Published in the March 2019 issue of Today’s Hospitalist
FOR HOSPITALISTS who think they’d like a seat in the C-suite, the opportunities have never been better. From chief quality officer to chief medical officer and VP of population health, these jobs aren’t only plentiful, but they seem tailor-made for hospitalists.
But before you decide to enroll in business school or go after a group leadership position to start blazing a trail to the executive floor, you might want to take a step back and ask yourself why you’re interested in a leadership job in the first place.
“Do you want to move into an executive position due to a real interest?” asks David M. Grace, MD, senior vice president and group medical officer of Schumacher Clinical Partners, a national physician staffing company based in Lafayette, La. “Or are you burned out and think leadership could be an alternative to your current clinical role?”
In Dr. Grace’s experience, “a fair number of folks say that burnout is what motivates them to want to become an executive.” That’s why he recommends hospitalists start with some serious soul-searching to figure out if leadership really fits their personality and plays to their strengths.
“Leaders need to figure out processes 90% of the time, but doctors always look at only the 10%.”
~ Kimberly Bell, MD, MMM
He and other physician leaders say that the No. 1 mistake aspiring hospitalist executives make is choosing careers that don’t fit their personalities, skills or work ethic. What doctors may not realize, they point out, is that the jobs of clinician and chief differ dramatically. Can you handle multitasking? Do you like having patients appreciate you every day, and are you OK letting that go? Would you be willing to up and move and then relocate again, and can you tolerate risk?
As a doctor, you’re used to giving orders. As an executive, you make requests instead, and your goal is to influence and negotiate. “Do you have those skills?” That’s what Jasen W. Gundersen, MD, MBA, president of TeamHealth’s acute and post-acute care services, says he asks young hospitalists who come to him for advice on how to get his job.
And don’t assume that an executive level job is an antidote to burnout. “I don’t want hospitalists to go to an executive level thinking that it is less stressful work than clinical work because, in some ways, it is more stressful,” says David J. Yu, MD, MBA, who has held leadership positions in both hospitalist groups and health systems and is currently medical director of a health plan in Albuquerque. “They should not do it because they find clinical work difficult.”
If you’ve thought of testing the waters for a leadership role, you know that hospitalists are in great demand. With business models stressing value over volume, health systems need senior executives who have boots-on-the-ground experience with achieving high-quality outcomes.
“You can’t fake it for too long.”
~ Titilola Britto, MD, MBA
Aurora Health Care
But all the clinical experience in the world won’t help you in a leadership position if the fit isn’t right. As a clinician, you’re probably so well-trained that you can be unhappy in your role as a hospitalist and still deliver high-quality care. But that’s not necessarily the case for doctors unhappy in an executive role.
“As an executive,” Dr. Grace says, “you live in a world with increased complexities and ill-defined solutions that demand creativity. If you are unhappy, you are less likely to devote the time and energy needed to solve those complex problems and generate results.”
And even when leadership is a good fit, hospitalists face knowledge gaps that can leave them feeling in over their heads. Kimberly Bell, MD, MMM, has held many leadership posts in both local and national hospitals and health systems and is now the Tacoma, Wash.-based regional medical director for TeamHealth West. She points out that physicians don’t train in Lean thinking—or any other process approaches—in medical school.
Dr. Bell was recently working with a young hospitalist director who needed to help a program come up with a standard way to admit patients from the ED. As with many doctors, she says, that young leader didn’t really understand the process methodologies behind that handoff, only individual patient characteristics.
“You need to become bilingual, speaking both medical and financial language.”
~ Dean Dalili, MD, MHCM
“It was a struggle,” Dr. Bell points out. “Leaders need to figure out processes 90% of the time, but doctors always look at only the 10%. One challenge is how to change your frame of reference.” Another challenge is conflict avoidance, Dr. Bell adds. “Your job is to not just let it go” when a problem needs fixing. “As a leader, your responsibility is to remove obstacles and lean into conflict.”
How to prepare
Some educational and “emotional intelligence” deficits, Dr. Bell says, may stem from inexperience. Historically, physician executives used to be seasoned doctors ready to scale back their clinical practice and do something different.
Hospitalist leaders, by comparison, tend to be in the middle or even the beginning of their careers, Dr. Bell explains. “We are sometimes pushing people who may not be prepared for executive roles,” she says, “because the specialty is young, the pace of expansion is huge and the need for leaders is great. There are not enough hospitalists or medical directors.”
The good news is that aspiring hospitalist leaders have ways to prepare themselves, whether by studying for a master’s degree in business, health administration, health care management or medical management, or choosing continuing education in business- or leadership-related fields.
Dr. Bell finished her MMM degree last year after practicing medicine for 25 years. She says that having a credential— specifically, some sort of master’s—is now “almost required” of aspiring physician executives. Checking off that box may be even more essential, she points out, when candidates don’t look like most people in C-suites (read: women) or when they’re seeking jobs outside of their own hospital and want headhunters to notice them.
“Hospitalist executives in general have a relatively short shelf life.”
~ Thomas McIlraith, MD
Mercy Medical Group
Titilola Britto, MD, MBA, president of hospital medicine for Milwaukee-based Aurora Health Care, which merged recently with Illinois’ Advocate Health Care, recommends that if you think you want to become an executive, “spend at last 50% of your CME, if not more, learning the business of medicine, process improvement, rudimentary project management skills and leadership.” The bottom line, she says: “You can’t fake it for too long.”
