, sometimes it's slippery. So, it takes somebody who's been back and forth a few times, who's surefooted, who is focused to to cross that bridge.

And bringing together all those communities, translating their needs and their goals and their concerns from one party to another, can be very risky. If you don't do it correctly, it can really backfire. That's why I consider the role as bridge builder. The Pope himself is the official title is Pontifex Maximus. The greatest bridge builder. I don't think the CMO is the Maximus, but I think it's a very important bridge builder, we can all build bridges. And hopefully, the CMO can exemplify that.

John: The ironic thing is that if you go back the last 20-30 years, for a while there, there weren't that many physicians in leadership positions, at least on the community hospital side you always had academic hierarchies. But I think in the 50s, up to half of hospitals might have been owned by physicians, and then over time, it just everything got split. And so I think what you just said, it's important that physicians be in those roles. So I'm glad that there are more physicians and when I started as VPMA, our hospital had never had a VPMA or a CMO. So many hospitals now do.

Building on that, tell me in your opinion, the pros and cons of being a CMO. Like I say, I have many people that are a little reluctant to make that commitment. But to me, it was a natural thing to pursue. So, what are your feelings and some of the challenges and also just what you love about it?

Dr. Mark Olszyk: Yeah, for me,this can sound a little pollyannish or saccharine, but for me, there's no downside. I guess it just fits my personality. When I was a brand new attending physician, I would see these larger forces at work in a hospital, budget, staffing challenges. And I'm like, man, I just want to be able to fix that I want to get involved in that. So it was kind of a natural course. I got my MBA so I could talk the talk and understand some of the discussions a little bit better, and then got more and more involved.

And it's just hard for me to resist trying to represent my fellow medical staff members, physicians, but pretty much trying to weigh in. If we're planning an expansion to the hospital or adding a new service line, or how do we go about on some major quality initiative, I really want to have a seat at the table and have a voice. So the best way to do that is to get into the C-suite, you get into medical leadership, develop those relationships and connections.

What I love most about the job is probably as a CMO, I'm an ambassador, plenty potentiary, I can go to any clinical department, I can go right down to pathology right now, talk to my chief pathologist. And he's got a two sided microscope, and he'll show me some slides which look like pink and purple squares. And he'll say, what is this, and I'll get it wrong every single time. Then we talk about his family. I get to know him as a person. And that builds a bond of trust, it furthers our relationship. I can walk out of there and I can go up to radiology and look at some of the images with the radiologists. And then I can walk in to the surgical suite and get gowned up and just see what the surgeons are going through, see what their day is like. Yeah, I can do the same thing for the hospitalists, for pediatrics.

I actually like being a medical student in my third and fourth years because you have a different rotation every month. It was always fresh, it was always interesting. And that's why I went into emergency medicine where you're expected to be somewhat proficient in almost anything because you don't know what's going to walk through the door. So, you have to know about pediatric medication doses, you have to know how to treat people struck by lightning or bitten by rattlesnakes or CHF in a hundred-year-old.

So, you have to know everything you have to know enough about every specialty. And then you wind up calling every specialty, sometimes in the middle of the night, but often during the course of your shift, either for follow-up or for intervention. And so, you have to learn how to speak their languages. And I just never really wanted to give that up. I didn't want to find myself just in one specialty and not continuing to learn and stay abreast of all the others.

So, I think that's the most fascinating aspect of being a CMO is, I'm pretty much given a hall pass to go wherever I want in the hospital and no one questions that. In fact, they kind of expect that. And that carries over. I get to go to the board meetings, to the finance meetings.

I can drop in on the chief nursing officer, chief quality officer. So for a person who's emergency medicine docs tend to be a little bit restless and always looking for some new stimulus, that was just a perfect job for me. So, that's my favorite aspect and one I would not ever want to give up.

John: Excellent. Now, it's interesting. We all have our own particular things that we like. I loved interacting with the board. I was on the every board meeting. I had an official presentation and I actually love spending an hour or two preparing that. I like being alone in my office and doing things to prepare for that. Whereas other people are like I want to be out there in the public. There's so many different things that one can do.

So, if there's someone in the audience who's either thinking about, well, would I like this or should I do this? Or I'm about 50% sure that I want to do this. What advice would you have for that person early in the thought process of pursuing a leadership position, let's say, rather than and it may be eventually CMO?

Dr. Mark Olszyk: Yeah, I'll approach that a little bit obliquely. So, I've given a number of leadership talks over the years and folks are always asking, well, how do I get experience being a leader? I'm like, there's no end of opportunities. Having been in the Boy Scouts, I have three sons, and they're all Eagle Scouts now. But people are always looking for leaders. And it might not be the thing you want to do forever.

But whether it's your church or civic group, the schools, they're always looking for someone to step up. And I said, boy, if you can be a Scout leader, and hold the attention of 60, 10 and 11 year olds for 90 minutes, you can do anything. First of all, brush up your leadership skills wherever you can find the opportunity doesn't have to be in the hospital.

Secondly, the hospitals are always looking for medical leaders. I've seen a ocean sea change in the last 10 years. It used to be that our medical staff meetings, our quarterly medical staff meetings, were raucous affairs, we would have 60 or 70 people there.

As our models have become more contracted or employed physicians, I guess they don't have the same feeling of being community stakeholders as when it was mostly independent physicians in the community who had been there for decades. Now the days are long. And I think after a 12 hour shift, the hospitalists want to go home. And there's also the opportunity to Zoom into a meeting. So we don't see as many people attend in person. And it's getting harder and harder to get people to volunteer to spend an hour or two, even if it's once a month, in a peer review committee, because it does take some commitment to read over the cases and then show up for the committee. And we don't stipend or remunerate anyone except for the chair or the chief.

So it's volunteer work. We're always hungry for that. I'm sure every hospital has opportunities. If you want to get involved in peer review or bylaws or credentialing, or on the pharmacy and therapeutics committee, there's definitely opportunities there. Or the foundation or fundraising, or there's lots of opportunities.

And then you begin to network. I guess the next opportunity would be just to ask your chief medical officer. You could probably shadow him or her for the day. We all like to talk about ourselves. I'm doing it right now. If someone came to my office and said, hey, I'm interested in one day being a CMO or an assistant or vice, what's the path? And it depends on the person, on their personality, what they would like to do. Everyone does it differently. Every hospital has a different set of requirements or needs. So it's dependent, but I would be very willing to talk to them. I think anybody would.

Next you could buy the book and look through that. A little selfish promotion, or you could join one of the organizations, AAPL, ACHE. States have their own chapters. Every specialty has its own chapter as well. I think there's lots and lots of opportunities. You can write articles. Journals are always looking for articles. So there's a lot of ways to just get more involved. I don't think anybody in a medical leadership position would be reluctant or hesitant just to make the time for someone who expressed an interest and wanted to learn more.

John: The other thing I found useful, I don't know if it's still the same, but talking to the CEO, hey, what's your perspective on physician leaders and what should I do if I want to get up and be part of the senior executive team? So there's tons of opportunities.

Dr. Mark Olszyk: Absolutely.

John: But we are going to run out of time. So let's talk about the book again. Let's start with what do you think is the best way to get the book? Should we go to the AAPL? Should we go to Amazon? Are there other ways of finding the book?

Dr. Mark Olszyk: Either one of those is fantastic. If you go through AAPL and you want to order a lot, there are volume discounts or you can go to Amazon, it's easy. You can type in chief medical officer or even my last name, which is not too common, Olszyk book, and it'll pop up. You'll see a couple of Amazon reviews. Unfortunately, some were written by my children. Ignore those. And if your listeners or podcast watchers do get a copy, please do leave a review. It's important. But yeah, either way, you go through AAPL. I think there are some other platforms out there, but those are probably the two most common and easiest to go through.

John: That makes sense. What if they have a question for you? Can they reach out to you?

Dr. Mark Olszyk: They can reach out to me. Yeah, I'm on LinkedIn, as you know so you can direct message me. People have done that and I've responded quickly.

John: Okay, good. Excellent. It's good sometimes just really to talk to the editor or author. Of course, you wrote several of the sections of the book in addition to being the chief editor and you said you had some help with that. But okay, well, any last bit of advice before I do let you go in terms of the future of medicine and physician leadership therein? Any other words of wisdom before I release you from this torture?

Dr. Mark Olszyk: No, it wasn't torture at all. I really enjoyed it. It's good seeing you again. And again, thank you for the opportunity. Clearly, like everything else, medicine is going to change more in the next 10 years than it has in the last two generations. So if you want to be part of that change, get into a leadership position, let your voice be heard. I think a pessimist is someone who takes no joy in being proven right. And an optimist is someone who thinks the future is yet uncertain. So if you want to help craft the future, get involved.

John: That's awesome advice again. And I think physicians do resonate with that for the most part. I want to thank you again for being my guest. I might have to have you come back and dig into one of these topics that's in the book, maybe in more detail at some point, but it's been great talking to you again. We appreciate you sharing your expertise with us today.

Dr. Mark Olszyk: Cool. Thanks, John.

John: You're welcome.

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The post The Essential Guidebook to Being An Outstanding CMO appeared first on NonClinical Physicians.

An Important Business and Management Tool

In today's episode, John describes why the SWOT Analysis is an important tool for physician leaders and how to use it for project and strategic planning.

The process of shifting to a nonclinical career often involves learning and applying new business knowledge and skills. Most physicians have not been exposed to formal project management or strategic planning concepts during their medical education. The SWOT Analysis is a well-known business tool that is easy to learn and implement.

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The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, contact us at john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

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Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

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Building a Stronger Skill Set for Career Advancement

This week, John emphasizes the importance of acquiring new skills to enhance one's professional profile. The focus is on business skills crucial for executive and management positions. John suggests that expanding one's skill set in negotiating, contracting, health law, management principles, HR principles, and leadership can significantly enhance attractiveness to employers in the healthcare sector.

Mastering the SWOT Analysis in 15 Minutes

By sharing personal experiences and using a hypothetical healthcare scenario, John illustrates how SWOT analysis can be effectively applied to make informed decisions. Below is an example discussed during the presentation.

Decision Whether to Expand Healthcare Services

Scenario: John recounted a situation where his team needed to decide whether to expand healthcare services (urgent care) into a new area.
– Strengths: The organization was the largest and most successful hospital in the community, with a significant financial advantage, brand recognition, and a successful history of physician recruitment.
– Weaknesses: Lack of experience in urgent care, ongoing strategic initiatives such as starting an open heart program, recruiting a new radiology group, and completing a new wing addition to the hospital.
– Opportunities: Rental space availability, community demand for more physicians, and a supportive medical group interested in expanding primary care services.
– Threats: Large uninsured population, potential external competitors, and concerns about the reaction of the existing medical staff.

By considering the above factors that were discovered during a SWOT Analysis, our team was better able to make an informed decision about the risks and benefits of proceeding with the planned expansion. Based on this analysis, our health system decided to move forward with this initiative.

Using a SWOT Analysis in Other Situations

Doing a  SWOT analysis is also very useful in the context of regular strategic planning meetings. When dealing with various strategic initiatives a SWOT analysis of each can be part of the decision-making process for allocating resources to specific projects. A SWOT Analysis will help identify priorities, assess the potential impact of each one, and help decide how to allocate resources effectively.

Summary

John illustrates how SWOT analysis can be effectively applied to make informed decisions in the healthcare sector. It is a simple process that any healthcare leader can learn to do. And it makes a great addition to your portfolio of management and leadership skills needed to land your first executive position.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• How to Pursue a Nonclinical Career in Hospital Management – 080
• How to Deploy a Powerful Tool to Identify Goals – 054
• From SWOT Analysis to Inspired Goal Setting
• When to Use a SWOT Analysis
• Dr. Debra Blaine's Coaching Services

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 336

Add the SWOT Analysis to Your Growing Skill Stack

John: It's a good idea if you're thinking about moving into some other area that you might consider obtaining new skills that you can stack on your existing skills, and that makes you more attractive to certain types of jobs. And a lot of those skills and a lot of that knowledge is basically business skills and information. In fact, I was thinking about this earlier and much of what I'm going to talk about today, the types of skills that you might want to accrue, we talked about last time. You're pretty much going to find those if you happen to be a member of the American Association for Physician Leadership, including a leader in an executive position. So, you're going to need to know all of those business skills like negotiating and contracting, health law, and management principles, HR principles, leadership principles, and so on and so forth.

Today, I want to give you a little mini MBA course in 15 minutes. This is a session in which we are going to talk about SWOT analysis. What is a SWOT analysis? Now, I remember probably sitting in a room one day, I think it was shortly after I became VP for medical affairs. I was in the C-suite, and I was listening to these conversations. I was acclimating to this new job, and I heard somebody talk about, "Well, we've got to do our budgeting at the end of the year here, and we're going to be setting some management goals and so we need to do a SWOT analysis. Then we can be prepared to move forward on that." I'm thinking "SWOT analysis, that sounds pretty... Is that like a SWAT team or something?" But for those that know what it is, you're kind of chuckling because the SWOT analysis sounds like some really great tool, but it's been around forever.

The SWOT just simply comes from the acronym of what you're doing when you're doing a SWOT analysis. And that is for whatever problem you're looking at, you're trying to solve and maybe develop a set of goals or make a decision about, you're just going to look at these factors which have been shown to be important in decision making about whether to proceed with something like this or not, or choose from among a multitude of options. We got 10 different things we want to do. How do we figure out which of those 10 are the highest priorities? Well, you could do a SWOT analysis. There's lots of ways that a SWOT analysis is used.

Now, I will mention this. You may want to read about this, and actually, even Wikipedia does a pretty good job describing this, but you can look it up on Google. You can find almost any kind of business management book will have it. I'm sure it's taught in schools that provide MBAs and MMS and MHAs and things like that.

But the SWAT simply refers to the S is Strength. The W is Weaknesses. The O is Opportunities, and the T is Threats. And so, you take whatever it is that you're dealing with and you bring it through that process. I'll tell you when we use this frequently. I would use it with my managers, and sometimes the senior team would use it to develop a maybe an hour or two session at our strategic planning meetings.

Now we had biweekly or weekly strategic planning meetings. Then we would do a SWOT analysis every time at that, although we could do it at a particular meeting. But if we did an annual, you would call more of a management goal meeting, because the old days we did strategic initiatives that would be looking out three to five years. And there's still sometimes where that's important to do, but generally we're doing year by year.

And that's that short term strategic analysis and plan became really the management plan, which meant that every V line goals that the superior had decided we were going to do for that year coming up. We usually did this towards the end of the year, although not quite at the end because we wanted to know what these initiatives would be before we actually set the budget, as opposed to saying, "Well, I think we're going to extend our hours on weekends." You could do that without necessarily a huge budgetary impact. And in that case, the revenues would offset the expenses anyway. But still, even there, you might want to do that.

I've written about in the past an example of what this might look like. So, I'll just give you an example and we'll walk through it. Let's say that we were in a group, either a private group or part of a hospital medical group, and we decided that we were going to do a SWOT analysis to decide whether we should proceed with an expansion into a new primary care or urgent care service in a new area that we hadn't been in before. We're like, "Okay, we're in a hospital, we have a competitor hospital basically within walking distance. There are some other competitors out further, but basically we have that to contend with." And then we have to consider all the factors that might go into whether we can and should do this. Do we have the budget for it? Are we growing? Do we want to grow? Do we have staff for it? And so forth.

So, let's see what the SWOT analysis might look like. And this is just a partial SWOT analysis, but we're looking at this. And so, let's talk about in a brainstorm about our strengths. At the time, we were definitely the biggest hospital of the two and the most successful I would say in the community. We had a much bigger bottom line. We had $300 or $400 million net revenues, and the other one maybe had a third of that. We had employed a base of physicians. We were fairly successful at recruiting physicians. We had a very healthy bottom line for the last five years. We were making money unlike other hospitals in the state of Illinois who many were losing money.

And what are the other strengths? We had a great brand recognition. We had gone through some marketing consultations in previous years. We had some pretty tight branding and marketing. We had good logos and they had been consistent color palette and that sort of thing. Like I said, the finances were strong.

And then the other thing is, do we have physicians interested in this? And we did have those inside the medical group, the primary care doctors already interested in finding new locations to do this. And if we looked at who was in our team right now, the team that was running the group had a lot of depth. And so, we could take on, we felt in that situation, pretty readily expanding into a new territory. Now, we would also have to decide things like "Are we going to build or are we going to lease some space? How much do we want to commit to this from a budgetary standpoint? Is it going to be enough?" But so far so good.

Now, weaknesses. At the time we were looking at adding an urgent care clinic. Basically we had no experience in urgent care. We were not doing any urgent care. There were some urgent cares in the periphery of our service area. They were all either independent, freestanding, individual urgent cares or large regional groups that we're expanding. And it's a little different competing, let's say, with an urgent care that's run by an entrepreneur as opposed to an urgent care run by a hospital, which typically loses money, but they make it up on the referrals and that kind of thing. No expertise in that.

We had already several pretty pressing strategic initiatives. I don't remember exactly, but let's say that we were do starting an open heart program and we were in the process of recruiting new radiology group and we were still finishing up the addition of a new wing to the hospital. Those are weaknesses because there's a lack of depth in terms of the ability to manage something at maybe a higher level management directors and VPs because we had these other big projects going on because we didn't have the experience.

And the other thing is we were really having trouble at that time recruiting staff fast enough to maintain and keep up with our growth. The area we were looking to go and didn't have urgent care. In fact, the general area around us didn't have urgent care. We were looking at ways to prepare for value-based contracting or prepaid plans, keeping costs down basically which means keeping people out of the emergency room, which is basically what primary care and urgent care does if you have enough capacity. Shunt those people. That's one opportunity we had never pursued before.

It just so happened there was rental space available at several locations in the town in which we were looking to put the urgent care. And we had heard that the community definitely wanted more physicians. We probably should have done a little more digging on that, whether what type of physicians, but basically they just wanted physicians because there was a lack of. This place is a good 30 minute drive outside of the main area where our hospital was located, and it was pretty rural, but still had some population density there.

Now the threats. That's T. The threats for the SWOT analysis could be things like, again, you just look all those areas, finance, growth, marketing, branding, reputation, quality, staffing and HR issues. All those things. And now you look at the threats. Mostly we're looking at threats that are coming from outside, but one threat is that there was a very large uninsured population. Sometimes that could be tricky in terms of how to set it up and how to make sure that you could serve the needs but not lose a lot of money in the process.

The second threat was that we had heard there were both competitors external to our market looking to expand potentially. And then also at the other hospital and in a group of primary care physicians thinking of doing it themselves. They were probably going to start it on their own, in their own offices and expand maybe into this other thing. We need to be aware about that.

And the other threat that we came up with at that time was the fact that our medical staff might not like this idea of us recruiting more and more physicians because a lot of the medical staff at that time were still private medical staff. They were not employed. And so, they would feel threatened by us and they could do things that would make it difficult. They could say, "Okay, we're taking all our business dealer hospital because they're not hiring physicians as much as you are to compete with us. So, those are the kind of examples of some of the strengths, weaknesses, opportunities, and threats.

Now you do that for five or six or seven different projects that you're thinking about. And then by balancing those out and really get into the financial piece, you'll need a pro forma or at least a thumbnail sketch of what the cost of the different projects are, and then what's the return on a clinic or something that might take two or three or four years to really break even. If you add a new service line and get to be successful in three or four months, then you're going to get the return on investment more quickly.

What we would do from taking that SWOT analysis, we would take that to the next step of goal setting so that this is how we would translate it. We would use language like this. For my department, how can we utilize our strengths and acts to take advantage of the opportunity? That's the strengths, the S. How can we utilize our strengths in this A, to minimize the threat coming from B, or how can we take advantage of the opportunity to Z minimize our weaknesses in V.

Let me just give you some examples. This is how we would phrase things if we're going to put some of these together. Following what I just mentioned, I'd say for my department, this would be a manager talking. I had usually between four and eight departments reporting to me. But for my department, how can we utilize our financial strength and strong interest by the medical group to staff an urgent care clinic? Again, how can we utilize our strong management team? That was one of our strengths, to minimize the threat of the large percentage of uninsured in the market. Somehow take care of the uninsured, we've got a good team, we need to leverage them.

