In mid-1999, I was hired as  a novice VPMA (vice president for medical affairs) for my new employer, a regional medical center outside of Chicago, Illinois. I had attended many conferences devoted to management and leadership. I had worked as medical director for several different clinics. And, I consistently read the journal produced by the American College of Physician Executives (now called the American Association for Physician Leadership). I felt modestly ready to assume my new role as a hospital physician executive.

My First Direct Reports

The CEO suggested that we take things slowly to allow me to acclimate. He initially assigned the directors for physician services and quality improvement to me. I knew both of them very well, having worked with them for years on various medical staff committees.

Yet I experienced a bit of culture shock having these two well-trained and very capable professionals reporting directly to me. It was no longer a matter of simply serving as an adviser. I woiuld not just be signing off on policies and procedures, as I had done as a medical director. I was now part of the formal hospital management hierarchy. So, I would be accountable for the “output” of my new departments.  And I would be monitoring and evaluating the performance of my two direct reports.

A second major eye-opener would come later in the year. In October I was expected to understand fully the details of both directors' budgets. And I would be helping to present them to the COO and CFO.

The Executive Team

The other event that occurred simultaneously was the weekly planning meeting with the senior management team, chaired by the CEO. I had become aware of reticence by members of the team about having a physician join them. The team had included other full-time nursing executives, but had never included a physician.

During those early meetings, I could sense that the executives around that meeting table had respect for its medical staff, and a realization that the very existence of the organization ultimately depended on the physician-patient relationship. But physicians really weren't interested in, or capable of understanding, the business side of the hospital enterprise. And would this new member of the team bring the kind of ego-based grandstanding that they had so frequently experienced in medical staff meetings?

These were the opinions once shared by executives at hospitals across the country. Although some of them had already abandoned such opinions as a result of employing one or more physician executives. But at the time there were many hospitals and health systems that had not yet joined that growing trend.

Over time, I was accepted as an integral member of that team. And I learned about managing my direct reports, working on and leading teams, and other important lessons necessary to be an effective part of a successful organization.

Three Domains of the Physician Executive

In a previous post, I talked about four new skills that I first recognized when I began as VPMA. But there are more such skills that the executive physician must acquire. I thought about how to organize these new aspects of competence and performance. It seems to me that they all fall into a larger construct of major domains of expertise.


Three domains of executive physicians

To me, it boils down to three areas that need nurturing and attention in order to function effectively as a physician executive. Those areas are:

  • Leadership
  • Management
  • Executive Teamwork


Physicians are natural leaders. They are trained to be decisive, to collect and analyze information and implement a course of action that gets a desired clinical result. They are well-trained. They are accustomed to leading small teams, whether in the clinic or the operating room. Some of the gravitas that physicians have in these arenas is a consequence of their professionalism and extensive and lengthy education and training. Many have a learned “presence” as a result of being the decision maker in urgent or emergent medical environments. They take control when necessary.

But those attributes are not sufficient to make a great leader in the corporate world. Leadership in a healthcare organization is different. It demands the ability to:

  • define, communicate and model the organizational mission and vision
  • actively listen and integrate input from others
  • engender trust and loyalty in others
  • enlist others in your cause
  • see the big picture and think strategically
  • collaborate with others to achieve organizational goals
  • model integrity and accountability


This domain is typically seen as separate from leadership. Not all great leaders are even good managers. But a clinical executive, whether physician, pharmacist or nurse, must learn to fill the management role that is needed to keep their division, department or unit achieving its goals and meeting its core responsibilities.

Management responsibilities are much more practical and clear-cut. These include:

  • Understanding financial reports and preparing budgets
  • Working with direct reports to achieve organizational goals
  • Goal setting and project planning
  • Directing quality improvement, patient safety and risk reduction
  • Hiring, firing and succession planning
  • Running effective meetings
  • Understanding contracts
  • Implementing performance improvement processes
  • Collaborating with peers

Executive Teamwork

The final side of the physician executive triad is the domain of “Executive Teamwork”. I am still not sure if this is the best term to use to capture this important domain. We have all experienced working in teams and have a sense of what it means to be a productive team member.

However, being a member of an executive team is unique in my opinion. This is a concept that took me several years to begin to fully understand.

While working as VPMA, I always considered “my team” to be the direct reports that worked with and for me: directors of laboratory, imaging, physician services, pharmacy and quality improvement. I spent much of my time interacting with these team members, mentoring them, helping them think through problems, partnering with them when coordinating with other departments and representing them to other members of the executive team.

Through a series of onsite retreats, led by our CEO and facilitated by an executive coach from Vistage, the senior executive team (CEO and VPs) came to understand that this was our primary team, not our individual divisions. And we learned that as a member of the team, if we wanted to achieve outstanding organizational results we would need to:

  • embrace accountability
  • commit to shared goals
  • engage in conflict when needed
  • build a platform of trust within the team

We essentially followed the model described by Patrick Lencioni in his book “The Five Dysfunctions of a Team“. I have since concluded that the ability to trust, to engage in fierce conversations, to commit even when not fully aligned and to be 100% accountable for results are abilities that MUST be learned in order to become a vital physician executive.

Coming Up

I have begun to describe a model that helps categorize the skills needed by the evolving physician executive. In future posts, I am going to discuss specific tools and skills that the new clinical executive might find useful. I also plan to explore in more detail the concepts described by Patrick Lencioni and other authors that are pertinent to the physician executive.

Please join my mailing list, and share these posts with your colleagues to stimulate more discussion. And post your own thoughts on these ideas so I can see if I am on the right track or not.

Thanks so much.