Over the past decade, there has been an explosion in the number of health systems recruiting high level physician leaders. We have also begun to see the rise of the physician hospital CEO. But we still need more physician leaders. Here is a list of reasons.
Shift of Balance of Power
In the 20th century, most medical care was provided by independent physicians, either individually or in groups. The number of hospitals and hospital beds grew from the beginning of the century and peaked in about 1970. During that time, much of the care shifted from the home into the hospital setting, enhanced by the growth in new technology, better anesthesia, new surgical techniques and more intensive care beds.
Historically, the medical staff was an independent organization within the hospital organizational structure, with fairly autonomous physician governance. Under this model, a hospital CEO and board needed to collaborate with the independent medical staff to implement new service lines and new policies and procedures.
During the past two decades, there has been an increasing shift from independent practice to employment of physicians. This has eroded the autonomy of physicians and led to commoditization of their services. In turn, physicians have encountered less control over their work and less power in determining the direction of the health system.
Physicians can feel misunderstood and disrespected in an employment model. This causes disengagement, mistrust, and turnover in the physician workforce. Skilled physician executives can help healthcare organizations to better understand and communicate with their physicians. Such executives can build trust and loyalty.
Demand for Integration of Value and Quality
There is a strong push by payers to link payments to quality. It is no longer simply a matter of increasing volume and holding down expenses. And no one is better positioned to understand and manage the interplay between quality and costs than physicians with training in healthcare finance, quality, safety, and population health. A motivated physician is the best case manager.
Evidence Suggests Content Experts Lead More Successful Organizations
Evidence shows that content experts tend to be more successful leaders in large organizations than even highly skilled non-experts. A study published in 2011 demonstrated that quality measurements in cancer, digestive disease and cardiac medicine were 25% better in hospitals run by physicians. This doesn't mean that there aren't some fantastic CEOs and COOs who don't have the MD or DO credential. But having a deep understanding of medicine and the needs of patients can translate to better outcomes.
In a recent comparison of the top quality hospitals ranked by U.S. News & World Report, a strikingly high percentage of top quality organizations were run by physicians. Even though physicians make up a tiny percentage of all hospital CEOs, ten of the 18 Honor Roll hospital systems were physician-led. Some of the more well-known systems include Johns Hopkins Hospital, Massachusetts General Hospital, Mayo Clinic, Cleveland Clinic and UCLA Medical Center. And the majority of successful Accountable Care Organizations are led by physicians.
There are may health system CEOs that are very capable at balancing financial performance and patient care. But leaders whose primary training and background is in business (MBA, MHA, etc.) seem to be focused first on cash flow, expenses, and financial performance. Physician leaders tend to focus on the patient first, while also assuring financial performance and sustainability.
There is Demand for Physician Executives
Given these and other considerations, it is no wonder that there has been a tremendous demand for physician executives. Recruiters report that systems are no longer just looking for physician service line leaders and managers. Systems are actively seeking well-trained and experienced physician COOs and CEOs to lead their organizations. They report three or four open positions for each high level physician executive placed.
There are multiple factors contributing to the demand for executive physicians. And there is no better time than now for engaged physicians to step up and accept the challenge of leading our healthcare organizations.
Can you think of other reasons that we need more physician executives?