Another example, how can we take advantage of community support to minimize our weakness, which is difficulty in recruiting support staff. How do we get the community to help support us getting staff in? And there are big ways to do that. That's where I'm going to end it. But this is something that like I said, you can learn about pretty much anywhere, any business book. You can actually do some business courses at the AAPL that we'll talk about this.

But for a quick review and definition of all the terms, then I would just say go to Wikipedia and look up SWOT analysis. And whatever job you're in and you're being asked to participate in a planning session or to provide feedback. Because I've done this, I am on the board of a hospice and we were doing a strategic plan one year and I said, "Hey, if you want me to take the team through a SWOT analysis, we'll go through the whole thing, all these different areas for where the hospice is in terms of strengths, weaknesses, opportunities, and threats." And we used it for the management team to develop their goals for the following year. And since I had done several SWOT analysis and I thought, "Well, let's have him lead this one and then we can get someone next time to lead it for the rest of the team."

All right, that's all for today. Thank you for listening and I will see you next week. Thank you for listening and watching.

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The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

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The post Add the SWOT Analysis to Your Growing Skill Stack appeared first on NonClinical Physicians.

Interview with Dr. Nilesh Dave – Episode 335

Today's podcast episode describes Dr. Nilesh Dave's four-year career transition to health system Chief Medical Officer. We pick up from his previous appearance 4 years ago in Episode 99, as he lists the steps he took on his interesting career journey.

Starting with his role as medical director at a regional Blue Cross Blue Shield subsidiary, he describes the steps he took to land his position as VP for Clinical Effectiveness and CMO for a large hospital system.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, click this link=> SPONSORSHIPS.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Career Transitions and Leadership Growth

Dr. Nilesh Dave's evolution from medical director to CMO for a health system highlights the importance of diverse skill sets in nonclinical leadership roles:

1. Adaptability across domains
2. Cross-pollination for innovation
3. Strategic thinking
4. Learning and adapting to new technologies

Nilesh emphasized that a combination of clinical knowledge, business acumen, and the ability to adapt to new technologies is essential for success in these roles. Some of these skills developed as he pursued additional formal education, including an MBA and executive training in Artificial Intelligence in Health Care at M.I.T.

Navigating Challenges as Health System Chief Medical Officer

Dr. Dave's role as a CMO involved navigating the challenges of a complex healthcare system. It requires a combination of strategic leadership, analytical thinking, effective communication, and collaboration to drive improvements in clinical outcomes and overall system efficiency. He began developing many of these skills in his previous management roles.

Summary

If you're interested in connecting with Dr. Nilesh Dave and exploring more about his insights into nonclinical roles in the healthcare industry, you can reach out to him on LinkedIn. Dr. Dave often shares valuable perspectives on clinical effectiveness and leadership, making his LinkedIn profile a great platform for networking and staying updated on the latest developments in the field. You can find him on LinkedIn by searching for Nilesh B. Dave MD. 

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Dr. Nilesh Dave's LinkedIn Page
• First Gain Know-How Then Secure an MBA – 099
• The Eight Essential Abilities The CEO Wants In A Chief Medical Officer
• 6 Important Assignments of a Hospital CMO – 218
• How to Become CMO in a Year – 052
• Dr. Debra Blaine's Website

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 335

What Makes a Great Health System Chief Medical Officer?

- Interview with Dr. Nilesh Dave

John: I can't believe it's been four years since I last interviewed today's guest. I wanted to have him come back because his nonclinical career has flourished since he was here before. And he's in a leadership position now of a large hospital system, which is awesome. I think he has a lot to share with you all today. With that, let me welcome back Dr. Nilesh Dave. Hello.

Dr. Nilesh Dave: Hi, John. It's great to be back. I'm looking forward to chatting with you over what's been going on over the last four years and hoping that any of your listeners out there will hopefully get some nuggets of information and hopefully that'll help them get to the similar or whatever pathway they're on.

John: I think it's going to help a lot, and I have a lot of questions. But when we last spoke in July of 2019, I think it's okay I can mention you were basically working for one of the regional Blue Cross Blue Shield companies but you're no longer there, obviously. That's why I wanted to have you come back. You've made a couple of different changes and you've also done some other things in between. Why don't you tell us what happened, why you decided to move on and what the next job that you did was that would utilize all of your skills and education?

Dr. Nilesh Dave: Yeah, sure. I'm happy to. When I was working for one of the subsidiaries of Blue Cross Blue Shield, I was outreached by another insurer to join their team. And the resources there that they had in analytics and the opportunity to get involved with more business innovation in that space, as well as population health, was too hard to pass up. And so, I literally had to just drive down the street for that when I took that position and learned a ton. I was never someone who actually liked the utilization management component, and this was a minimal part of the entire role.

A lot of jobs in the nonclinical world will sort of describe themselves as working across a matrix or working across silos, so to speak. And I have to say that doing that transition to the other insurer ended up really teaching me some of those skills that it's not anybody that is above or below you in sort of a hierarchy. It's another department and group, but you've got a common client or something like that. And that's what brings you together in achieving some of the business objectives.

And when I was there COVID was starting up. And so, I was enjoying that role. And then I thought, you know what? I want to maintain my clinical skills. And so, I signed up to do some tele ICU moonlighting shifts. With being in a corporate position and having regular hours, it was not difficult to find time to do a clinical shift.

I started doing that and it was different. It kind of checked off the box of, yeah, it's critical care, and I'm an intensivist by training, but it was in a different way. It was tele ICU. I wanted to learn more about that because things were shifting towards telehealth and certainly COVID accelerated that and made telehealth a more accepted way to also deliver healthcare. And so, I just expanded my skill and exposure to it and signed it up.

And then I guess serendipity is what happened next, because I ended up being asked to oversee that multi-state tele ICU operation. And I almost did a double take when I was asked that because this was an opportunity that aligned my clinical skills. I had gotten a business degree before. I was in charge of quality, metrics and policies for the health system that this was a part of. And so, that had some inroads to my master's in public health I did in between medical school years. It just seemed like this makes complete sense. Like why not do something like this that you can get at all these skill sets in under one roof?

John: That's impressive in a way. But also what was the old saying? What is good luck? It's the combination of preparedness and opportunity. Unless you're open to it and you're prepared, however that preparation occurred, you just never know when you take a new position or volunteer somewhere or whatever, what opportunities might show up. What were you doing there? Just to clarify, I was going to ask you about the location, but it sounds like you did not have to move to take on this new role. You said it was down the street.

Dr. Nilesh Dave: No, in fact the company's headquarters moved from Boston to Dallas. And so, their operations for their tele ICU was also located literally within a block of the other two jobs I had previously. It was just sort of a business park, I guess, and that's why. I didn't have to drive really anywhere else.

John: Another serendipitous thing in the sense that there's a lot of movement out of many states, but Texas is one where there's a lot of movement in. And that includes corporations as well as people.

Dr. Nilesh Dave: That's for sure. Yes.

John: You loop selected a good place to live and grow in your career. That's another thing to keep in mind. Tell us again, at the beginning, before you were doing the moonlighting, before you were heading down this telemedicine service, what were the actual duties that you were doing that were different from what you had been doing earlier in your career?

Dr. Nilesh Dave: At both insurance positions, there was a new program that both insurers had started in terms of a white glove population health management service for employers, employees or members of the insurance. And looking at cost of care, drivers of care, managing and understanding the population of workers and really using your medical knowledge and understanding like, okay you've got diabetes, which is a risk factor for coronary disease, and the folks that work in the different divisions of this company. The company had 400,000 people in the Blue Cross Blue Shield subsidiary that I was overseeing. And so, that was a lot of that population health more so. But when I moved to the other insurer, there was more sort of KPIs, key performance indicator, and data associated with that that we focused on as we were managing.

I was managing three different companies with very disparate populations and risk factors. And so, I had one that employees would be in remote locations building solar farms, wind farms and stadiums, and another that was building nuclear subs and the third in drug development. And these are all employees with different kinds of health problems and some very similar.

But in that second role, there was a lot more of a business focus, a lot more strategy, data-driven analytics, and the opportunity to use that data capability that the company had to think of innovative approaches to some of those problems. And so, when I pivoted away from the Blue Cross Blue Shield position, that's what I got out of that second job.

And that retrospect, I think that set me up pretty well for when I started doing the tele ICU operations across multiple states. We had the same kind of set up. We had a lot of analytics. We were in charge of quality and metrics. We had key performance indicators that we had to meet. The usual ventilator length of stay, ICU length of stay, mortality. That's in the medical clinical world, that's when you're in these sort of hybrid clinical business positions, a lot of those things are what you're looking at. And so, being able to be in that tele ICU position really solidified that. And I was able to leverage then my clinical knowledge as well, knowing what does it take to take care of an ICU patient and translate that into the business side for health system.

John: That's what I think is great about physicians that move into these more executive positions, is that they do have that understanding of the relationship with the patient, the needs of patients, medical terms and all that. And if you can just add the business side of it, to me, it's an ideal situation. I think the companies you've worked for, they've recognized that. They have CMOs and they have physicians in pretty high leadership positions unlike a lot of hospitals. Some large hospitals do, but there are a lot of hospitals out there that the first thing they did when the pandemic hit was get rid of their CMO because it was an expensive position, at least from what I've heard. That's why I think physicians sometimes get frustrated working in a health system, but I think you still have to fight for that. And if your colleagues that are at the hospital recognize that they can hopefully encourage the leadership of the hospital to get more physician leaders like yourself. Tell us the next steps. Anything else you want us to tell us about that position you were just describing? I know after two or three years then you found something new to pursue?

Dr. Nilesh Dave: Yeah. There were a few variables that sort of were in the mix, that the health system where I was doing the tele ICU had some struggles and things that were financially related. And so, the tele ICU program was being contracted and expansion was being halted. And being able to grow in that position, it was pretty clear it was going to be delayed for several years. And a lot of the planning and things that we had at the beginning of when I took it a few years later, that was all sort of cut. And so, at that point, an opportunity at a Dallas based health system, the largest one by footprint, in terms of hospitals and things, was advertising a clinical effectiveness chief medical officer position.

And so, I threw my hat in the ring. And obviously after rounds of interviews and things, they offered me the position. One of the things, my background is a divergent one. When you look at, I'm at a system level. We have a system CMO. In some ways you could say I'm an associate system CMO, but they carved out a different CMO role with different parameters. And my background does not fit the "Hey, I've been in a hospital CMO for years and now transitioning to a system level." I was at a system level with the tele ICU, and in some ways I was the critical care subject matter expert overseeing our tele ICU operations and quality and meeting all those metrics. In some ways, there was some similarity to that CMO role, but I did not follow a traditional pathway. And in fact, I think I was very fortunate to be in a company now that actually appreciated my payer experience and my telehealth experience, which they've never had that background. And they thought that that would be an advantage for them based on the personnel and skillsets that they had which was a nice refreshing thing to hear.

John: When you were looking at the job title, if they posted it as such clinically effective CMO, they could have said chief clinically effective as medical officer or something else, but I've heard the term clinically effectiveness, but I've never heard that applied to a CMO. What were you thinking when you first looked at that?

Dr. Nilesh Dave: I figured that there were probably service lines or clinical service lines that between hospitals, they were probably performing at different levels. And I'm sure I expected that there would probably be similar sized hospitals with similar availability of specialties, but their quality metrics, we're not predictably the same. And so, I was sort of trying to figure out what's driving that? And it turned out that thinking before learning more about the position, the position was a new one that they had. It wasn't one that they had established years ago. They got rid of one position and sort of reformatted it. And so, for them it was also a new thing. And it was not only clinical effectiveness from the way you would think in the service line area, but also risk management, safety, credentialing, medical staff affairs.

I'm also involved in deploying our telehealth strategy. I'm on their AI governance task force, the tele ICU. And I've always been into the tech stuff. And so, now with AI, generative AI and things really versioning and so many platforms and vendors out there trying to get a piece of the pie, we had to create a governance structure, and I helped create a framework and took some time to take a certification course from MIT on AI and healthcare as a way to just compliment that because I knew some, but I didn't think I knew enough. And I just did that on my own while in the role taking classes and things online and learning that stuff. Once I saw some of these other aspects of clinical effectiveness, and it really is just making the clinical engine run, as smoothly as it can, that's what it kind of boils down to now. And it's been a phenomenal experience.

John: Describe some of the things that you do in that role, that are more leadership management and so forth. I think it's difficult sometimes for physicians to understand what it's like to move from that strictly clinically, even if you're the head of a service line or something, to working at the level of let's say a senior VP chief medical officer. But it's going to be different for every system as well. You move from one to another. What does it look like for your system? Who are your peers? Which other senior leaders do you regularly meet with or report to for that matter? That would be interesting to hear how that's structured.

Dr. Nilesh Dave: Yeah. Interesting. I'll add one other point is that when I was in the tele ICU position, I had 40, 50 nurses, and probably the equivalent number of physicians on our internal tele ICU operations. I had a whole team, had administrative folks helping to run the operations, a nursing counterpart, and a few other internal business partners. When I joined my current role, the directive was to get things done working through the business. Other than an administrative assistant who's fantastic, I do not have a hundred person team under me or any of that. That's one big difference that I have already in the job, which was a bit strange to me, based on the projects and things.

But I came to learn through listening to interviews like this, that there are many folks who are in these sort of officer positions that work through the business and get things done. And so, on a day-to-day basis, the folks that I interact with could be other VPs who oversee our hospital channel, for example. We have all our hospitals in a channel. We have an ambulatory channel and telehealth channel. And so, we have VPs that oversee that and a lot of them are nonclinical, business trained background. And so, I work a lot with them on different aspects of my projects. I even will directly collaborate with the COO of the company, and occasionally with the CEO and CFO as well as the strategy officer.

It's not a completely sort of flat organization in that sense, but the opportunities are there, and at times necessary. And I also work with the chief medical officers of each hospital. They don't all report to me. They're sort of a dotted line to myself and my colleague. And so, we collaborate together with them. We work with the chief nursing officers, hospital presidents are sort of in the business channel, but we work with those executives at the local hospital levels and then their sort of system counterparts who are maybe senior VPs or executive VPs or whatever. It's all across the board. I work closely with the VP of care transition management who oversees all of the folks in the hospitals. And so, it really is a pokery of various officers. At all levels, it's not just officers.

John: Yeah. When I was working as a CMO, of course, it was a small, it was a hospital, so it was very contained. But we just say that was a matrix relationship. We knew that if we had something we had to get done, it wasn't that I had to go through another VP. I would just deal with whoever I had to deal with to get it done. And then hopefully we're all on the same page, had sort of the same strategic plan and management plan that we were working on. And so, at that level, you even have to learn how to give up a little bit of something. You have to make someone else's thing work, because it's for the overall improvement of the organization, not your own little fiefdom within it. That sounds really goods.

The other thing that it makes me think about is when going through some of the courses at the AAPL and what I've taught when I've heard from others doing MBAs and so forth, the importance of things like negotiation, communication, persuasion even as a thing. And it's all about doing that rather than there's no such thing really anymore for the most part of just saying, "Okay, I'm the boss, so I'm going to tell you what you're going to do."

Dr. Nilesh Dave: I think that's a great point because one of the things you had mentioned is that a lot of times folks with these opportunities sometimes struggle, and in reflection, I think there's a struggle. Part of the struggle comes from just the language. A lot of us who may be doing day-to-day clinical practice and maybe are involved in some greater hospital initiatives or maybe it's the health systems doing your cardiologist and there's some cardiovascular service line initiative, and you're doing some of that, but being able to translate that into business speak.

And in fact, when I had to do my resume as I was pivoting into the nonclinical world, I think on our last discussion, I had mentioned that it took me a while to understand how to convert "Hey, I set up a system-wide inpatient hospice program." Well, there is another way of saying that on a resume that resonates with the nonclinical business executives that you might end up working with.

And to your point about getting allies and strategizing, it's a lot easier when you have that one patient in that one room and you're talking with different consultants. For one consultant or for a combo, your hand is forced because of the clinical scenario situation and the direction it is going in. And so, you have no choice but to agree and just take care of it. On this side, you know that is going on, but you're doing things system-wide that aren't directly related to that patient and related to operations or strategy, and a lot of that maneuvering, change management negotiating, let me do a solid favor for them now and hopefully that'll be repaid when I'm in dire need of something as well. And I'm not keeping a little notebook of what I've done, but the people you work with, you kind of know, they'll remember and sometimes you have to bring it up. That's a different skillset. I had to learn a lot of it. I wasn't like one of those schmoozers who could easily just do that kind of thing naturally. That's not always the kind of people who can get things done in these roles. There are skills to learn.

John: Yeah. Yeah. If you have a culture where that's the way things are done, it helps, but there's always individual personalities and some people are more forthcoming. I remember I had a director that reported to me, and I loved her dearly, but she may be crazy because if somebody didn't do something they promised like within a week, she'd be like, "It's not my problem. But they said they were going to do it." It's like, no, you have to take responsibility beyond yourself and enable those other people to do what they are supposed to do without being so black and white. That's just another example.

I'm glad you're here because I did have one or two other things I wanted to ask your opinion on, because you have some experience with these things. For example, you did that MPH back while you were in med school or between years or whatever, you did get an MBA and at Kellogg too, I think it was. It's not a community college MBA. And you've done other things. I don't know if you've ever been a member of the AAPL. I'm just wondering your opinion on all of those things, whether there's a prioritization, if someone hasn't done any of them, or what your advice is on deciding on an MBA, deciding on doing an MPH or doing some other things. Like you said that you got some additional training in telemedicine and AI and that kind of thing.

Dr. Nilesh Dave: Yeah. Funny enough, when I was in med school, my desire was to be in infectious diseases. And at the time, I wanted to learn more about epidemiology, biostats and health outcomes. At the time that was the buzzword. And when I did mine at Johns Hopkins, they had a program for with all that, and it was just a one year program. I didn't go into infectious disease but I did learn some skills, especially with the epidemiology and the biostats that from a data analytics perspective, which I would not have predicted back then, ended up helping me out. I pursued that because in the moment it made sense for what I was trying to do.

The business degree, I've been asked and I also hear the question of, "Well, I wanted to do something nonclinical so I better go ahead and get my MBA because that's like a lot of our physician pathway, we've got to get a medical degree, or a doctor of osteopathic medicine degree or something and be able to be that doctor." But here, an MBA is not mandatory. There is the American College of Physician or I forget, Healthcare Executives or something. The ACHE or something.

John: Yes. That's the one that's more for the hospital. ACHE.

Dr. Nilesh Dave: Yeah. There's an MBA like program you can go through there. I did it because I knew I lacked the ability, and when I was doing system-wide stuff as a practicing intensivist, getting involved in some of the health system initiatives, I was having a hard time trying to communicate effectively with nonclinical business leaders. And if anything, I felt like I was just oversimplifying things and as I listened closely in meetings, I saw that there was a gap. And so, I did that.

But at the time, I was not doing it hoping that it's going to open a thousand doors of opportunities. That did not open really any doors right away. Even with an alumni network that was strong in all of that. That was not something that was automatic. You still have to hustle and try to find those opportunities and hope that one thing builds on another and sort of strategize like that. And those skills ultimately will come in handy and they have for me now.

But it's a false way of thinking if getting an additional degree is the gateway to doing things like this. There are plenty of folks that I know that don't have a public health degree or an MBA or Master's in Health Administration, or any of those, that are fantastic leaders. And whether they've done work on the side to learn that stuff, it's possible, I don't know. But it's not necessary.

John: What I'm hearing, it was like the MPH, there was a reason at the time that you did that, and then with the MBA, you were already understanding, I don't know, maybe budgets, maybe financial statements. You had the people you were talking to at that time and you thought, "Okay, this is going to help me to address that need."

Dr. Nilesh Dave: Yes. And I was also at the time thinking a little bit entrepreneurial that maybe I'll sort of do something different on my own. I wanted some of that background and I thought about should I go and pursue a healthcare related MBA or not? And I actually decided conscientiously to not do a healthcare one. I wanted to meet people from all kinds of industries because my background is divergent, my thinking is divergent. I like to cross-pollinate with folks in other industries to have a better innovation mindset. And so, I looked at it that way and chose a program.

John: Yeah. That makes sense. Because I do hear the same thing. "I don't know what I want to do. I want to get out of medicine, so I'm going to get an MBA." And it's like, well, that's a little bit of a shotgun approach in the sense that it doesn't really give you any particular direction. And I think employers too, they're going to be working for someone like a big system or insurance company or pharma. They're going to look at that and say, "Well, it doesn't really fit in any kind of logical step in your career." You just decide one day to get an MBA while you're practicing full-time in family medicine or something. I'm sure those things long-term can benefit in unknown ways as well, but it's a lot of time and money to invest without having necessarily a direction that you're shooting for.

Dr. Nilesh Dave: I wanted to add, especially for the benefit of the listeners, that when I took on this role, and even when I was in my previous role, I had started to work with an executive coach. And at first I was like, "Well, I don't know. Do I really need that? We're all smart and savvy enough. Maybe we can figure this out." But no, emotional intelligence is probably the number one most valuable skill and capability that you need to grow and mature when you're in these types of positions.

And there's frameworks of how to manage workloads and how to have those conversations and negotiating the talking with different folks and trying to not only get the stuff on your table moved forward, but a collaborative project as well. There's skills there, not necessarily soft skills, but there are some hard skills as well that for me, it was something that I thought would play into the brand that I wanted for myself. What I want to be known for and how do I want to execute on that.

An executive coach was something that continues to make sense. I've been working with the same person now on a second year, monthly, before it was more frequently, especially when I was onboarding in this new role at the end of April. I throw that out there just because not everything is in the books. You do need it. You do need sometimes some coaching. Will there be a time where I won't need it? I'm not sure. It just depends.

John: Yeah. Unless you've had a coach like that, you really can't imagine the amount of wisdom that you can get from a coach. And they're kind of like a therapist in a way. They don't just tell you what to do. They get you to generate the "aha" moments and just help you to clarify your thinking. The bottom line is it doesn't make you a better person. Everything you would've maybe eventually learned, I think just happens faster when you're in that situation.

Dr. Nilesh Dave: I agree. And sometimes in the chaos, they can help tell you "Yeah, that's not the way for your role, what it is. You should be really having this resource or support, or you should really be looking at things this way. Or you're now in a position that's different than what you did before." You got to start sort of shifting, to have executive presence or to do those things which are skills to get success.

John: No, it's a really good point. Because we know how we feel in our internal talking to ourselves. When you have someone who's objective and really has no vested interest other than in your success, it's just a different perspective that just really can open your eyes. It reminds me too of something that one of my friends colleagues, advised me, and he was a hospital leader way before I was, and he said, "The next time when you apply for a job at one of these hospital systems or something, you should ask them to provide you with a business or leadership coach as part of your contract." I thought that was a brilliant idea. I never had the chance to implement that, but I thought that is a really good idea.

Dr. Nilesh Dave: Yeah, I agree. I had been told that after a year into the job that my company also provides that.

John: Okay. Nice.

Dr. Nilesh Dave: I was like, "Whoa, really? You guys actually provide that kind of stuff?" I'm very blessed to be in a company that really invests in their own people, with innovation programs for officers and things like that, to really understand the business. That was one of the other things that I went through as I was learning the company. They're like, "Well, we're going to throw you in this program for seven weeks." And I heard from all the strategy leaders, finance leaders, and it kind of fast tracked me in my education of just knowing where am I working at? What have been their goals? Where are they trying to get to? And how do I fit into that? And that's just investing in their people. Not every company does that kind of thing.

John: Yeah. That's awesome. It really is. I think outside of medicine, it's very common for large businesses to invest in coaches for their CEOs and senior leadership team, and even managers sometimes. We're a little bit over time here, but I do want to ask you any thoughts about AI in medicine? It sounded like you have some experience. Is this something we can ignore for a while or do we have to really start to learn about AI if we want to get into clinical or nonclinical future jobs?

Dr. Nilesh Dave: Yeah, I've been involved in my own current job and just reading and talking to different folks in the AI space. I think that some of the takeaways that I would say to answer your question is, one, the physicians and the healthcare teams that learn to work with AI as a tool are going to do better than those who say, "Well, I'm not getting into this. Or maybe reject the idea or think that it's a fad and eventually it'll go away." I don't think it's going to go away.

But with that said, the most important thing is understanding how do you evaluate a proper AI partner for your clinical operations? What they're calling AI, why are they calling it AI? How do they develop it? How do they test it? How is it biased? What's the risk that it can create harm? And that's a lot of the governance, sort of points that we set up. For anyone working in the hospital side, if your health system or your independent hospital doesn't have a governance structure, you need that.

Secondly, you need a framework to evaluate all the different vendors and folks that are going to come at you with, "Hey, we've got this cool thing." And you never know, it could be half baked. And they're just looking for a partner to use data to test it and iterate on it. Well, do you want to be that partner or do you want to wait till it's baked more?

But I think overall it's going to be a very helpful tool. We're using it, we're piling it in our outpatient clinics, especially generative AI. There are ambient AI programs that can listen to in a HIPAA secure fashion physician patient interactions and create a soap note or an APSO note and then you can edit that and clean it up a little bit. But it's screened by human and then sent to you very quickly so you can just focus on talking to the patient and not even need Scribe.

We have it being used in imaging, some of our business side, like revenue cycle. And so, we're looking at that, even looking at programs that will evaluate when patients call a hospital and have a conversation, what's the tonality and what is that doing from a business side? What's the engagement? What are they mad at? What are they telling us that we may not have picked up on? Because it's otherwise done manually. There's some cost savings potentially there, but in all of these, you want to have a governance structure to work through. Because data security is also a very important thing.

Yeah, you should get on to the bandwagon, but carefully I see. With structure, with a framework and see where it can help you the most. I think all these burdens and cumbersome tasks that have been attributed to burnout, there's an opportunity here to reduce some of that. Doing all your notes at the end of the day and all that stuff. There are tools out there that are good.

John: Yeah. Okay. Good to know. We need to embrace it at some point but also to make sure there are ways to monitor it and make sure it's safe and it's secure.

Dr. Nilesh Dave: Absolutely.

John: I really thank you for being here today. I hope the listeners get the same that I got out of it. It's very interesting and it's inspiring and it's also a lot of good points to think about and remember as maybe my listeners are pursuing a career in hospital management or any kind of management or leadership position. I know that we'll probably have some questions for you. I think LinkedIn would probably be the simplest way for people to reach out. I know they can just look up Dr. Nilesh Dave and they're going to find you. If you do have a question, those of you at home listening, then Nilesh can help you out.

Dr. Nilesh Dave: I'm happy to.

John: This has been really good. I'm going to have to catch up with you again in a few years. Maybe I'll have you come back, even maybe a panel on AI. Again, I'm just afraid it's going to become overwhelming very quickly. All right. Thank you very much for being here and with that I'll say goodbye.

Dr. Nilesh Dave: Thank you very much for having me. Happy holidays and happy New Year.

John: Thank you.

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Consider This Well-Compensated Career – 323

In today’s podcast, John shares invaluable insights on the critical areas of expertise for physicians seeking hospital leadership jobs.

John recounts his transition from a clinical role to leadership within his hospital. Like others, his transition started with physician advisor and medical director roles, which provide management experience.

Our Episode Sponsor

This week's episode sponsor is the From Here to There: Leveraging Virtual Medicine Program from Sandrow Consulting.

Are you ready to say goodbye to burnout, take control of your schedule, increase your earnings, and enjoy more quality time with your family? You’re probably wondering how to do that without getting a new certification or learning a whole new set of nonclinical skills.

Here's the answer: The quickest way to achieve more freedom and joy is to leverage virtual medicine.

Dr. Cherisa Sandrow and I discussed this in Podcast Episode 266. Cherisa and her team are now preparing to relaunch their comprehensive program for building and running your own telehealth business.

If you want to learn the tools and skills you need to live life on your own terms – then you should check it out today. After completing the 10-week program, you’ll be ready to take your career to the next level.

The program starts soon, and there are a limited number of openings. To help you get a glimpse into the program, Sandrow Consulting is offering a series of FREE Webinars. Go to nonclinicalphysicians.com/freedom to sign up and learn why telehealth is the quickest way to begin your career journey.

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We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Transitioning from Physician to Hospital Leadership Roles

Transitioning from a physician's clinical role to a leadership position within a hospital system is a significant and rewarding shift. It begins with clinical-administrative roles within the hospital, such as medical directorships. These roles offer valuable management and administrative experience and a bridge to more senior leadership positions.

As physicians move through these roles, they encounter a dynamic shift in responsibilities and gain a deeper understanding of healthcare systems. Through this transition, responsibilities shift to greater leadership responsibilities. These administrative positions often involve advocating for colleagues and patients, while enhancing healthcare delivery at a community level.

Key Areas of Expertise for Hospital Leadership

Several broad areas of expertise are considered critical for physicians transitioning into hospital leadership roles. They cover the skills necessary to lead and manage effectively in a healthcare setting:

1. Leadership Principles
2. Data Management
3. Business Management
4. Talent Management
5. Quality Improvement

Summary

John shares his transformative journey from family physician to hospital CMO. He explores the advantages of hospital leadership roles, where to start as a medical director, salary expectations, the impact of your medical specialty, and the crucial areas for developing new skills.

John also extends an invitation to listeners to explore the NewScript 2023 Nonclinical Career Summit, presented in April, offering all 12 lectures with Q&A sessions for a reduced price of $199, with a special discount for NewScript members. Join NewScript at nonclinicalphysicians.com/newscript to unlock this special discount and access a wealth of nonclinical career insights from our 12 expert presenters.

NOTE: Look below for a transcript of today's episode. 

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Links for Today's Episode:

• physiciancoaches.com: This website lists coaches for physicians.
• nonclinicalcareersummit.com: This site offers access to all 12 lectures presented at the 2023 Nonclinical Career Summit for a special price.
• From Here to There: Leveraging Virtual Medicine (affiliate link) – Learn how to leverage telehealth to build your own business.
• NewScr!pt – Join today to get the best deal on the All Access Pass to the April Summit.

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 323

Why Hospital Leadership Jobs Are Both Challenging and Rewarding

John: This is what I'm talking about - Roadmap from Physician Advisor to Hospital CMO. I am going to first start by telling you my story. It seems to be a good way to start these presentations. I was a family physician. I joined two other physicians. We were in a private practice. They had full practices. I had no practice when I joined them. I had to grow my practice during that time. And as a result, I had some free time during my first two, three years of practice. And so, I looked for things to do that really was more to make some extra money. It was like moonlighting. I would work at the family planning clinic and I would work over at the local college health center. I worked in the STD clinic at the health department. And so, I got involved in other things as I was growing my practice.

And as a result of doing those things, I was often asked to become the medical director because the medical director that was there would leave, for example, the family planning clinic had a gynecologist and they got busy and so they left. And okay, I thought I would do that. And I got paid for doing it.

We had an occupational medicine clinic. Again, I started working there to make some extra money and lo and behold, they needed a medical director for that. So I thought I'll do that. I was learning as I went, and over time I became comfortable doing those kind of things. I actually kind of liked it.

Then as I got further into my career, 5, 10, 15 years in, we were all doing everything OB, pediatrics, working in the nursery, nursing home patients, routing at two hospitals. And we did cut back over time. But I found as I got into the stretch of my family medicine career became rather tedious. I had episodes of burnout and frustration. That was a time when things were changing and they were ramping up the tightening down on payment by Medicare, which continues to this day. And so, it seemed like we were doing more and more work rushing patients through, as many of you have experienced.

And I just started to think maybe I should do something else. One of the things I did in that timeframe, I was tended to say "yes" to most anything, and they needed someone to join the CME committee. I liked planning CME and providing it to my colleagues. I had done that as the chief resident at my residency.

And then when I came to my practice, I got the Illinois Academy Family Physicians involved, and they had a program where we could bring in speakers and continuing the CME for our colleagues. So I liked doing that. And then the chair of the CME committee left or he got sick or something. And so, then I was the chair. And then within six months of doing that, we were surveyed for our accreditation. So I had to learn all about that. And I guess we did well enough that the Illinois State Medical Society asked if I would join the CME committee that did the accreditation for the state, which is delegated by the ACCME. And I thought, okay, I'll do that.

And after being on that committee for a couple of years, I became the chair of that committee, all to say that it just gave me a lot of experience in running meetings and following agendas and communicating and working with people and meeting deadlines and all the different things that we don't necessarily do as physicians.

And so, at one point, I was really getting burnt out and I went to the CEO of my hospital. I said you don't have an executive level physician here. You don't have a VPMA, which was a big thing at the time. You didn't have a CMO. And so, I asked for a job and basically was given the job as a part-time VP for medical affairs. And I grew to really enjoy that job.

Now, part of the reason I'm telling this story is one of the first things I want to do today is what our other speakers have done, explain to you the pros and cons of this job because I talked to many of you when you have questions about non-traditional and nonclinical careers.

And one of the things that I find is that the last thing you want to do is to be around the hospital. It left a bad taste in your mouth because it's the administration of that hospital or a large system that employs you in a large group. It's part of this sometimes multi-hospital system. You feel like you have little control, you feel like you're being abused and you just want to get away from it.

I have found that while I thought my work was really good, and I'll get into that, what I actually did as a CMO. I want to just spend a few minutes talking about why you should consider it, and that's going to be on my first stop. But it leads into another story, and that's the story of one of the physicians. And when I was the VPMA and then moved into the senior VP and CMO role, eventually I was responsible for the medical group that we were growing.

It was very small when I started, but by the time I left, we had 80 physicians and another 40 PAs and NPs. And one of the benefits of me being the chief medical officer is I could really stand up for our physicians. I had an internist who was a geriatrician who was generating a lot of RVUs and the CFO had it in his mind that we really shouldn't pay that physician the same rate per RVU, which hopefully most of you understand, that's kind of how physicians can be compensated in certain contracts.

And in any event, he was doing the work of one and a half internists based on the population that he had, and he wasn't getting paid for it. When I took over the management of the group, over a period of five years, he got two significant raises because I got his RVU compensation rate brought up to the rest of where the rest of our colleagues were.

And so, that's the first big pro for me is that if you're in a position like this, you can advocate for your colleagues, you can advocate for your patients, and you can be the counterbalance to decisions that are made sometimes by the board, sometimes by the senior executive team to cut certain programs or to de-emphasize certain programs or to abandon certain types of patients because they're not lucrative. And when you're in a nonprofit hospital like I was and you're looking out for the community and for the patients, you have much more leverage in that position than as an employed physician or someone on the medical staff.

That's the first thing that I would think about in terms of why it's good to move into a position like this. There's other good reasons as well. And they're going to fall in the areas of leadership, income, intellectual challenges, and helping the community in different ways. That's kind of the way I look at it.

The title of this is From Physician Advisor to CMO. So, what are the jobs? I'm going to get into some of the jobs in a minute, some of the more entry level jobs, but let me just tell you what the higher end jobs are, where you get most of the benefits of working in the hospital system. That's where they accrue.

Obviously, most of us know what a chief medical officer does. We've maybe heard of chief medical information officer. Those are pretty common. But you've got chief quality officers. You've got chief clinical officers, which in many institutions, historically have been nurses. We've got chief patient safety officers, chief population health officers. The CMO can move on to become the COO, chief operating officer, or chief executive officer for that matter. And then there's even something called a chief patient experience officer, which sometimes is physicians in very large organizations.

There's a lot of good jobs, leadership jobs, high paying jobs in the healthcare system. The healthcare system is responsible. When we talk about mainly the hospitals part of it, approximately 25% of all healthcare dollars. It's the biggest chunk of money because we know that when people get ill at the end of their lives, they spend a lot of money. And that means there's a lot of jobs and there's a lot of jobs for physicians.

I mentioned salary. The average chief medical officer in any size hospital is going to make typically well above $300,000. It's not unusual for a CMO, especially one who's more seasoned to make $400,000 to $600,000 or $700,000. You can do your own research on this. You can try and find surveys that are difficult to find. Executive physician surveys. You have to pay a lot of money.

But you can go to something called guidestar.org, which is where all the 990 tax forms are put for nonprofit organizations. Every nonprofit organization has to report these things. And in those reports, they list the salaries of the most highly compensated members of those teams. Sometimes it's a board member, although most nonprofits don't pay their boards unless they're a big system. And then it's the CEO, the COO, the CFO, all those people. And usually you can go in there and look up the CMOs salary. There's less data available now because with a lot of the merging of different systems, you'll only get the top earners for the whole system. You might have six or 10 hospitals, but you might catch one CMO plus the CEO, the CFO and some of the board members.

But you can do that. Find a small community hospital or a medium sized community hospital near you that's a nonprofit, and go in there and just look up their salaries. They're published there every year. Guidestar.org is free. If you want to get more up to date report, you have to pay, but it doesn't really matter because the salaries don't change that much. So, it's a very good, well-paying job.

Now, as far as the intellectual stimulation, if you've worked in a hospital setting, I'm sure you've come across all kinds of challenges that would be very interesting to work on. Usually you don't have time, you got to get back to the office, you got to get back to the OR, you got to go to the ER. But some of the areas where physicians are really important, and you see this on the medical staffs because they ask you to get involved, but everything from quality improvement, patient safety, you learn about sentinel events and root cause analysis, lean process improvement, protocol development, top 100 hospitals, leapfrog, CMS hospital compare, health grades. It's all in the realm of quality improvement. It's all very important and it's interesting.

And we all have a background in epidemiology and statistics. We learn that in medical school, sometimes in residency. We know what quality is. We've been on different committees. I think it's very intellectually stimulating. Then you've got clinical documentation integrity, utilization management and length of stay, case management. I was always involved in the pharmacy formulary decisions and medication errors and how to minimize those.

Informatics has been huge in the last decade in growing. And healthcare law because you got the regulatory, you got to deal with the DOJ, CMS regs. And then there's the contracting, which I really got into heavily during those last five years when I was in charge of the medical group for our hospital.

And I could pick and choose any of those to work on any given day. And they were all very interesting and mentally stimulating to me. And so, it's just fun to do those kinds of things. To me, seeing patients one after the other for a mundane problem, that worried well, the sixth influenza patient in a row, that gets boring. But there's so much more that you can get into in the hospital setting when you're dealing with some of these areas that they need physicians to deal with.

Now, I often get the question, "What are the best specialties for doing something in the hospital management, hospital leadership?" I actually get that question about other areas too, like UM, like pharmaceutical companies. Any number of jobs. What about nonclinical jobs? What specialties will have the best opportunities? And really what I usually tell people is it doesn't really matter. You can be in any specialty and do UM. You can be in any specialty and get through into pharma. Same thing in the hospital.

Now, the way that I went about it, and the easiest way to segue into a hospital management position is to be in the hospital. I wouldn't say that a dermatologist who's doing only outpatient or a pediatrician who hasn't set foot in the hospital in 10 years, probably would want to pursue something like this because they're not in that milieu.

But anybody else who's in that, whether it's full-time, you're an ER doc, you're a radiologist, you're another type of surgical specialty that's there several days a week, you're going to committee meetings, you're already participating on quality and pharmacy meetings and things like that. It's just a natural transition that you can make. And it does take time. And I'm going to go through the process that I would recommend you follow to do it.

But if you plan it properly, you can make that segue before you get too burned out, before you reach that point of no return where "You know what? I just can't step a foot in that place again." So, you want to do this, begin that process if you think it's something you consider a little bit earlier rather than later. Pretty much any specialty that's in the hospital.

Also, if you happen to be, let's say the managing partner kind of role, or the medical director for let's say a big medical group that's part of a hospital system, you could segue from that as well, because you're going to be going to meetings and rubbing elbows with the other leaders in that hospital system.

But in general, it's someone who's going to be in the hospital. Probably fewer family physicians these days than when I did it, because when I did it, I was in the hospital every day making rounds, going to committee meetings, and volunteering for some of those things. And then working, getting paid to do some of those medical directorships part-time. So, what are the areas that you need to learn as you're going from that physician advisor or even a medical director role into more of a leadership role?

Because the physician advisor role, really, you're not doing any management or supervision at all. Nobody reports to you. You just show up, look at charts, electronic medical records. You might call physicians. You might just approve things based on what you can find in the record and move on.

But when you get to a medical director role, now you're doing a little bit of management. You can be, and I'm going to list some areas where you can be a medical director, but now you're starting to get into that. And if you're thinking about that, let's say you're having a good time, you're working 20% time as a medical director, and you're thinking, "Well, I want to go further and I want to start to pull back on my clinical and increase my leadership", then these are the five areas you need to learn more about.

I get this from the AAPL, the American Association for Physician Leadership. I'm going to maybe talk really briefly in a minute about the CPE designation, certified physician executive. But the AAPL has a subsidiary called the CCMM, which puts out the CPE designation, and basically they describe what they feel are the five areas that we need to learn about as physician beyond the clinical that we know. So, it's pretty straightforward.

The first one is leadership principles. That one is a little bit nebulous, but it includes things like motivating people and persuading people. It includes things like understanding strategic planning and that kind of thing. And it's probably of the five areas, the least concrete, but you kind of know when someone's a good leader and not when they're good leaders. Most people now kind of follow the path of servant leadership where you're trying to create teams and motivate people and work together. If you have a little bit of charisma, or at least again, the ability to persuade people, that's a big part of it.

The second is what they call data management. Now, for us, that's usually quality improvement. Those are the data that we usually deal with. We already have some experience in that just from our clinical practice. We know that we're being measured usually in what we do. Most of us have been exposed to maybe some of the data that the hospital shares with us when we're admitting and discharging patients or when we're doing procedures.

And so, there are some part of data management spills over into financial management because finances are data too. But usually we consider that as separate. And basically what that is, just understanding basic accounting principles, maybe P&L, balance sheet. And for me, and for you, if you're going to be in a hospital setting, understanding hospital financial reports because they're unique, because of the way they're paid. You have your gross revenues, which is what you bill. Then you have your net revenues, which is sometimes up to a half of that. You can say some hospital has a gross revenues of $900 million, but their net revenues is closer to, let's say, $600 million. And then you have write-offs. These are just unique to the healthcare system. So you have to learn that if you're going to be a leader in a hospital.

And then you've got the business management part of it, and that is just the management skills that you need to motivate people. One of the biggest things I had to learn when I started moving up into that area, was all of a sudden now I've got three, four or five, maybe up to six or seven directors reporting to me.

Well, how do I interact with them and what's my role? It's a little different from, let's say, leading a team as let's say an ER doc in a code or leading a team in the OR or something. When you're leading a big organization, it's more of a vertical thought process. How are we going to help each other? How are the directors that are reporting to me going to work together to get our division working and moving in the right direction? It's understanding how to set goals, how to plan projects, and how to keep projects moving forward with timelines and deadlines. I would say that's an area that physicians need a lot of help with at first is in the business management sphere.

And then the last area, and it does overlap a little bit with the leadership and the business management, and that's the human resources, or you might call it talent management. That's when you're getting a little more into "How do you recruit people? How do you train people? How do you monitor their performance? How do you resolve disputes?" Those are all areas where most physicians have some knowledge, but not a lot. So you need to get more exposure to that, and you can do that by some of the ways I've mentioned already and then some that I'll mention shortly. I just wanted to point that out that you got to think about how you're going to get experience in those areas.

The other thing I like to remind physicians about is sometimes we can get pretty cocky. We're pretty confident people. We've had a lot of education, a lot of experience, and so we kind of feel like we know a lot and we do, but we don't really know everything about finances and business management and that sort of thing.

I think it's good when you're making this transition to be a little humble and just suck all the information, all the knowledge that you can from those around you. And they're happy to tell you and show you how to do things. They don't expect a physician moving into a new leadership or management role to know how to do that. We basically have 70 or 80% of the knowledge and the skills to do the job, but that last 10, 20, 25%, we have to sometimes learn on the job, even going to classes and courses.

Getting an MBA doesn't really teach you day to day how to interact and how to work on a team because you have to do it. And that's where doing those things I talked about earlier about managing a committee, being the chair, leading meetings, leading projects. They may be ad hoc projects that just come up, you volunteer and then, oh, okay, you can be the chair and you help us get this thing done. We got six months to do it.

Where do you start as you're going on that path to that senior executive position? Well, the most common jobs that I have seen in the hospital setting are the ones I've mentioned already with a couple of others. They always need UM docs to do the physician advisor, but then someone has to lead that group, particularly if it's a large hospital. You can become a medical director in utilization management. Clinical documentation, integrity. It used to be called clinical documentation improvement. Every hospital has to have a CDI team. They have to. If you're not documenting properly, you're losing a lot of money. And the bigger thing is the quality of your care is going to be misrepresented.

Quality improvement. I talked to one of my guests who was a hospitalist. He was in a big organization, a big group of hospitalists working at multiple hospitals, and he had a halftime job as a medical director for quality just for the hospitalists.

Now most of the time, if you're going to get into quality improvement, you're going to be the medical director for quality improvement at an entire hospital. But if the system is big enough, then you can have even multiple medical directors and associate or assistant medical directors working just on quality, just on safety, just on informatics is another one. Those are the big four that are sort of not clinical areas that I have experienced people starting in.

I hope you enjoyed that excerpt from my summit lecture. All of the other 11 lectures were even more inspirational, informative, and educational. They were really excellent. One of the reasons I chose to present that audio today is that we opened up the all access pass for lifetime access to the NewScript 2023 Nonclinical Career Summit lectures last week at a special low price of $199. The usual cost is $249, and for that $199, you will have access to all 12 lectures, which also includes their Q&A. I think there's also some bonuses with the all access pass.

Now you can get an even better deal. If you're a NewScript member, the price is just $139 for everything, for a total savings of $110 from the usual price. If you're not a NewScript member, you still have time to join NewScript at nonclinicalphysicians.com/newscript. And then once you're a member, you can use a special coupon code to get that $110 discount off the usual summit pricing.

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The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

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The post Why Hospital Leadership Jobs Are Both Challenging and Rewarding appeared first on NonClinical Physicians.

Begin Your Career Transition in Earnest

In today's episode, we revisit the topic of 5 persistent myths that clinicians believe when they begin to contemplate a career transition. This presentation was given at the 2023 Licensed to Live online conference.

In today's fast-paced healthcare landscape, many professionals find themselves yearning for a more fulfilling and rewarding career path. To embark on this transformative journey, the first crucial step is recognizing the widely held beliefs or myths that hinder progress. The prevailing misconception that the only way to succeed is by adhering to the status quo may be one of the main barriers preventing professionals from embracing a more fulfilling path. 

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

5 Persistent Myths

Once the myths are dispelled, a world of possibilities opens up. This journey often involves exploring alternative career options where one can leverage their expertise and training to make a meaningful impact in unconventional roles. Embracing a different direction, such as pursuing a nonclinical career or venturing into healthcare innovation, allows professionals to find new avenues for personal and professional growth.

In this list, we debunk the following persistent myths:

1.  “There are no jobs.”
2.  “I'm not qualified.”
3.  “The salaries are low.”
4.  “I'm abandoning patients.”
5.  “I won't be respected.”

Best Kept Secret

The first of the 5 persistent myths pertains to available jobs. In fact, there are several large industries that hire thousands of physicians each year to do nonclinical work:

• Hospitals and health systems,
• Pharmaceutical and medical device companies,
• Medical publishers,
• Educational institutions,
• Consulting firms,
• Federal, state, and local governments, and,
• Life and health insurers.

Additional Training Not Required

The next of the 5 persistent myths pertains to necessary training and skills. For most of these new careers, the primary qualification is the completion of medical school. Such physicians have broad exposure to the life sciences, an understanding of the U.S. healthcare system, and how to interact with patients. Additional education during residency and fellowship and board certification are sufficient to qualify us for most of the remaining positions.

Sometimes, additional certifications and degrees may be preferred. But for the most part, it is the physician's unique background, training, and experience that prepares them for these nonclinical jobs.

Incomes Improve

The next of the 5 persistent myths pertains to income levels. Salaries may be less than those for clinical work initially. But that will be offset by improved lifestyles and work-life balance. Benefits and vacation time are often quite generous. And most physicians experience opportunities to quickly advance and enjoy very attractive income levels over time. 

What About the Patients?

You'll be helping patients in new ways and sometimes much broader ways and in larger numbers as you can one patient at a time…

In pharma, you'll help develop life-saving drugs. You'll reduce pain and suffering for large groups of patients in public health. And in consulting, you'll bring new and improved models of care to hospitals, and help implement new service lines.

Reputations Improve

The last of the 5 persistent myths relates to your reputation and identity as a “doctor.” Generally, these positions have an impact on larger groups of patients. And physicians become content experts, managers, and leaders over time by combining their medical expertise with skills in their new industries. 

Summary

In the ever-evolving healthcare landscape, it is vital to challenge long-held myths and beliefs that may hinder professional growth. By breaking free from corporate-style, high-volume models of care, healthcare professionals can unlock their true potential and enjoy their work again. Leveraging one's medical expertise in innovative ways is the key to unlocking a fulfilling and purpose-driven career when the traditional healthcare system fails us.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• How to Kill the Myths About Alternative Jobs for Clinicians – 252
• Month One of the 12 Month Roadmap to a New Career – 269
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 309

Let's Dispel These 5 Persistent Myths About Nonclinical Careers

John: All right, nonclinical nation. Let's get right into today's presentation in which I do my best to dispel five persistent myths about nonclinical careers. Let's start by talking about Dr. Brenda M. She's two years into her first job as a hospitalist, and she's feeling very unhappy and disappointed.

Now, when she was in medical school, she really enjoyed it, although at times it was a little bit overwhelming, but all in all, she felt maybe some slight burnout during certain parts of that for a year program. And then she went on to her internal medicine residency anticipating becoming a hospitalist. And during that time, again, she was happy to be there, but she really started to feel as though she was getting burned out. There just was too much work to do. There wasn't enough support and not enough recovery time before the next shift or the next clinic and that sort of thing.

But she thought, "Well, I'm going to try and find a really good job in a location that I'm interested in, and by then, things should get better." And we've all heard this, right? And some of us have felt it recently. It seemed like the burnout from medical school to residency to practice just kept building on each other.

But she joined a group. She thought, "Well, it seems like the coverage is good. There's enough of us to take care of this hospital." She was promised a certain number of days off each month, and things were going well at first, but then the support staff seemed to be falling off and not being replaced. And the volumes that she had to see during those two years kept increasing to the point she felt like she never really could keep up. She had to go back and do her medical records when she was at home online. And she just thought that things were not going the way she anticipated.

Now, she was really starting to think, "Well, maybe this just isn't what I thought it would be, and maybe I need to do something else." But every time she had those feelings, she sat back and thought "There's just no way I've spent my life learning to do this job. I don't really have other options. I'm going to see a drop in my income." With still having some outstanding loans, even though there was some partial payback through her employer, she felt constrained. That's what someone in the past called the golden handcuffs, in a sense. You make a good living, but at the same time, there's huge pressures. The income doesn't really seem to go up unless you just work longer and harder. And it also seemed as though she would be letting people down if she were to not continue on in her clinical career. Her family, her friends, and even her patients.

This is a common thing that we see in today's healthcare environment. And if you're frustrated or disenchanted about your work in healthcare, if you feel as though you're being ignored and taken for granted, or that you've been forced to forfeit your autonomy to do what's best for your patients, then it is entirely reasonable and even necessary to consider a nonclinical career in order to maintain your integrity and maybe even maintain your sanity.

You certainly aren't alone. In fact, tens of thousands of clinicians over the last decade have come to the same conclusion. However, many of us like you are hesitant to do that because of several myths that our employers and training programs promote in order to maintain the status quo.

We continue to suppress our feelings that something is wrong and delay implementing the solution to these problems. So, what is the solution? Well, for the most part, it is to take the next step in your professional life and join all the other professions who make at least five to seven job changes, and try and find a career that leverages your training and experience outside the traditional unrewarding assembly line corporate style approach that is currently the predominant way that healthcare is being provided.

But to do that, one of the first steps we must take is to recognize these widely held beliefs or myths that hold us back and dispel those myths and enthusiastically embark on the next phase of our professional lives. That is really the major solution. Other solutions would be to retire early, do something else. If you're independently wealthy or you have a spouse who's willing to provide the financial while you do other things, that would be great. But basically what we need to do is set ourselves on a new path. But first, most of us have to try to overcome these widely held myths that hold us back.

All right. So, let's talk more about that. I think if Dr. Brenda does the same thing, she will find herself in a better place. And so, I want to answer these questions today as we go through this discussion. First of all, what do I mean by nonclinical career or nonclinical job? What are the five most common persistent myths that we encounter? And how can I dispel those myths and prepare you to find a nonclinical or non-traditional career, if that is your goal?

All right, what I'm talking about today when I'm talking about a nonclinical or non-traditional career, it's an alternative career, an unconventional career, one that is based on your background, your education, training, and experience in medicine, or even nursing or dentistry or pharmacy. Because a lot of the concepts I'm talking about today apply to those other clinicians that often find themselves on the same team and in the same situation as we are in which is we're being overworked, we're being abused, and we need to try something different.

Now, those nonclinical jobs usually include a term that indicates that it's still within the healthcare system. For physicians, it means it might include the term physician or medical. For nurses, it'll include nurse or nursing. And dentist, dentist or dental, those kinds of things.

For example, I'm talking about careers like physician advisor, medical director, medical writer, executive medical director, chief medical officer, chief medical information officer. It could be the same thing. Chief nursing officer, nursing director, that kind of thing. And these kinds of jobs also apply to those other specialties in other fields that I mentioned a minute ago.

Now, I'm not addressing what some might call self-limiting beliefs, the feeling that I'm not good enough, I might fail, there's something wrong with me. It's too much to learn, it's too hard to do. Those are internal, again, self-limiting beliefs that are really generally pretty easily overcome. We had to overcome those kinds of thoughts when we contemplated going to medical school or nursing school, or get our PharmD or our DDS, those kinds of things.

I'll list the five most common myths that I encountered. I'm going to list them, state them in a way that is at the extreme. What we're saying to ourselves, what our former instructors and professors and employers wanted us to think while we were in training and even in our current positions.

And these are the kind of things they want us to think we fall victim to. One is that there are no jobs for us that aren't within healthcare, per se, in patient care, that I don't have the qualifications. I have no qualifications. I'll make no money. Obviously, you'll make some money, but the money I'm going to make is going to be completely inadequate. That I won't be helping patients anymore, which is what I really went into healthcare and medicine, or nursing or pharmacy to do. And then I'm going to lose my stature. I'm going to lose all my respect because I'm just going to step away and do something that's not as noble in a way.

I'm going to take each of these individually, describe them in more detail, and then address how to really understand why these are myths and therefore, kind of take away those barriers to you moving forward with your next professional advancement and next stage in your professional career in that field. You can be a physician, you can be a nurse in the nursing field, in the medical field, but not in the same clinical way that we've done in the past.

I remember a colleague and a mentee of mine, Dr. DH, I'll use his initials. He was a vascular surgeon, and he really got to the point where he just felt like he could no longer do his job. He was in this situation, we often find ourselves in, particularly if you're a specialist, which is relatively uncommon. What happens is you end up working somewhere and there's a few number of you helping each other, supporting each other, and covering for each other.

So you go to, let's say, even a big academic center, and they say, "Look, we need to have a service of three or four vascular surgeons." Okay, great. That's a profession that takes a lot of training. So you're careful. You do all your interviews, you find you're going to join this group of three other vascular surgeons, you're going to be able to do this surgery that you want to do, and not be doing general surgery, for example, when really you were trained to do vascular.

And some of the vascular surgeons even narrow that down further, of course. Well, Dr. DH found that he was there and things were good at the beginning, and then they had EMR issues, and they had to change EMRs. And all of a sudden he was having to do a lot of documentation at home and on weekends, because it wasn't really that efficient. They were still trying to bring it on and develop better protocols and order sets and so forth. So that didn't help.

And then the staff, again, I mentioned this with Dr. Brenda, the staffing was cut back on the areas where he was working, whether it was in his clinic or even in the OR. And then it turned out one of his partners left and they dragged their feet. Even though he was recruited to be one in four, they dragged their feet, then he was one in three call, and then if someone took vacation, it was one in two call for a week or two at a time.

And there seemed to be no effort to really find a replacement and no ability or desire to hire locums, even to provide some temporary relief. And so, he found himself in an untenable situation. Meanwhile, his kids were growing up, he was working long hours, he didn't get enough time to spend with them, and he found it was time to make a change.

At first, he thought "I'm going to have to look for a different kind of clinical job because of this myth of I don't know how to do anything else or I can't earn enough money." He was a really good one to remind me about this common myth that "There aren't any nonclinical jobs that a vascular surgeon can do. I hear about my primary care friends doing these jobs, but I don't think there's anything I can do."

I'll come back to his story in a moment. But before I finish off with Dr. DH, I want to explain something to you about maybe one of the best kept secrets in medicine and healthcare, and that is this. What we're taught and what people talk about, especially in medical school, in our residencies, in our fellowships, is that there is this process.

You go from medical school to residency, you may have a fellowship after that and then you make a choice. You go into an academic practice, maybe you go into an employed situation that's not academic or in a small percent, you may even find yourself in an independent practice. And that's it. Basically, that's what you have to choose from. You have to kind of make a choice. Academic, large employed, maybe you can do something independent with two or three partners come in initially as an employed physician, and then later become a partner.

But what's going to happen in all those situations is as payments to physicians go down, even though you're sheltered a little bit from that in an academic setting or an employed setting, eventually it's going to trickle down to you that you need to produce more RVU and see more patients and do more procedures to maintain the income that justifies your salary.

Some large institutions, especially procedural ones, an ortho, other surgeries and cardiovascular can subsidize that through those procedural activities. But the bottom line is you're going to have to do more, and you're going to have to do them faster, and you have to see more patients to feed into that. And so, the whole system kind of breaks down, and it usually leaves us really disappointed and disillusioned.

What most people don't really realize, especially while they're still in their training and early in their career, is there is something beyond those options. In fact, as I think about it, I can define and describe at least nine major industries, all of which hire hundreds or thousands of physicians every year to do nonclinical or non-traditional work. Let me just go through that list. And again, your instructors, your professors, your employers, they won't tell you about this, but sometimes you'll see it. It's obvious. If you're working in a hospital system, you'll find out, "Wow, there are people who are leaders, who are managers in these health systems." Whether it's a freestanding hospital, a three hospital system, a large academic system. They all pay physicians and other non-physician clinicians to do management and leadership.

Pharma companies hire tens of thousands of clinicians every year to work full-time jobs in pharma that do not involve direct patient care. The insurance industry that includes disability insurance, somewhat more so life insurance. And then the big one is really health insurance. They hire a lot of physician advisors, medical directors, who become senior medical directors, who become chief medical officers. There's a lot of education by physicians in which they're doing straight education. It doesn't have to be in the context of direct patient care. It could be at universities, at medical schools, at PA schools, nursing schools. It could be online.

And there are, again, thousands of jobs. There are medical writing jobs. That's one of the most common nonclinical careers. There are consulting jobs, both freelance, individuals, small groups, consulting, as well as national and international companies that hire consultants.

There's consumer health, which means teaching the consumer about medical care, about the healthcare system, about anything related to that. There's government jobs, and a lot of those are in public health and so forth. And then there's lots of nonprofits that are related to the healthcare field that have to hire physicians with their expertise.

Again, I just wanted to remind everyone of this first one, that it's foolish to think there are no jobs. In fact, there are thousands of jobs. And it turns out that these jobs are available for every specialist in any area with any length of training, with any degree of experience. That's myth number one that we need to really put aside. You have to realize there are a lot of jobs out there.

Sometimes you've got to learn and do a lot of research to find the jobs, and there's some strategies to that. I'm not going to get into that today, but let me just say, go on LinkedIn, look up medical director, and you'll see page after page after page of jobs, and then it's necessary to figure out which of those might be appropriate for you, located in the appropriate places, and then begin the process of trying to find them.

That's exactly what Dr. DH did. He really started doing research. He was involved in a mastermind that I was running. So he had the opportunity to engage not only with myself, but with other physicians in various stages of their career transition. And he really did reach out to other past colleagues, did some networking, and within a very short period of time, had two or three options. Some of them were part-time clinical options, doing just a very smaller part of his specialty.

And he was looking at wound care and vascular, but other types of non-traditional jobs that did not require being on call, did not require long hours, didn't have complicated and difficulty use of EMRs. But ultimately he found a utilization management job in which he could apply his vascular background. And he became a UM physician advisor or really a medical director when you, when you're working for a healthcare plan. And he was the vascular surgery specialist as well as doing some general reviews. And he's been very happy so far.

Okay, that's myth number one. Now, what is the second myth? Well, that is like I said, "I don't have the training. I have no expertise." Sometimes I hear this put as "Well, all I know is medicine." And if you think about that, in a way, medicine isn't a thing in and of itself. We obviously talk about as though it is, but to provide medical care is really a compilation of many, many skills in different areas that one outside of medicine wouldn't think of putting together necessarily. I usually like to go through this thought experiment where you're at a large ship and the ship is sinking and everyone's jumping into the life rafts to try to get somewhere safe, to someone can come by and pick you up or find yourself on a desert island.

And in the experiment, just think about the professions of the people you would like to be in the boat with. Just think of all the people you run into. Sales people, managers, directors, instructors, police, welders, taxi drivers, you name it. If you were going to be able to choose the people in the boat with you, and there were two people you'd want to be with you in that boat, who would they be? And I contend that they would be an engineer and a physician. And some of this relates to the broad experience, a broad education both of those types of people have.

But how many times the people come to you to ask a question, whether it's about chemistry, whether it's about their pets, experts in medicine. There's many, many sub, I guess I would call them, expertise that we have that makes us attractive. And we're excellent employees.

I'll give you an example too of Dr. MA. She was a foreign medical graduate, basically, and she also did some work in preventive medicine, but she was having difficulty finding a position in the US because she couldn't get licensed. She started networking, she started taking a lot of courses, and she became aware of the fact that there was a job called the medical science liaison, which is quite often open to those without residency or a license or board certification.

And after about a year of networking and taking courses and joining the MSL society, she landed her first job. And really everything that she does as an MSL does use her skills as a physician, as an MD or some places would be an MBBS and so forth. But everything that we know is included in the curriculum applies to jobs like this. The biochem, the pharmacology, physiology, pathology, microbiology, anatomy, epidemiology, statistics, laboratory interpretation, physical examination, interacting with patients, radiography, interviewing skills, teaching and presenting to colleagues, healthcare, economics. There's just so many areas that we become experts in when we're going through our medical education. And there are many jobs even for those with the medical school background, a medical degree without residency.

If you're a physician, if you're a nurse, especially with an advanced degree in MSN, definitely an APN. If you're a physician assistant, if you're a PharmD, you have a lot of skills, knowledge, and also work habits that employers are looking for.

And so, let's really dump myth number two is that you need special qualifications, or you need an MBA, or that all you know is medicine, when in fact you know a lot and the combination of things that you know put you in a position to fill a lot of these jobs, otherwise, you will not be qualified for.

Now, the big one that also affects us more so in the last 10 to 20 years is this idea of really making no money or making an inadequate income because a lot of us have loans and those have to be paid off. And sometimes you get a clinical position where they're going to help you knock off $10,000 or $20,000 a year on your loan. But if you've got $150,000 out there, it's going to take a long time to get that paid off unless you're making a really, really super high salary, and you can accelerate that. And thinking, "Well, I know I'm going to take a big hit in this career in my salary, this nonclinical career, then it'll really hold you back."

I can think of Dr. ML, who was an OB-GYN, and she was very busy. A lot of OBs, a lot of weird hours, a lot of call, similar situation. Staffing was cut back. Some of her partners left, even though she was part of a large multi-specialty group. She was employed, and it just became quite miserable. And she thought, for sure, I don't have any special skills and there aren't that many jobs out there in a nonclinical field for an OB-GYN and also it's not going to pay enough for me to pay my bills.

Well, she ended up looking around, networking, working on her resume, working on her LinkedIn profile, and she ended up landing a job after several months of search, working for a Medicare MAC. For people that work in the hospital that have anything to do with billing, they will know that a MAC is a Medicare Administrative Contractor, and it's an intermediary that processes the payments between CMS and hospitals. And she became a chief medical officer at a MAC.

And so, she made a very good income. She had to work fewer hours. In fact, mostly now she's working from home, which was enhanced a little bit by the pandemic. But she has children at home so she can be available for them, work for this Mac, make a very good income that is commensurate with her clinical income.

And again, as I mentioned before, our incomes are going down, Medicare's paying less for each patient care visit, not keeping up with inflation. And a CMO job pays very well. In fact, if you look at some of the stats out there, this is from last year, from salary.com, the typical physician advisor, which remember includes some that are not licensed, that simply have the medical degree, would be about $134,000 a year. Now, that's a median. So people make more, people make less.

If you're an experienced clinician, you become an MSL and you've already got some contacts for that job, you're definitely going to make well over $200,000. Overall average for a medical director is $295,000 per year. And quote, chief medical officer is over $400,000 a year.

I don't know what she was making per se. I would say that she's probably at least in the 300 thousands. I think those higher salaries are for CMOs and hospital systems, pharma and big insurance companies. But definitely if you have a CMO position, that is usually a very awesome, well-paid position.

So, this whole idea that there's inadequate income, it's a farce. And plus you have to compare apples to apples. If you end up working a job like she's doing, which is for sure no more than 40 hours a week, most times, most of these nonclinical jobs are 40 hours a week, sometimes even less. Often they offer complete or at least part-time remote work from home and while traveling. To compare that to a OB-GYN who's doing 60, 70 hours a week of work minimum, being on call and having a really disastrous schedule, because you never know when you're going to have to leave home, really, there's no comparison if you have to take a little bit of a pay cut.

But everybody that I've talked to that's started a nonclinical job, within two to three years, they have surpassed their clinical income because now they're really hitting their stride and really providing benefits and support, and really are doing something at the job that really helps their employer succeed. That's three of the myths.

Fourth one, patients. "I dedicated my life to patients, and I won't be helping any patients in a nonclinical career. And it's hard for me to do. I don't want to abandon people." Well, here's the thing. If you look at it from a different perspective, there are reasons these jobs exist, and there's reasons why these jobs need a physician, because a physician or a nurse or a pharmacist is providing the expertise that's going to benefit patient care. That's the whole point.

You can go through almost every industry, and maybe it's not 100% across the board, but if you're working for a hospital system, you're probably helping with quality and improving quality improves patient care. If you're working in pharma, you're developing new drugs to either save lives or improve lives. There are some extreme examples. Imagine the people that worked on Gleevec. Now there's a drug that took what was a pretty much uniformly fatal disease and turned it into nothing. If you take Gleevec every day for that particular illness, you will never have a recurrence. I personally know a family member that's been using this drug for 15 or 20 years now. And there's hundreds of those drugs coming out every year.

And so, obviously, if you're a physician working in pharma, as a medical director or a chief medical officer, you're definitely benefiting patients. What if you're working in UM in the insurance industry? Well, I'll just say that you will on occasion stop patients from having a procedure or surgery that really was unwarranted to begin with, and you've avoided a possible death or disability or error resulting from that procedure. You're teaching in any capacity. You're helping bring on the next group of nurses, pharmacists, doctors, PAs, NPs, who are going to help patients.

Writing. You're educating by writing or doing journalistic writing or doing technical writing to protect patients. Again, I can go on and on. Consultants are bringing new services to hospitals and pharmacies and pharmaceutical companies and home health, consumer, health wellness nutrition, helping patients, sometimes better than the actual physician is helping them. When you step into a nonclinical, non-traditional clinical job, oftentimes you are greatly enhancing patient care, community care, and so forth.

All right, the last one that I want to talk about is "I won't get any respect." It reminds me of Rodney Dangerfield. Do you remember the comedian? He's been deceased for a few years, but he always talked about not getting no respect. He gets no respect. I guess I'll use myself as an example. We all have a decent amount of respect and admiration and a certain recognition in our communities as physicians. Everybody knows it's hard to do. It's a difficult career to pursue and maintain. It's a lot of hoops to jump through. And there's licensing and there's board certification and recertification.

And so, we think, well, we have that stature in the community, and it's fun, and it's good. It helps to interact with people, and it puts us in a position that helps us to help people actually. So, if you go into a nonclinical job, your reputation, your influence is going to be gone. Could say your gravitas as a physician might disappear.

But I'll use myself as an example. I was a physician, family physician, and back in the day when I first started, I was working at the hospital. I had admitting privileges, I had nursery privileges, and I even had OB privileges. I knew a lot of people. I did all those things as long as I could so I could grow my practice and over time I started to cut back. And I also did other things because I was interested in that. So I did physician advisor for a while and medical director for a family planning clinic and some other things.

But I was one of a hundred primary care doctors on staff at that hospital. I had no special sway or pull, people didn't listen to me a whole lot like the other family physicians. They had a little more likelihood of being heard if they had a concern or a request at the hospital, at least if they were a surgeon, particularly an orthopedic surgeon, neurosurgeon, cardiac surgeon, and so forth.

But over time, as I became VP for medical affairs and then chief medical officer, instead of being one of 500 primary care doctors that didn't bring a lot of revenue to the hospital, I became basically one of the most well-known and go-to physicians on the medical staff or in the medical and administrative hierarchy because I was responsible for quality and safety and hiring new physicians and recruiting groups to work for our hospital. I was over the lab in the pharmacy and people would come to me talk about formulary.

Really, when you get into these other positions, you're still a physician. Everybody's still calls you doctor, but now your influence and reputation in certain areas will actually be much more enhanced. And so, I've never really felt or heard or talked to anyone who said that as a result of them moving into a medical director role, or chief medical officer, chief quality officer, any chief role, for sure, that they had less of a reputation or felt like they were contributing less, and that it was recognized than when they were a physician.

You're still a physician. You'll always be a physician. You're likely going to end up managing a team. You're usually seen as a content expert. That's why they're hiring you in the first place as a physician for that role. And you're often a leader. In the hospital setting, you've always got a CEO or COO, but you've got a chief medical officer, chief nursing officer, and so forth. Same thing in pharma, same thing in health insurance. You're going to end up there if you persist.

That's what I wanted to talk about today. There were five common persistent myths that I hear about all the time and that are concerns to physicians, nurses, pharmacists, trying to move into a nonclinical career so that they can have a better lifestyle, they can have more control, more autonomy, and less feeling like an assembly line worker.

And so, these myths are wrong and there are a lot of jobs. You are already qualified for most of those jobs. In some cases, you might need to do a little bit more. You'll learn on the job for sure. Sometimes getting an MBA or an MHA or an MPH or something would be helpful or another certification. But basically you've already got the qualifications you need.

You will make a similar salary and you'll have the opportunity to make even more. I made much more as chief medical officer than I would as a family physician. You'll be helping patients in new ways and sometimes much broader ways and larger numbers as well than you can one patient at a time, and you'll still be respected. You'll still have that gravitas or that recognition.

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The post Let’s Dispel These 5 Persistent Myths About Nonclinical Careers – 309 appeared first on NonClinical Physicians.

In today's podcast, Dr. Laura Clapper joins us to discuss jobs in leadership roles with health plans and self-insured organizations, and how to best prepare for those positions.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Leadership Roles with Health Plans

There are numerous positions in Fortune 50 companies, including Medical Director, Contracted Physician Reviewer, and Physician Consultant. The entry-level positions are in utilization review and benefits management. With more experience, these jobs can lead to leadership roles with health plans.

Preparing to Work for Insurers 

Insurance companies perform hospital-like credentialing. Therefore, physicians must be board qualified and remain so with an active license. Also, an active DEA in one of the U.S. states is often necessary. 

Dr. Clapper highly recommends a book by Dave Evans and Bill Burnett called, “Redesign Your Work Life”. It can help readers think about their careers differently.

Networking and shadowing can also be very helpful. Laura describes ways to use those techniques for finding jobs and learning about them before committing to a specific one.

She also suggested completing the Certified Physician Executive (CPE) program through the American Association for Physician Leadership. She maintains that you do not always need a master's degree, but it can be helpful when pursuing certain positions. Taking business and management courses can be a good way to learn business principles and demonstrate commitment to advancing your career. 

Summary

Check out Dr. Clapper's LinkedIn profile to learn more about her training and professional background. You can connect and message her there. She is trained as an executive coach and has been coaching physicians, so you can contact her if you are interested in those services. She has extensive experience coaching women physicians to help them assume leadership positions.

NOTE: Look below for a transcript of today's episode.

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• American Association for Physician Leadership
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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 265

Pursuing Leadership Roles with Health Plans and Self-Insured Employers

- Interview with Dr. Laura Clapper

John: I'm really excited about today's guest because I want to learn more about managing and leading in the payer side of things. It's like a black box to me. Obviously as a CMO, my hospital interfaces with insurers and payers, but I really don't know how they work internally. My guest today has a lot of experience with very large, well known healthcare insurers. And so, with that, I'd like to welcome Dr. Laura Clapper to the podcast. Hi Laura.

Dr. Laura Clapper: Hi John. I'm so excited to be here. We've talked about doing a podcast together almost since you got started. So, I'm really excited to be here today and share about payers and self-insured employers.

John: Excellent. This is going to be very useful and I am going to learn as much as you my beloved listeners today because it's again, something I know very little about. I'm glad you're here. Why don't you tell us a little bit about your background and clinical training and so forth? It is a long list of things. I do have a separate intro that includes most of those, but anything you want to tell us today that would be helpful to get us started.

Dr. Laura Clapper: Sure. I think it's interesting, at least to me, when we talk about an early career path is that my father was an entrepreneur and was in the aerospace industry and really dealt with satellites. And so, I worked with him when I was in middle school, late elementary school through high school till I went to college. And he did AI and was known for pattern recognition. His patents, he helped develop the barcode for Fred Smith at FedEx. He worked on for Hughes for Digital TV.

But the point that I'm getting to is when I went to college, the idea that we could use AI and algorithms data to really improve healthcare was really what got me excited about medical school and going into healthcare. And the Dartmouth Atlas had come out a couple years before that. And so, this idea we could use data to figure out was more hysterectomies happening, one town versus the other and some of the initial Dartmouth Atlas work. I just got really excited about that. We could use data and dashboards to improve care and look at patterns and have algorithms and really leverage technology. So, I think that's a different path than most people take going to medical school. And so, that's why, and if you look at my career, it really did influence the kind of work I've done and kind of the projects that get me really excited.

John: Well, healthcare was behind in terms of implementing a lot of the technology that other businesses implemented. As physicians and being involved with the health provider hospital, boy, it was just interesting to see with patient safety and quality, the ability to measure things and then risk adjust, and then put systems together to find patterns, as you said, and try and use them to improve safety and care. It's just been really fantastic in the last 20 years. So, it sounds like you were right where you needed to be, if that was what your interest was.

Dr. Laura Clapper: Yeah, it's interesting. Because as physicians, we know patients are not the same. They have different genetics, different environment. Their families are different. What they want to get done and their values and kind of what they hope for themselves in the future are different. And so, we really have to think about each patient differently. That's where I think early on clinical practice guidelines and this is the right way on care really didn't take into account patient nuance and we're getting much better at understanding and be able to do risk adjustment and compare patients to patients so we can have cohorts as well as starting to bring in social determinants of health.

John: Now, one thing I would mention to the listeners is you were also in the Navy. I think for 14 years. So, I'm not sure if a lot of that learning was while you were in the Navy or before, during, after. But when you talk about leadership and management, of course, there's a lot of lessons learned there I'm assuming.

Dr. Laura Clapper: Being in the Navy was great and going to the Uniformed Services University, the military medical school. We actually work with the public health service also. It was important in terms of thinking in a much broader way because there's a huge system trying to provide care globally and trying to figure out can someone stay on their ship and get care through the mid-level who's on the ship and get consults over the phone or does the person need to be flown off? Is the person able to stay in the Middle East or do they need to come back for care at a medical academic center in the US? So, all those things were brought into our training.

John: Very interesting. Well, the thing that impressed me or at least caught my attention was the time that you spent at these large national insurers. My listeners are mainly interested oftentimes in finding jobs that they're not really aware of. So, what kind of opportunities are there in working for these insurers? Maybe just tell us your story in terms of what you were doing. And as we go along, just kind of some hints how they might be able to follow a similar trajectory.

Dr. Laura Clapper: I'm a pediatrician. I'm board certified and primary care. And I think that ensures, there's multiple. We think about Anthem, Cigna. I was at Health Net. That's now part of Centene, in Aetna. So, I've been at some really large employers that are insurers. And it's not one job there. And I guess that's my main point. There are multiple jobs.

These are companies that are under fortune 50 or bigger. And they have jobs where they are leadership team jobs, where you're having multiple medical directors work for you. You may have jobs where you're working more quality and clinical practice guideline development. You may be working with pharmacy, researching, pharmacy drugs, and working with the pharmacist and maybe doing support work for either running or being a support staff person for the pharmacy and therapeutics committee or doing pharmacy. You may be sitting as a specialist.

If you're someone who's a neurosurgeon, an oncologist, someone who's doing a lot of more expensive, orthopedic surgeon or back surgeon or anything like that, you, there may be opportunities in the insurance companies where they're doing prior authorization. And that would be something. Even Aim Specialty, Evercore, they're now owned by insurance companies.

So, your job in those roles would be looking as people are requesting back surgery, maybe multiple levels and you're looking against the clinical practice guideline to see if you can approve it or if you have questions then doing it peer to peer. Usually in those situations, you'll have a team of nurses that are reviewing. So, if the person clearly needs it, it gets to approve it as fast as possible. And so, it'll get approved. The health plans are even working. So, if you put all the information in, it could be like auto approved, then it would go to if a clinical team member could approve it. If it's still not meeting criteria, then it's going to go to especially matched physician who can review it and either potentially deny it or say that there's questions or things like that. So that's prior authorization and it's similar too for pharmacy. You need to match up to the specialty.

Also, there's an inpatient review. So are they meeting InterQual or Millman clinical guidelines and working with the discharge planning. Are they going to go to staff? Are they going to go to an assisted living facility? Are they going home? They need a home house. So, working with the nurse care teams on coordinating the care and discharge planning, and connecting them in with their primary care. So, there's physicians who do those roles.

John: Now let me jump in there just to help clarify. I'm assuming that many of those might be called physician advisors. In the hospital side, working in a hospital, usually if you're doing any kind of that benefits management or clearance, it's a physician advisor. Although I could imagine that might also be a medical director role if you have more experience, maybe you're supervising a clinical team, would that be right?

Dr. Laura Clapper: Yes. In the health plans or the insurance companies, we would call them medical directors.

John: Okay.

Dr. Laura Clapper: They might be associate medical director, assistant. There are different titles, but basically a medical director would fall into that category. You may be working with a big team. You may have some people, that the early listeners may have done some work as case-by-case work or per diem, like they're covering certain days for an insurance company.

But the medical director role is really working on that coordination, responsible for complex cases, review, quality review and working across the team with the nurses, the medical directors, and probably some contracted physician reviewers and the contracted or per diem physicians may be called physician consultants. They may be advisors, but usually once you're a full-time employee, you're called medical director.

John: All right.

Dr. Laura Clapper: And I do want to clarify, to be in that role, the insurance companies actually do credentialing similar to a hospital. So, you need to be board certified and currently board certified. You need an active license. It doesn't have to be in every state, but in one of the US states, you have to have an active license and you need to have an active DEA. Usually, you can have a waiver for hospital privileges, similar to primary care where someone else is covering you. They're not expecting going to the hospital, but you need to have quality discussions and represent your specialty as someone who's a respected expert.

John: Got it. Yes. Because you're having those conversations with the attendings and the surgeons and so forth. So, you need to be able to talk to their language and have some authority, it sounds like.

Dr. Laura Clapper: Right. Correct. And I think that's important because people think about them as nonclinical jobs. So, some of the sad stories I hear are people who didn't renew their board certification, or they let their license lapse and then they want to come work for the Health Plan because they see it as being nonclinical. And I have to talk to them about how can you go renew your license because you can't be in a clinical job at Health Plan or insurance company without being... Because you're the clinical voice, internal and external. So you need to have qualifications to really be able to be an expert.

You'll hear about physicians who are not, but you actually need to look for nonclinical jobs at those health plans. So, an example would be if you also knew technology and you wanted to be like an engineer at the Health Plan and you were clinical, but you let things lapse, you wouldn't be able to work as a physician at the Health Plan. You would have to actually take on a sales role.

John: Okay.

Dr. Laura Clapper: Or I know somebody who's a physician, who's actually at Anthem, who's in contracting. But he doesn't do anything as a clinical voice in the company. He actually does all contracting.

John: Got it. Now, are there other jobs that are outside of let's say the utilization and benefits management, those kinds of things within these large industries?

Dr. Laura Clapper: Yes. And so, some of the other roles that people take on would be working in innovation and technology. You would think there'd be a lot of those, but it's actually pretty small. And usually, the health plan wants you to have a day job to work on those. So you may be doing UM and for a nephrologist who may be kind of leading the idea around, or is the expert around nephrology and doing some UM and other things, working on clinical practice guidelines and then working with the technology team on what's needed to support chronic kidney disease and dialysis and act as an expert in that area may work with the contracting team that's working with the large dialysis organizations, providing clinical expertise around his or her specialty. So, you start to be kind of the SNE in that clinical subject matter and area.

Some of the other ones that you and I've talked about is self-insured employers. Usually in the large insurance companies, there's national accounts, sometimes there's strategic accounts, but usually they fall under the clinical support for the national account team. And then you're working with self-insured employers. And most self-insured employers may have some insured pieces and some self-insured, but their primary product is self-insured.

And usually, you work in a team. You're working with a team of clinical consultants, really experienced, excellent nurses who will go out and work in a more frequent manner with the self-insured employer and then you're being their consultant. And then you're going to the client meetings, maybe their annual meeting or for really large employers you may be going like every couple months. If they're like in the top 10 employers for that health plan, they're going to get higher level service and included in that is having a physician consultant that is assigned to you. And you're their person or their medical director.

John: Okay. I'm going to clarify something too. I'm trying to understand this. The employers are self-insured, but they have a relationship with the payer or the health insurance, because they're actually managing the claims. Is that why there is that partnership?

Dr. Laura Clapper: Well, it's a good question. And so, the self-insured employer usually has a broker or consultant. So, think about Towers Watson or you'll have Aon or other kinds that will be helping them coordinate their health benefit package.

John: Okay.

Dr. Laura Clapper: And so, they'll have that team member or consultant, and then you have the health plan. Now employers will sometimes, especially if they're a large employer, will have multiple health insurance plans working with them. Some they want to give a choice. So, they'll give a choice. They may say we have like in California, it's pretty common. You'll have Kaiser and another health plan.

John: Okay.

Dr. Laura Clapper: And then if their employees wanted HMO, they'll go with Kaiser. If they want PPO or some form of PPO, they'll go with the other health plan. Sometimes they'll offer HMO in both with Kaiser and the other insurance, but they'll have a combination. So, you'll see different insurance companies with one employer. But that tends to be a lead insurance company that either has most of their employees that they work with. And they'll tend to coordinate among the three. The self-insured employer, their consultant, and kind of their lead health insurance company will kind of work on when it's going to be open enrollment. What changes are they going to make to their benefit plan? Are they going to change their deductible level? What are they going to need to do to be able to communicate to their employees? What's coming? And everyone works together with that.

When I first started doing this, which was 25 years ago when I first went to Health Net in 1997, none of the employers really had their own chief medical officers unless they were a health-related company. If they were a health system and we were providing their insurance, then they might have a chief medical officer come. But otherwise, they didn't.

And the medical part of the service that the health plan was providing was to have a medical director who would explain clinical questions or if someone was upset, why they couldn't get a surgery, because it had been denied under prior auth. They would act as a second opinion in some ways to kind of look like not that you were that in that specialty, but you want to say like, "Was the process followed correctly?" You might talk to someone about if they had questions about what their appeal rights were. So, you wouldn't change anything, but if you saw something when you went through it, like, "Did you have all the faxes when you made your decision? Because I can see these facts that got maybe added the next day and you might have not seen it or something like that."

So, you would look, was there integrity to the process and then talked to someone to kind of explain what the process is and what are your next steps if you're going to appeal. So, you could play both roles as a physician being kind of like the speaker of truth. Having taken the Hippocratic oath, you're there trying to represent that. I think over 25 years that more companies are hiring their own chief medical officer that would come and sit in the company and represent the companies. I think a lot of times the national account medical directors act as the medical director for the employer, but there is an uptick and I think COVID also increased the chief medical officer that they're being hired by self-insured employers.

You see Delta hiring chief medical officer, other larger corporations because they need someone to be looking at, "Do we have the right procedures in terms of personal safety hygiene? How close can the seats be? Working with the industrial hygienist, OSHA and occupational medicine team and facilities team trying to figure out. And so, they've gone and hired a chief medical officer.

And what I just said about COVID might've sounded like that's crazy to have a medical director working with these different people. But when I was at Cigna during most of the COVID pandemic, we literally were talking to people, working with facilities to pull the diagrams, to look at ventilation, to say, could people be in those parts of the building? What do we know? Could we do something to upgrade the filtration? Because we had people that need to be providing pharmacy or we have the Cigna medical group in Arizona where they are safe in their buildings and were their patients safe and what could we do? So, the medical directors of the plans do get involved in those things. But I definitely keep hearing different large organizations hiring chief medical officers.

John: I guess that leads me to the question on both sides of that equation, both for the insurers themselves and for these large corporations. What kind of preparation can you do if you're practicing and you're deciding, "Okay, maybe that sounds interesting to me. How do I prepare myself or position myself for applying for a job? And where do I look for these jobs? Do I start with the insurers? Do I think about going directly to an employer at this point and try and map that out?" So, there's two questions for you to try and hit.

Dr. Laura Clapper: I really believe there's a book that I really like. I've actually read it twice and I would recommend it. It's called "Redesign Your Work Life" by Dave Evans and Bill Burnett. They wrote "Redesign Your Life" early on. But their big thing is think about like three paths, think about and prototyping. So, I would say to someone who really wanted to get involved with the self-insured employer, maybe there's a large employer in your town. Maybe go figure out how you could talk to them about do they have a need, see what they have going on? Does it fit with what you like to do to go and maybe look at their factory safety data or something like that? Talk to HR people who are talking about insurance. Is that something you're interested in?

So usually there's networking and asking questions, learning about it would be part of prototyping, figuring out if you could go for a day, maybe a tour or follow someone along. Is this something you like? Talking about this is reminding me of someone I know who was thinking about coming to insurance plan and actually went and spent one day with one of the medical directors that I really loved when I was at Anthem.

And after one day she said, "I don't want to be sitting there doing this. I like talking to patients." That kind of blew her. She was like, "No, I don't want to do it." Because she really saw what it was like. So, I think the more you prototype is you try things out and see. Maybe you're just looking. There are jobs where you could be 50-50. When you're not doing 100%, maybe you would love doing patient care. And so, maybe you don't have to decide. It's not like "all or nothing." Maybe you can figure out if you decrease your hours sum and do some case reviews or do some other kind of work with an employer in your town that you can do a combination.

John: Okay.

Dr. Laura Clapper: And maybe that fit is going to give you a lot of satisfaction, being able to do both. And other people might say, "Heck, now that I can do this, I feel like I'm done seeing patients." So, I think if you can figure out ways to test, to maybe take time off work and go do something for two weeks, try to do some ways you can test out your theory, you can get a better idea. Those kinds of questions, do you like working with those different kinds of teams? What do you like? What brings you joy?

John: It is a challenge and I never used to bring up this idea of shadowing as a way to find out about a job. Partly because sometimes it's difficult. Some companies will not allow that because it's HIPAA or proprietary information and this and that. But boy, if you can actually spend a day with somebody and see what the job really entails, that's going to give you some really awesome insights. So, I do now bring that up from time to time as an option. But like I say, I get pushed back from my listeners and others who say "They won't let me do it."

Dr. Laura Clapper: I think you have to be careful, like the instance I've talked about, the person was with one of the ACOs. So, I think in terms of cross training and understanding how they could work together, there was a reason, it wasn't just like randomly showing up. There was like a paperwork trail of meeting together. So, I think you're bringing up some really important points and you just can't randomly go and sit and listen to PHI. There needs to be good boundaries.

John: But if you're working in a hospital that happens to be, have an insurer or a payer that is providing their coverage. Well, then that would be potential in. It's sort of like when you're in practice and you're prescribing medications. You have a salesperson and that salesperson can connect you with the MSL who might then be able to tell you about what they do or even have you join them on occasion. So yeah, you have to be a little more creative I guess and look at what would be the best way to develop that relationship and then have that opportunity.

Dr. Laura Clapper: That's a good point though. If you're in a hospital, you could go and talk to the HR team and say, "Could you listen in on and do a networking interview? What kind of issues did they have? How do they plan about the insurance coverage for the hospital, particularly for the employed staff. So, it tends to be nurses, less physicians, but the employed staff. Could you listen in on a meeting?"

Usually in meetings between the insurance companies and an employer, you wouldn't talk about PHI. It'd be more things like how is the medical cost running, how much proportion the budgets spent for complex high-cost patients versus wellness and other kinds of costs. How are you doing in terms of HEDIS measures that are your mammogram rate, your immunizations for under five, your adolescent physical visits, where you look at the HEDIS and that's a big part of when you're working with the plan and self-insured employers. It's really looking at how's the total plan running, not just on cost, but quality of care.

John: And that's something to research when you're actually applying for a job. So, you kind of know what's going on. And so that's something that we talk about a lot. Things are obviously evolving. Are there certain jobs you think are in more demand now than let's say five years ago that we can kind of look forward to and anticipate some need growing in these areas?

Dr. Laura Clapper: Yes. Several different areas. One is I think telehealth roles are expanding. When I was at Anthem and we were working with live health online, which is kind of a white labeling of Amwell, you could have a small group supported. Now there's a much bigger component with COVID of care and the whole care model. You start to see medical groups that are having telehealth services. And I think everyone's trying to struggle how do you provide good longitudinal care and that satisfaction from both the provider and the patient, as well as provide better extended hour access, make sure someone really needs to drive in and park and do everything to come in just to say, "Oh my incision looks better." And we can do that through a telehealth visit that's better for everyone, yet, if you're in practice and you're trying to make your practice run well, and you have staff who are checking people in, check doing the receptionist, do all these things, it's difficult to do a telehealth visit and have your staff overhead be sitting there and not having things to do.

So, if hear people saying, well, they're taking certain half days to do telehealth. You're doing half days. And do you share your office now? Do you add more providers into the office planning because they're taking these half days of doing telehealth visits? If your patient needs to get seen, are we doing more of a group practice and not really individual PA provider practices because we're trying to do both telehealth and in person? Do we have parts of medical groups who just like we have hospitalists now they become the telehealth docs?

They put their notes into the electronic health records. So that's more connected than urgent care is to primary care because you're part of the same group. That you could actually then see in the electronic health record, the primary care visits, the telehealth visits and any ER hospitals visits. So, you could see care that way.

So that's good. But I think we're struggling, how do you do the most efficient manpower with providing this hybrid telehealth, inpatient care? And so, I think there's going to be jobs coming out of that as we rethink that whole care model. And what's the best for hybrid care? And at the end of the day, I think patients want to know that you know them, that they have a relationship with you, that there's trust. And that's what I love about primary care. That you know them, you know the family and I think this is a challenge for us. How is medicine going to be practiced in the next even five years? How do we create a system so we get the care we want to have and we want to have for our parents, our families?

Because not that long ago, physicians were practicing in their communities where they'd go to the grocery store, they'd go to the church, they'd be in community organizations. Their kids were in school. And they would know a lot of things about the community. Like the plant was closing down, there's a new employer coming into town, or there's been clacks in the last week and this family was impacted. You knew things about your patients because you were part of that community.

And now we are practicing a lot of times away from the community. We're on telehealth or we're covering different hospitals, or we're doing different things like that. And so, we don't really know the patients in the context outside the visit, like we did in the past. And I think that impacts our decision making or how confident we feel in our decision making.

To me in the future, we're going to have to figure out how to bring that context. And that's really where we start talking about social determinants of health, knowing more about your patients, knowing do they have housing insecurity? What's happening? Is their daughter bringing their food? Do they have food insecurity? Because they're struggling because the plant closed. Like what do you know about them? And when it's just becoming more as a systemized way to approach people that we used to kind of just know because we knew that family.

And when I think about this whole trust in knowing I hate it. When I go and I have to call someplace and you have to verify yourself multiple times. You put all this security information, they say, okay, and they pass you on and they want it again. I hate that. It feels really inefficient. I feel like you should know me. And I think patients feel like that. They feel like why I have to tell my story to so many people. I'm always trying to think, how can we know people, have a good handoff, make it efficient for the patient?

And I do tie this back to what your question was of where's the jobs in the future. Because there's going to be all those jobs, having a strong care team, a strong care model and who are going to be the physicians who are working on building that, whether it's data, technology. Epic has a big influence on us. Epic and Cerner.

John: Exactly.

Dr. Laura Clapper: When all physicians are sitting around talking about Judy pajama rounds and how they have to do extra hours doing their epic and closing their charts, I'm really a big believer that in the next 10 year... Well, I hope everyone's laughing when they're hearing that because it's really influenced physician's lives or families and everything. It's good having the documentation and you can go anywhere in the system and know if someone needs a mammogram.

That's great, but it's come at a cost. And the cost has been unevenly born by physicians at doing all this documentation that hasn't been taken into account. So, my hope is in 10 years, we have a different addition, whether it's a disruptor in the EHR space or they've evolved with Oracle acquiring Cerner. So, it is not with Scribd, but we actually have a better system.

I think that's just one way where I think there'll be jobs and technologies, especially for people who've practiced a long time because they know how it works and they know how people use electronic health records. They know how to use their phrases and can set it up. And people who are really good at being efficient in the EHR, they did EHR since medical school and residency and things like that. There's a huge gap. And so, how do we close that gap so everyone can be good at it? And I think better technology will do that.

I think that we'll start to see more physicians working with startups and independent boards and advisors with startups that's still growing, even with what's going on with the stock market and venture capital. I think this is kind of a pause, but I think that mostly more of that biotech and biosimilars, genetics, all these areas are growth areas, cellular therapies. They tend to be focused on certain specialties in certain areas. And if you're one of those, that's great, but I think there'll be more roles in those areas also.

And one of the things I pursued during the pandemic was actually working on getting my executive coaching certification. And I think we're going to see more physicians as executive coaches too in all different ways. More working on the team, maybe across the hospital. That would be my hope and dream that we really see physicians as an important part of the leadership team in health systems and having them play that role of being executive coach, be actually executive coaches with different executives, as well as other kinds. I think working as an executive coach/advisor at startups or other kinds of ways where you see executive coaching brought in. And so, I think there's a lot of different roles that will come out in the future.

John: Awesome. That's a good overview. When you were talking, I was thinking back to when hospitalists were first introduced and you talk about not knowing the patient. And then telemedicine another example. And so, how somehow the technology has to bring this all together. And then as far as the coaching, I had a physician once. He was a pretty stodgy old man like me. He was like, I don't get it with all these physicians becoming coaches. And it was just funny because business people have used coaches for years. In fact, I have a friend who requires that. He won't take a job unless they're going to give him a business coach.

And so, physicians are left to wander and learn on our own. It's like, that's not good. So, mentors and formal coaches make sense. I'm glad that you're getting involved in that. And especially executive, when you combine physician and executive roles, that's not something that's easy to navigate when you have no background in that. Even if you get an MBA or something, it doesn't teach you how to be a physician executive by any means. So that's fantastic. Well, we're going to run out of time here. Anything else you want to add to what you've already told us? Give us a glimpse and some ideas to shoot for potentially.

Dr. Laura Clapper: I really like what you said about the executive coach and having physicians who are taking on leadership role, even if it's short-term coaching for their first 90 days or for transition in the role. Other roles on the executive team are having coaches. I think as a physician, I wouldn't even have thought to ask for one. And I think we kind of have to increase our awareness and our negotiation into thinking about that. But you and I also talked about other categories. So there's cellular therapies is more combination around the pharmacy and biosimilars, and I think there's going to be a big change, especially with this inflation reduction act of how pharmacy is going to change. And I think there'll be roles for physicians in that as well as with the medical clinical liaison roles. But I think there's also these roles about how pharmacy and PBMs are going to work because they're going to be changing. And the value-based insurance design and how physicians play a role with that.

But I think also women's health is becoming a big area. I just recently was the chief medical officer in FemTec Health and really thinking about how do we address the disparities in health for women. They have a much higher autoimmune burden in terms of incidents of autoimmune disease. And those diseases tend to take six to seven years to get diagnosed.

John: Yeah.

Dr. Laura Clapper: They tend to be more vague. And so, people don't really think about the autoimmune. So how do we create either pattern recognition or profile to help or earlier identification? I think it is really important. Think about endometriosis. It's a very underdiagnosed condition. People may show up in the ER and say they have abdominal pain. They are having fatigue, different things that are seen as vague issues. And then when they're trying to get pregnant, usually endometriosis starts to be diagnosed either by very heavy period or when someone has infertility issues and then they'll figure it out. So, I think we really need to start. And I think part of it is we don't code it. We don't diagnose, we don't code it. So, we don't find people who need the help early enough. And I think it's partly because we didn't think about electronic health records or other kinds of visit forms to even start thinking about asking the right questions. We don't ask the right questions so we don't think about it. The prompts aren't there. And so, it gets lost. The story I like to think about, they had the Apple watch, everyone loves the Apple watch. It took them actually a couple years before they even added the last menstrual period into the mix.

John: Oh, really?

Dr. Laura Clapper: It was more than two years. And even then, they don't have other kinds of questions. We might have a lot of data. We may have technology and devices, but we haven't really thought from the women's perspective first, how to bring these things together. And yet even the work that we're doing in terms of Medicare and Medicare advantage and all the boomers, the growth that we're seeing in Medicare. There's a lot of startups in the Medicare space. And yet who's in the Medicare space for most of the time? It's older women.

John: Yeah.

Dr. Laura Clapper: I think we're going to have to rethink the care and the guidelines for older women. So, there's lots of new kinds of specialties or areas that I think physicians can take their clinical knowledge and really pursue.

John: Yeah. I think we've probably both been exposed to people that are interested in AI and with AI you can recognize patterns. They're not necessarily markers. They're just like patterns of behaviors or background or exposures, which it's just beyond me. I don't even understand how you would capture all that and put it together. But almost to where it'd be like a dog that could sniff a cancer and something totally off the wall, but it'll get there eventually. So, there's lots of opportunities.

I know that our listeners are going to have a need or a desire to get in touch with you somehow. So, I know you have a LinkedIn profile. You're there and I'll put that in my show notes. Any other ideas of how they can find you? Is that the easiest?

Dr. Laura Clapper: I think that's probably the easiest. The other way is through the American Association for Physician Leadership. I think that if you're a member, you can link up with me or connect with me that way. I teach in the Capstone Faculty. That's actually another thing that I think is a good step towards if you're interested in a more physician executive career.

John: Absolutely.

Dr. Laura Clapper: If you are thinking about getting CPE, you can do it. You don't have to go get a masters. You can take the different courses at your own pace. And I think that I've found that people get a lot of benefit from that. I got a lot of benefit personally from it and I continue to see people learning and having that kind of peer group they can talk to.

John: Well, you're in that group like "Oh, I'm one of these kinds of people. I'm one of those that are doing this medical directorship or CMO role or whatever it might be." And anyway, your comment too is very good timing because I believe that the podcast either before or after this one is my interview with Dr. Peter Angood. You didn't know that, did you?

Dr. Laura Clapper: I didn't, but that'll be great. He will be a wonderful interview.

John: Yeah. He's great. All right. I think that we are over time now. So, this has been really fun, Laura, a lot to think about. And I really appreciate you for spending this time today with me and going through some of this. Maybe we'll have you back on some time down the road.

Dr. Laura Clapper: Thank you, John. Thanks for having me. The pleasure was all mine.

John: All right. You take care. Bye-bye.

Dr. Laura Clapper: Bye.

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The post Pursuing Leadership Roles with Health Plans and Self-Insured Employers – 265 appeared first on NonClinical Physicians.

In today's interview, Dr. Peter Angood explains why the best way to empower physician leaders is to join the American Association for Physician Leadership.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

American Association for Physician Leadership's Benefits

The 50-year-old AAPL was founded to empower physician leaders and managers. The evolution of healthcare has evolved and grown increasingly complex. And it is imperative that physicians assume leadership roles in all aspects of healthcare.

The range of services offered by the AAPL is quite impressive:

1. Strong and in-depth information sources (journals, newsletters, and archives);
2. Webinars, Podcast Series, and 85+ educational courses;
3. The Certified Physician Executive Credential; and,
4. Access to advanced business degrees with 5 Universities and 7 Master's Degree specializations.

The benefits of membership are supported by dedicated employees and an excellent technical platform. And the organization provides 350 to 400 educational programs each year.

Importance of Certified Physician Executive

The CPE provides certified physicians with practical insights and a strong healthcare network. Acquiring the designation also requires at least a full year of meaningful experience in leadership and management work. Recruiters now recognize the value of the CPE and often list it as a desired credential in job candidates.

…some of the search firm consultants out there, if they're honest with you, they'll tell you [they] would rather have a candidate with a CPE than a candidate with a master's program.

Summary

Joining the AAPL will help surround you with other physicians already working in management and executive leadership roles. By networking with other members, you will find mentors and coaches to help you follow your leadership path.

By attending live or online courses, you will develop your business and management skills, while demonstrating your commitment to leadership to practice partners and current and potential employers.

If you pursue the CPE and or fellowship, oyo will distinguish yourself as a recognized physician leader.

NOTE: Look below for a transcript of today's episode.

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• American Association for Physician Leadership
  • CPE Program
  • Masters Programs
  • Fall Institute
  • Physician-Mapped Leadership Assessment & Development Tool.
• How a Great Physician Executive Combines QI Expertise with Strategic and Operational Skills – 198
• Are You Ready to Become a Certified Physician Executive? – 219
• 5 Steps I Took to Be a Hospital Executive – 175
• Advice for an Emerging Physician Leader – 032
• Dr. Peter Angood's email address: pangood@physicianleaders.org
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 264

What Is the Best Way to Empower Physician Leaders?

- Interview with Dr. Peter Angood

John: I've spoken about the AAPL many times on the podcast over the past five years mainly because it was a big part of my career transition. I was working as a physician advisor and a little bit of medical directorships and joined the AAPL. And eventually it really helped me to pursue my job as a chief medical officer for a hospital. I thought I would devote an entire episode to this topic today, the American Association for Physician Leadership. And who better to have on as a guest than the president and CEO of the organization, Dr. Peter Angood. So hello, Peter, it's nice to have you on the podcast.

Dr. Peter Angood: Hey John, thank you so much. And I very much appreciate the opportunity and I look forward to our conversation.

John: This should be fun. We're going to give it about 30 minutes or so. There's so much. The organization is really very complex and has a lot of offerings, but before we get into the details of the AAPL, how about just a thumbnail sketch of your background and how did you end up there at the organization?

Dr. Peter Angood: Oh gosh, thank you for the opportunity. I'm a surgeon by background. I spent a better part of 25 years in the academic side doing trauma surgery, surgical critical care. And both of those are multidisciplinary and very systems oriented. So, as I got into mid-career, I found myself thinking more and more about how to create larger scale systems change as opposed to patient-by-patient hospital by hospital.

I was very fortunate as I made that shift, I became the first chief patient safety officer at the joint commission. And that was just one of those career opportunities that really opened my eyes to a lot of the intricacies of our industry and how complex healthcare is actually. I looked after all of the safety initiatives at the joint commission and we did a lot also internationally as well as a bunch of work with the world health organization. Again, that national international exposure was wonderful.

I did that for a number of years and then shifted over to the national quality forum and looked after their safety initiatives and NQFs are all about measurement and how do we get better measurement tactics inside of healthcare. I spent a very brief bit of time with GE Healthcare looking after their patient safety organization.

So, a little insight to the for-profit side of life, but those experiences, John, made me really appreciate that it's all fun and fine to be doing policy development and deployment and all that sort of stuff. But those organizations often didn't have enough physician insight as to really how to deliver care. Take GE for example, a multi-billion-dollar international organization and their true appreciation of how healthcare is delivered from a physician perspective, if you will, was absent.

After those experiences and my ongoing desire for trying to create larger change, I was looking for an opportunity to work in that gap zone, if you will, where I'm still involved and aware of what's going on at that policy level, but also strongly connected to the front line. And I was very fortunate to be chosen as the successor CEO. AAPL at the time was the American College of Physician Executives. The organization is nearly 50 years old now, and I've been here about 10 years and it's been just a wonderful journey in the organization. Truly does sit right in that gap so it influences the policy side, but also very strongly tied to the frontline.

John: Yeah. It's grown, it's morphed over the years. And so, we're glad to have you there. It's been awesome since you've been there these last 10 or so years.

Dr. Peter Angood: Out there. Yeah.

John: Yes. Why don't you give us in a nutshell what the AAPL is? If someone is listening that never heard of it or maybe has heard of it, but has really not looked into it. What is it? What does it do? How does it help physicians with their career advancement?

Dr. Peter Angood: Sure. Well, as I mentioned, it's nearly 50 years old as an organization and the originating CEO, Roger Schenke was a clear innovator in his own right back in the day. And he ran the place for 35, 37 years. And almost I think created the whole concept of physician executives, physician leaders.

While he was running the ship, wound up with a strong constituency of physician leaders who mostly were mid-career, mostly looking at administrative roles in hospitals. And the pinnacle was you get to be a CMO. And yet healthcare's continued to evolve, as you said, in the opening, healthcare's very complex as an organization and so we've become more complex. And as we've been transforming the organization from Roger's beginnings, we really took a different philosophy and that is our society as a whole really continues to look at physicians as leaders.

And the medical profession is still by and large, strongly trusted, and the medical profession is a lead profession. I've taken the philosophy at some level, all physicians are leaders and how do we help physicians embrace that? It's like a responsibility, but it's also a privilege. And so, we're really all about that leadership development, but also professional development along the entire trajectory of a career.

We've expanded and diversified the variety of things that this organization offers. So, we've got very strong and deep information resources. We run a couple of journals, a number of newsletters. We've got a great archive. We've got webinars. We have our own podcast series, had some great guests on that, but then as well, we've obviously continued to expand our educational offerings. We have 85 plus different courses. We have our certified physician executive credential, which is an industry recognized credential. And then you can continue on to become a fellow of the organization. And that's not an automatic, you got to earn the fellowship, all those sorts of things.

And then as well, we have partnerships with five universities and offer seven different master's degrees in there. We've got a large community as you might well expect, and we've got a terrific technical platform to support all of this, the information resources, the education, the networking, the community.

And what a lot of people don't appreciate is that we also do a lot of institutional organizational work. As those of us who are physicians know there's a long-spotted history of the medical staff versus the general administrative staff of hospitals. And they don't always get along. But with the employment trends in about a half of physicians are now employed, many of them by hospitals and health systems, what we're finding is that those institutions are looking for ways to better integrate and engage and to get physicians into leadership roles. And the traditional HR offices are not necessarily all that good at that.

And so, we are working with a good number of institutions. We probably put on 350 - 400 programs a year with different types of organizations to help them with not only the physician leadership pieces, but how to better manage with their medical staff and that whole interface as well. And that's been just wonderful.

And then, yeah, there are a couple of pieces within the international arena. There are not that many countries that have similar organizations such as ours. There are maybe 12 or 14, and they all tend to view us as that best organization, sort of best of breed type of thing into that. And we were just doing some analytics on some of our website stats and purchasing stats. And could you believe this, John? There were 135 countries represented who had been poking around on our website and trying to sort things out. Physician leadership is strong, we're strong and it's just a privilege to be in that role where people want to learn more about it. It's a new era for physician leadership. It really is.

John: Yeah. Things are always evolving. And yeah, I think I've definitely spoken with physicians from other countries and they're looking for assistance in thinking about what direction their career should go and how to get more exposure to leadership and management principles and working together with teams and so forth.

Now, the last thing you mentioned in that whole long litany was working with these organizations. Now I'm kind of thinking some of that with the medical staff is like dealing with let's say burnout and resilience. Does that get into that? Because that seems to be something that's in big demand.

Dr. Peter Angood: Oh yeah. And all those of us that have been in this profession, we all know burnout was happening before the pandemic. The pandemic has brought it forward. The stats are horrible. And yet the way I view it, physicians are resilient as a breed. We got these incredibly long education tracks and then that whole startup of your practice. And so, to walk around telling physicians to be more resilient is kind of a lost cause in my mind.

John: You are talking my language there. We are already resilient.

Dr. Peter Angood: We are.

John: To deal with these other issues.

Dr. Peter Angood: And that's the point, John. It's those other issues, the systems and processes that create frustration that then lead down to the anxieties and the stressors and take this job and shove it kind of attitude that shows up sometimes. And our approach is really kind of in a few different ways. One is clearly there are some individuals who are truly burnt out and they need some assistance and they have to be helped and it's unfortunate, but that's just a reality.

John: True.

Dr. Peter Angood: But we also have to help organizations appreciate and understand that improving their systems and processes will go a long way to improving workforce wellness. And then the third piece therefore then is how to help the physicians in other healthcare professionals to understand better that systems change takes time. Don't just sit and complain about it, but look for ways to engage, help to create more change in the systems and processes. And that will help with sort of an improved awareness of why you're feeling frustrated. And it gives you a longer-range view on things.Because of the respect that the physicians get in organizations inherently and the medical profession as a whole, if we have a strong responsibility to engage in trying to help all of the organizations, whether it's our private practice, our hospital, our post-acute care systems, help them all because folks tend to listen to physicians. So, it's a wonderful opportunity to help abate the burnout by taking that broader based approach.

John: That kind of ties in with something we were talking about before we went live or went on the recording. And that is how the AAPL, although it's an organization for physicians run by physicians, you told me that we were kind of getting involved with other nonphysician components of the system.

Dr. Peter Angood: Yeah. Thanks for bringing that up, John. For a number of years now, multi-professional team-based care has been out there. And a lot of it started in ICUs and emergency departments, transplant programs, all those sorts of things. And so, it's natural that leadership begins to become more interprofessional as well. And as many of your listeners will recognize there's dyad models and triad models. Some of them work, some of them don't. All those sorts of things.

But what we're recognizing in our institutional programs is that as much as 20% - 25% of the participants are actually nonphysicians and organizations are looking more and more for physicians to be the CEO of places. And in that type of setting, obviously then that interprofessional leadership is critical. For those organizations that are more progressive, they're very much encouraging interprofessional leadership. And so, physicians are like "Hey, we're trained and we like being the boss of the team." That's a cool thing, but that's shifting and you can be a strong contributor of a team without having to be the leader of the team.

John: Yeah. That's something that I was not aware of. The extent to which the AAPL was getting involved in that component. So that's awesome. I do want to go back to something you mentioned briefly earlier and you were talking about the different programs and that's the CPE, because I get a lot of listeners who ask about, "Should I get an MBA? Should I get a CPE?" And then I kind of explain what that means. But why don't you give us your take on that? What is the CPE? Who would benefit from it and maybe even how that ties into the MBA and similar business degrees?

Dr. Peter Angood: Yeah. Let's state the other obvious upfront though first, and that is unfortunately medical schools and residency training programs still pretty much do not offer any leadership education or management training. It's gradually shifting a little bit, but that's still going to take a good number of years before that's more common within the undergrad graduate and postgrad areas.

In many ways then AAPL functions as this bridge organization. And as we've said, both of us, healthcare's a complex industry. There are still phenomena occurring. You seem to be a good person, patients like you, your results are pretty good. Your peers seem to like you, congratulations. You're the new CMO here. And you have no background experience. You're holding this high responsibility, high stakes job. How the heck am I going to do this?

So the reality is in this day and age, is that for those individuals who are wanting to help create more change, want to get engaged creating change, you pretty much need some further education and certainly more experiences, whether it's committee work, project work, et cetera. You got to figure out this new arena of leadership and management and how best to fit in there. And again, as we said a few minutes ago, you don't just get to go in and do the command-and-control thing that we've trained to do. So, that takes a new skillset. And as I said at the beginning, it's been 15 years since I've been in the operating room as a trauma surgeon, but I'm still unlearning all that behavior as a trauma surgeon.

John: Yeah, it's different.

Dr. Peter Angood: It is different. I go through all of that to answer your question finally. With the need for some added education, you can do some fundamental stuff and you can do a variety of courses, but we've recognized and for 20 plus years have had this certified physician executive credential. And that is now about 170 hours of coursework. Majority of it is sort of prescribed and there's about 20% of it is elective time.

And then at the end of that 170 hours, there's a three-, three- and half-day capstone weekend, which uniformly is transformative for the people that come in and participate. And the way we view the CPE is different than a master's program and it's very complimentary. And we have had several individuals who've got master's degrees come through the CPE program, do the capstone event and they'll off say, "Darn, I wish I knew about this CPE program before my master's because it's so much more practical, so much more real and it provides me the better tools in which to really do my job." Master's degree programs are great and that's why we offer some. But often as we all know, they're more theoretical, not necessarily healthcare based. And they'll give you a good construct of some of the higher learnings needed to manage and lead, but they don't give you that practical insights. And they don't necessarily give you a strong healthcare network either, which is the benefit of the CPE.

So, you need something, the higher performing organizations that are looking to recruit physicians into leadership roles are often looking for advanced degrees of some sort. And I would love to say that the CPE trumps everything else. No, it's complimentary to those master's degrees. And I can't think of an individual who's taken it that's been disappointed.

John: Not everyone actually completes it when they start it because it is rigorous and it does require some demonstrated performance at the end in terms of what the goals of the program are. Correct?

Dr. Peter Angood: Correct. Yes, absolutely.

John: And by the way, I've mentioned this before in the podcast, I do see that the CPE is sometimes mentioned in job postings for physician executives which is very interesting. And it's been several years that that's been true. So, it really shows that it's a separate complimentary demonstration of one's expertise and experience because like you said, MBA is like book learning. I mean, unless you've actually done it. And I think the CPE also requires at least a year's experience doing some kind of leadership and management work. So, it really shows to those recruiters that there's a different level of ability and expertise there.

Dr. Peter Angood: Yeah, you're absolutely right. That by the time you get to capstone, you've got a well reformulated leadership philosophy, you'll have had to do a project and you will have had to have some experience as you describe. And a dirty little secret, some of the search firm consultants out there, if they're honest with you, they'll tell you I would rather have a candidate with a CPE than a candidate with a master's program.

John: I want to mention before we get to the very end actually the website for the AAPL, which is physicianleaders.org, correct?

Dr. Peter Angood: Correct. Yes. And fresh news. By the time you put this podcast out, I think our new fresh-looking website will be up too. So, I'd encourage folks to have a look.

John: We'll have to all go and take a look at that. Excellent. All right. Let's see. I want you to tease something out a little bit, because you said that CPE is complimentary. A lot of my listeners will ask me this question. "I want your advice. And it's probably difficult to give, but should I get an MBA? I'm unhappy in what I'm doing now. I'm doing some medicine, I'm thinking of moving into some kind of management position. Should I go get an MBA?"

Dr. Peter Angood: Yeah. We often tease. You give a physician a textbook on a weekend and by Monday he'll come back and he's an expert or she's an expert on whatever the topic was. So part of our reflex is to want to learn more.

John: Right.

Dr. Peter Angood: I think there's a deeper set of issues underneath that question. And it gets back to in part we're not exposed to leadership and management through our training, we are idealistic and altruistic by nature. And so, we're looking to create larger scale changes beyond our practice. Not everybody, there's a lot of docs out there perfectly happy seeing their patient volume every day and all that stuff and I commend that. I'm not saying you shouldn't do that.

But even if you're running a practice, you're a leader. The staff are looking to you, the patients are looking to you, your consultants are looking to you, et cetera, et cetera. And so, the onus is on us to sort of own the need to sort of improve our leadership and management as best as we can. And I think if we recognize that then as individuals, or even as a group practice, it's worthwhile getting everyone exposed at least some introductory elements of management, leadership, et cetera.

Organizations, especially the higher performing organizations, more and more are expecting all of their clinical leaders, whether it's a physician and nurse, et cetera, to have some type of added credentialing or education. And I've been told by some of our CPE folks who are strong believers in the CPE, but they're in recruiting type jobs in their delivery system. Their delivery system is like "Hey, you got to recruit the docs with a master's or some other added credential." And so, there's an industry expectation that's evolving.

Does that mean you got to have an itch to create change and go into leadership? You don't have to get a master. You don't have to get a CPE, but just know that the industry oftentimes is looking for something. So, you have to be able to explain your choices. And for time pressures, monetary pressures, family pressures, there's a lot of people who can't afford to do a master's or a CPE, but recognize you have to be able to explain that as you go.

John: Yeah. And there's no way around it, I guess. It's kind of a chicken and egg, but I would say that too, if you join the AAPL and start taking some courses, that demonstrates your commitment and that kind of ties in with the CPE later. What I was advised is if you can get some level of management or leadership job and then get that company to pay for the rest of your education at getting the MBA and or the CPE at the same time, that might be a way to go.

Dr. Peter Angood: Yeah. And what we're seeing more and more is the institutional are sponsoring those kinds of programs. And a little bit of a shameless plug but we've got our fundamentals cluster of courses. You don't have to do the CPE. And we've also got a series of what we call the academies, which are shorter segment focus types of offerings. So, there's the CMO academy. There's the quality academy, there's the safety academy, there's the finance academy. And those types of things can be shown as credentials. And again, to your institution, you're showing commitment to want to do more with leadership and management.

John: There's so many options at the association that didn't exist when I joined 28 years ago. It's great. It's a fantastic organization. So, let's see, if people have questions or are curious, number one, I know you're on LinkedIn, of course. So, if people just want to learn more about you and your background and so forth, again, I'm going to let you give us the website for the AAPL one more time.

Dr. Peter Angood: Sure, sure. It's www.physicianleaders.org. And if your listeners want to reach out to me either through LinkedIn, or you can catch me through my email address, which is pangood@physicianleaders.org. Also, if you're interested, we have a bunch of advisors that can help you sort of guide yourself in terms of where you want to go. And hey, we got a whole bunch of psychometric assessment tools out there as well. You can get a better sense of who you are and what you are. And our technical platform will really help guide you in many, many ways with recommendation engines.

John: The list of services keeps growing as we just spend another minute. So that was a question I was going to have before we close. A lot of physicians asked me about coaching and you said you have advisors at the organization. So how does that work exactly? Is that free if you're a member? Are there paid coaches?

Dr. Peter Angood: There's a spectrum of stuff there, John. The advisors I just mentioned are more staff who will help you understand AAPL better and how to navigate it. But we also offer a lot of professional development services and I neglected to mention that earlier and that's anywhere from we can help you build a better resume cover letter and LinkedIn profile. We can help you with interview skills. We have some mentorship matching and then as well we have a network of executive coaches for those who may want to pursue that line as well. And for some folk's coaching's very, very beneficial. It's shifting coaching. It used to be thought you're in trouble, you better get a coach, but that's not the case anymore. If you just want to get better at who you are, coaching can help. And we've got a nice network of those, but the mentorship is a good way to go also.

John: Yeah. The CEOs and CFOs have been using coaching for years and years, and it's definitely not a negative that's for sure. Okay. Well, that last bit you told me about was actually new to me as well. So, I really appreciate that. Well, we're at our time now, so Peter, this has been fascinating. It's the most in-depth review of the organization I've heard in a long time. So, I really appreciate taking the time and sharing that with me and our listeners.

Dr. Peter Angood: Well, thank you, John. It's been a real privilege to be here. It's a wonderful profession that we all have, and it's a complex industry and physician leadership is really on the forefront of helping to create the next stage of change in the industry. So, it's good stuff.

John: Absolutely. All right. Thanks Peter. And with that, I'll say goodbye.

Dr. Peter Angood: Bye John.

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In today's podcast episode, I present my take on things the CMO should never say to the CEO. 

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4 Things the CMO Should Never Say

There are probably many more. But here are things the CMO should never say because they reflect negatively on accountability and commitment to the success of the organization.

“We’ve tried that before and it has never worked.”

This is a common refrain of those who are unwilling to revisit old goals.  But leaders need to accept the fact that goals that were formerly unattainable might now be possible with new technology, new ways of doing things or renewed energy and enthusiasm. 

“I completed my assignments, but somebody else dropped the ball.”

This is a comment that would make us cringe. The COO, CNO, CFO, and CMO should never say these words.

A team member fails to complete an assignment and the plan does not come together as hoped. While that comment may be accurate, it demonstrates that the person making it is not a true leader. A leader is going to take the bull by the horns and get it done, even if it means taking on more responsibility or monitoring the other team members' progress and assisting them when needed.

It's not that you need to babysit everybody. The point is to get the project done. And a leader is generally the most proactive in helping others to meet their commitments.

“I disagree with the decision on this and I cannot support moving in that direction.”

The way it works on a good team, the leader of the team gives everybody a chance to chime in, and share their input. However, organizations are not led by consensus. Once everyone is heard, a decision will be made by the CEO or whoever is in charge of the project.

Then, even if you didn't strongly support it, or vehemently argued against it, once the decision is made, you must fully get behind the decision. And everybody should then work together to accomplish the goals of the project. If it fails, the team can revisit the other recommendations later.

“I’m sorry IF…” 

There are apologies for doing something wrong, and apologies for making mistakes, but we're talking here about apologies for not doing what you said you would do. Everybody on a senior management team needs to be 100% accountable for doing what they said they would do, when they said they would, the way they said they would.

There should not be any contingency in an apology such as “I'm sorry if you don't believe that I did this properly,” or “I'm sorry if things didn't turn out okay.” That's not an apology. The word “if” should never be used. You must take ownership.

It should be, “Look, I'm sorry. I dropped the ball on this.” Admit that you made a mistake. Then, “I commit to correcting this and I will come back in one week and have everything that I committed to accomplished.” And finally, “This won't happen again.”

Apologize appropriately and keep your word.

Summary

There are certain things that any leader including the CMO should never say to the CEO.

If you're in a leadership position, you can undermine your standing by making one of these four blunders. It can be career-ending.

On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing appropriately, you'll be well on your way to being an exemplary leader.

NOTE: Look below for a transcript of today's episode.

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• The Best Healthcare Leaders Never Give Up and Never Stop Learning – 196
• Why You Should Evolve From Victim To Leader – 043
• What Do Recruiters Look For In a Physician Leader? with Paul Esselman – 041
• How to Quietly Build Leadership Skills As You Serve a Nonprofit – 016
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 251

4 Things the CMO Should Never Say to the CEO

John: Now this week, I'd like to present a topic in what I'm calling my effective physician leadership series. I've done several other solo episodes where I talk specifically about leadership. So, I'm giving it a bit of a moniker here as an effective physician leadership series or effective physician leadership notes.

But I learned a fair amount about working in a complex management environment as chief medical officer for a 300-bed nonprofit standalone hospital, which I did for 14 years. And we spent a lot of time honing our skills as a team together to develop trust and to build a team that could really effectively run that hospital.

And I learned a lot. We had coaching. Our CEO had a coach. We as members of the senior's team had the same coach. And we did receive coaching as a group together. So, I did learn a lot that I think would be helpful to share with you. Many of you are in leadership positions or will be in leadership positions. Now pursuing a management or leadership career itself is a nonclinical or a nontraditional career for physicians, although many physicians do become leaders. I think also even if you start as a medical writer, an editor, or something in utilization management or any other alternative type of career, you will have opportunities to take management and leadership positions. And so, you should probably learn these principles if you don't already know them.

Now, whether you're a CMO in a hospital, pharma company, insurance company, or other large corporation, these concepts will definitely apply. But even if you're not, if you're running a smaller organization, if you're an entrepreneur and you're trying to grow your business, you're going to need these kinds of skills. And if you're in a lower management position such as a medical director, by demonstrating these leadership skills that will lead to you being recognized and considered for more of a leadership position. So, you have to demonstrate these kinds of skills early in your career. And that's what enables you to move up. Because in violating these leadership principles, you will be passed over because it'll be obvious that you're not ready for that kind of a position.

And when I decide to address a topic like this, sometimes it's more fun and instructive to look at it from the perspective of what not to do. I know I've done a presentation on eight big mistakes to avoid while pursuing a nonclinical career. That's one example, but it can be useful to do it from the perspective of things not to do, the common mistakes to avoid. And so, with that, let me describe the four things the CMO should never say to the CEO.

Before I get into the four things, I want to remind you of a couple of things. First, these apply to anybody in senior management. So, it's not just the CMO. It could be the CNO. It could be the senior VP for HR. It could be any of a number of senior-level positions, but these are the things that you don't want to say or express even to the rest of the team because it'll show that your leadership is failing.

Now, let me define what a senior management team is. And basically, when I use the term, I'm referring to the CEO and all the CEO's direct reports. So, I'll use a hospital as an example. In a small hospital, such a team may consist of the CEO, the CFO who sometimes also serves as a COO, the VP for HR, maybe the chief nursing officer, and there might be a VP for ancillary services who covers all of the lab testing and respiratory testing and imaging because it's a small organization. So, there might be five or six in that senior management team.

A larger hospital might have those positions, plus the chief operating officer, plus a VP for strategy or strategic initiatives, maybe a VP for post-acute services, and a CMO. And then the larger organizations might have those plus others like the chief legal officer, or the chief academic officer if it's an academic institution. The chief medical information officer might be a separate position and or a chief quality officer. But you get the idea.

The senior management team will consist of 6 to 12 members setting the vision and strategic direction of the organization under the leadership of the CEO and the direction of the board of directors or trustees, depending on if it's for profit or not for profit. And so, the execution of the strategic and management plans that are developed by the senior management team is done at the level of the directors and the managers, and the frontline employees. They're the ones that actually run the hospital per se day to day. But the role of the senior team is to be certain that each of the component parts does its job, follows its budget, and coordinates with the other components to meet its mission.

And the other thing I want to comment on here is counter to what some may believe. Each senior management member should be committed to the success of the organization as a whole, and not just the success of his or her own division. That's really one of the highlights or the hallmarks of a truly effective senior management team. You don't consider the people reporting to you to be your primary team. It's your team, but your primary team is the team that you work with on a day-to-day basis to coordinate all of the functioning of that organization, meaning your senior management team. And you'll sometimes have to give up certain resources to help the other parts of the team succeed so that the organization can succeed, even though it may take a little bit away from your part, your division, let's say. So, I wanted to mention that.

Given all that, here are four things, there are probably many more, but there are four things the CEO does not want to hear from any member of the leadership team.

One is this. "We've tried that before, and it has never worked." This is something I heard a lot when I was CMO, but it was usually from team leaders, managers, and physicians. And it's a way to try to stall things. It's a way to get stuck. Sometimes it's due to a fear of change, fear of doing things in a different way. Sometimes it might be that people really actually believe that, but it's usually because the stakeholders, whoever's in that group, again, whether it's a department or a part of a department, they don't want to try something new. They don't want to change the way things are done now because they've got it down, it's routine, they can handle it and it's not challenging.

I'll give you an example. We knew at our hospital at some point that several new things were coming down the road. For example, hospitalists. We knew that was a type of service that ultimately would be coming to our hospital because it was growing across the country and there were good reasons why it was growing.

Another was the institution of an observation bed unit. And the fact that the observation unit should be staffed by dedicated physicians. So, let me take that one. We, for several years, tried to create an observation unit because with Medicare changing its rules, it was saying that it would not accept having certain patients admitted to the hospital, particularly if they weren't going to be staying for more than a day or two. That by definition, meant they should be an outpatient.

And so, we tried several different ways over several years to make that happen. And we constantly would hear that "Oh, we tried that two years ago and it didn't work. The patients weren't treated well or the outcomes weren't good or the physicians were losing patients." There are lots of reasons, but this is a common thing that you hear when you're rolling out something new. It's that "We've tried that before and it's never worked." This is something that if I heard one of my directors say, it just drove me nuts, because look, there's a reason we're discussing this. There's a need that exists. And we are here as leaders of this organization to find out how to come up with a plan to discover how, or to make it happen, that this has to be addressed.

And in the observation situation, we had a lot of denials and we were actually writing off a lot of care because we would just keep patients in the hospital. And then we would after the fact change, convert the inpatient to an outpatient and not charge anybody anything, because patients weren't really being told that that's what was going to happen. The bottom line was, ultimately, we had to come up with a plan. We had to work together and make it happen.

And when you heard that comment, "We've tried that before, and it's never worked." That is basically looked at by the CEO and the other senior management team members as just dragging your feet. We can acknowledge that that's true, but that means we just didn't implement it the way we should, or we need to come up with a new way to implement it. So, that's the first, this is probably not the biggest one of the four I'm going to discuss, but it's an important one.

Now, by the way, these kinds of comments usually come up in the following setting, at least in my experience. Organizations generally have regular meetings of the senior executive team. That's one way they become a team is because they're constantly communicating directly and working together. Now they might meet by Zoom call more than they did before, but our team met in person at least weekly. And we would have a two-to-three-hour meeting. And some of them were devoted to strategic issues and some were devoted to operational issues and sometimes they would overlap. But we were face to face addressing these issues and hearing these comments sometimes maybe when we shouldn't have, but that's when they would be called out and then we'd learn. At those meetings, we're constantly planning and tracking our progress forward on management goals that we had set at the beginning of the year. That always meant that there were multiple people getting together that reported to us to work together to get these different projects going and completed.

So, this is a comment that we sometimes heard that would make us cringe. And that is on reporting back on their project, which we usually had a team working together. One of our members would come back and say, "Well, I completed my assignments, but it's still not done because somebody else dropped the ball."

This is one of those comments where you're assigning blame to somebody else because something didn't happen. I had managers and directors that would say this. Again, it would just kind of drive me crazy and I'd have to call them on it because it could be phrased in a different way.

But being phrased that way just doesn't sound good to the CEO or anybody in charge for that matter. And it doesn't sound good to the board if the CEO uses that comment. And a good CEO, never would. Even though I might be on a team as a monitor or maybe even chairing the committee. Let's say we're putting in place something like a new service line. And we have people from the lab and we have people from the pharmacy and we have people from nursing and people from credentialing all together. And one of my directors might come back to me after we had gone through a great planning process and we have these Gantt charts that tell us when things are supposed to happen and what each person is supposed to do.

And one of my directors would come back to me and would say, "Well, I had all my work done last Thursday and I knew we were getting back together early this week but somebody else dropped the ball. If it hadn't been for so and so, well, this whole thing would've been done by now. I just don't see why they can't do their job." Then I might ask my director, "Well, did you do any kind of follow up or did you reach out to find out what was happening along the way? Maybe you could provide them with some support." And then the director's comment would be something like, "Well, no. We each had our own work to do. I'm not their supervisor and I'm not their babysitter."

I think these things happen all the time because somebody drops the ball and then things fall through the cracks. While those comments are basically accurate, what that shows in that person is a great lack of leadership because the leader in this group, whether they're a chair or not, is going to take the bull by the horn and they're going to say, "Look, I've got my part done. I'm reaching out to the other members of this team. Hey Mary, did you get your part done? And if not, how can I help you? Joe, did you get your part done? Because I want to go back. We're all getting back together in a few days and I want to make sure that my VP is pleased and that we've done our job as a subcommittee on this team to get this part done."

I can tell you that there are employees that will argue at this point to the end of the Earth saying that as long as they're doing their job and they're part of the job, then they're a good employee. But that is a person who's going to be in that management position forever because they're never going to advance to be a leader. And so, that's why I'm telling you that I should never hear that from you if you're in a potential position to be looked at as a leader.

So, it's not that you need to babysit everybody. The point is to get the project done. It's not really important who does what work per se, but it'll become apparent who does what work and the people that are doing the most work and taking the most leadership, which means being the most proactive in getting things done, it will get advanced in that organization. If you want to just be someone punching a clock and making widgets, then so be it. But if you want to be a good manager and a good leader, then you need to be proactive. And when the project doesn't happen, it doesn't matter whether you did all your part, the project didn't happen. You are part of the team and you failed the team.

All right, the next one. Now this one, you don't hear a lot, but every once in a while, you might hear someone say something to this effect. "I disagree with the decision on this and I cannot support us moving in that direction." In other words, I bring this up because there's a situation, an understanding that when you're a member of a senior management team, you have to understand that sometimes decisions are made that are not going to be the exact decision that you would make in that situation.

But the way it works is that in a good team, the CEO or whoever's leading the particular team gives everybody a chance to chime in. And generally, to make that happen, you have to be proactive and you have to elicit responses from everybody in the room. Because you can make a situation where the team doesn't work cohesively because only two or three people pipe up. We always had people on our team that were very vocal. They were very extroverted. They always had opinions. They could hear something and then within three seconds they had an opinion.

Now I'm the type of person that needs to think about things. So, I would come back a week later sometimes with a really serious consideration on a topic we were discussing. And I always felt bad that I couldn't be more spontaneous, but that's just the way my brain works. I need to think about things and then come back with my thoughts rather than just my knee-jerk reaction, which may or may not be valid.

But we definitely had people on a team who always had an opinion and that's fine. But the CEO was pretty good about saying, "Okay, now I want to hear from Pete and now I want to hear from Sarah. And now I want to hear from everybody." And that's another sign of a good leader by the way. A leader will elicit input from everybody, even those who are not naturally expressive about their opinions.

So, the point on this is that none of these organizations are run by consensus. None of them are really a democracy depending on how you define that. Somebody has to make the final decision ultimately. Now sometimes you all may come to the same conclusion on your senior management team and say, "Yeah, this is fantastic. We came up with a great plan. Let's do it."

But a lot of times you're going to have disagreements about the best approach or when you're selecting a strategic initiative you might have to choose from among two or three, and you're going to be fond of one and somebody's going to be fond of the other. They're feeling it's the best thing to do, but it can't all happen. You have a budget. You can only spend so much this year. So, one thing's going to have to be put aside. And when you're in a team like the ones I'm talking about, everybody has to fall in line once a decision is made.

We assume that the decision, whether it's a board decision or a CEO decision, that the decision is made for the best of the organization. And it's not always a hundred percent clear, which is the best way to go. But the thing is with a team in order to trust one another and to work collaboratively going forward, what the CEO is going to demand, what the board is going to demand is that everybody gets on board with the plan.

Even if you didn't strongly support it, and even if you vehemently argued against it, that's fine. And everybody should have that input on that senior management team. That's what that team is for. To inform the CEO, to challenge the CEO. The CEO is usually going to have an idea of what they want to do and why it's the best approach. Just like the chair of any committee or team is going to have their opinion. They're going to come to a meeting and ask your opinion and your input, but they're going to have what they think is the best approach to take.

But the thing is until they hear from everybody on that team on that committee or on that senior management team, they don't really know everything. And that's why they need to be challenged because they may be working off assumptions that aren't a hundred percent accurate or that might be missing something. Again, the idea here is not that you can't disagree, you can, but it's the second part of the statement stating "I cannot support moving in that direction." The whole statement is "I disagree with the decision on this and I cannot support moving in that direction" or something similar.

And the point here is that once you've all had your say, whoever's making the decision, makes a decision, and then everybody gets behind it 100%. Then one of several things can happen. It's going to go great and it's going to be wonderful and the outcome is going to be just like everybody wanted. And that's good. Or it's not going to work or it's going to partially work. And then you just learn from that. And then you redirect and, in the case where there are multiple competing projects, well, then next year we'll do your project once this one is going.

But you don't remain as a squeaky wheel or a thorn in the side going forward once a decision for one of these big plans is made and we're moving forward. So, let's say we decide we want to do a hospitalist program, and the CMO myself, or maybe the CMIO or some other advisor says, "I don't think it's a good idea. The doctors aren't going to like it. The patients aren't going to like it." Okay. Give us the information, the support, the evidence. We'll discuss it, we'll consider it. But if we decide to move forward with it, then you're going to need to help us institute this hospitalist program.

Enough on that. The last statement I would say, the last thing the CEO doesn't want to hear from the CMO or anybody else on the team is, well, here's the short version. "I'm sorry if..." This is really just a comment on how to be accountable and how to apologize.

Now there's apologies for doing something wrong, apologies for making mistakes, but I'm talking about really apologies for not doing what you said you were going to do. That's one of the things. You need to be accountable. You need to keep yourself accountable. Everybody on a senior management team needs to be one-hundred percent accountable. Now, we're human and things can fail and falter, but the expectation by the CEO and by all the other members of the team is that if you say you're going to do something, you're going to do what you said you were going to do in the timeframe you said you would do it, the way you said you were going to do it.

Now, most people don't care too much about the way that you do it. But again, you're in a meeting. You've got a big project going on. Each of you has your part of that project. Let's say that as a CMO, since the pharmacy reports to me, the part of the project that depends on the pharmacy and the pharmacy director then is my responsibility. And I'm in a meeting. And I said, "Yes, we were going to deliver this protocol and set up the use of this medication for let's say this new unit. And that will be ready to go when I report back here in two weeks."

Then let's say two weeks rolled around and I got sidetracked. I let the ball drop and then it's my time to be accountable. Part of that is admitting that I didn't do what I said I was going to do. And that's where the apology comes in. But this is true of any kind of apology. There should not be any contingency in the apology like "I'm sorry if you don't believe that I did this properly or I'm sorry if things didn't turn out okay." That's not an apology. The word "if" should never come in there. You have to take ownership.

In this case where I didn't deliver the pharmacy protocol and maybe get the meds and get things cleared by the pharmacy and therapeutics committee and all those other things, there should be no "if". It should be, "Look, I'm sorry. I dropped the ball on this." That's number one, admit that you made a mistake. Number two, "I commit to correcting this and I will come back in one week and will have everything that was expected of me for today. And it'll be in place and it'll be ready to go. By the way, this won't happen again."

That's really part of a good apology. And unless you know how to apologize appropriately, you can't be a good leader. So, you're going to accept what went wrong, that it was your responsibility, that you're going to correct it usually within a certain timeframe, and that it won't happen again. This is pretty concrete and becomes a way to identify those members of the team that need to be let go.

If there's a member of the team who simply cannot keep their word, continues to commit to things that they don't complete, then makes mistakes, and then doesn't apologize appropriately, then they're not really worthy of being an ongoing member of that team. And take the steps needed to eliminate that person from the organization. And that's true of working with people in any business. So, if you're an entrepreneur, if you're a consultant, whatever it might be, you definitely want to follow that process with people that are reporting to you.

Those are the four statements or four things that the CEO doesn't want to hear, or four things that the CMO should never say to the CEO or their senior management co-members.

If you have any questions, feel free to contact me by email at john.jurica.md@gmail.com. If you're in a leadership position, you can really undermine your standing by making one of the four big mistakes I mentioned today. On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing in the appropriate manner when it's warranted, you'll be well on your way to being an exemplary leader.

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The post 4 Things the CMO Should Never Say to the CEO – 251 appeared first on NonClinical Physicians.