Dr. Britto started studying for her MBA after 18 years in primary care, nephrology and hospital medicine, serving in several medical director and CMO positions. “I had wandered into leadership,” she says. “When I decided to take it seriously, I realized I needed a different perspective.”
With experience, Dr. Britto has also come to believe that physician leaders need to continue practicing clinically, even as it becomes more difficult to juggle patient shifts with never-ending administrative work. The “credibility” of physician executives, she says, comes from “people thinking you are a good clinician.”
“I meet people who have gotten their MBAs and now want to stop clinical care,” says TeamHealth’s Dr. Gundersen. “I say that if you don’t do any clinical care, then you are just someone who has an MBA and costs more.”
“As an executive, you have a much higher risk of losing your job related to factors outside your control.”
~ David M. Grace, MD
Schumacher Clinical Partners
You can’t erase, he adds, “the MD or DO after your name. People hire you because you are a doc with an MBA, and they expect you to have doctor skills. You have to work clinically until you have enough on your resume that people are not going to question you.” Dr. Gunderson figures he is just reaching that point now, 13 years after his first leadership post.
Most executive roles “require you to exert leadership through the ability to influence rather than having the authority to hire and fire or allocate resources,” says Dean Dalili, MD, MHCM, the Houston-based president of hospital medicine for Envision Healthcare. “That doesn’t mean you don’t have power, but it does mean you need to think about how you influence people differently than just making decisions.”
And a physician leader’s ability to influence, Dr. Dalili adds, comes in part from likability, communication and negotiation skills—but also, importantly, from credibility “based on the caliber of the clinical work you do.” What doctors in executive roles have to strive for, Dr. Dalili adds, is this: “You need to become bilingual, speaking both medical and financial language and understanding business and clinical processes. A great physician leader is someone who can translate.”
But New Mexico’s Dr. Yu says that he would rather have a physician leader who gets results and does no clinical work than one who puts in clinical time and whose program is a disaster. “At the end of the day, your superiors and frontline hospitalists want a physician leader who’s an effective physician leader.” And if you’re a physician executive who doesn’t have a good clinical reputation? “You are starting out with one hand tied behind your back.”
Do you have real authority?
Then there’s this factor: Many new leadership posts, particularly in health care organizations that are strapped financially, come with little more than a title, which can leave hospitalists who are leaders or executives feeling handicapped.
Thomas McIlraith, MD, who served as chair of hospital medicine at Mercy Medical Group in Sacramento for 12 years, calls this the “authority-accountability” equation. “This comes up a lot in hospital politics,” Dr. McIlraith explains. “People want a fall guy, someone to be accountable when things don’t turn out right, but they want to keep all the authority.”
The only way to succeed within that equation, says Dr. McIlraith, is to make sure you have the resources you need to deliver the results expected of you. (Dr. Yu notes that it helps to have “some business acumen to know how to ask for resources—like framing it in terms of return on investment—in a way the C-suite understands.”) When Dr. McIlraith mentors up-and-coming leaders, he recommends that they negotiate for “direct links” with the CEO or board of directors before they even accept a title. “If they are going to make you accountable for things,” he says, “you need executive sponsorship, authority and access. One of the worst mistakes a physician leader can make is to promise something and not deliver.”
Can you stomach risk?
Nearly 14 years after finishing residency, Dr. Dalili looks back on all the mistakes he made in his first physician leadership role. He admits he didn’t know how to listen, negotiate, influence, think systematically, resolve conflicts and communicate clearly. Perhaps not surprisingly, he says, “I wasn’t successful.”
It took some soul-searching, but Dr. Dalili figured out what went wrong. “These were my weaknesses, and they are all essential skills,” he says. “So I went and got a master’s and learned how to do all that better.”
That soul-searching also helped him realize that an executive career will inevitably be less secure than that of a clinician, something he says he is fine with. But others are not.
As Dr. McIlraith points out, “Hospitalist executives in general have a relatively short shelf life. Physicians who go down that pathway not only face the prospect of a new mortgage and town” every few years, but also “the possibility that eventually there may not be a job for them.” Physician executives do get fired, or they see their post eliminated due to a merger or acquisition. For Dr. McIlraith, that prospect was part of his decision to no longer keep climbing an executive ladder but to return instead to full-time clinical work.
“When thinking about making the leap from the bedside to an executive position,” says Schumacher’s Dr. Grace, “hospitalists really need to weigh their acceptance of risk. As an executive, you have a much higher risk of losing your job related to factors outside your control.”
Deborah Gesensway is a freelance writer covering U.S. health care from Toronto.
Get educated to fill in the business and practice management gaps you didn’t learn in medical school. That doesn’t necessarily mean business school. “An MBA with no experience is just another credential,” says Jasen W. Gundersen, MD, MBA, president of TeamHealth’s acute and post acute care services. “MBAs don’t make leaders; MBAs make leaders great.”
David M. Grace, MD, with Schumacher Clinical Partners, recommends taking as much non-clinical CME as you can find and getting involved with hospital committee work. “Local leadership positions will let you find out if the role of physician executive is appealing to you,” he says, “and you’ll meet lots of people who are potential mentors.”
“You really need to be able to select your own team.”
~ David J. Yu, MD, MBA
Cultivate sponsors as well as mentors. Sponsors are people at your facility who can advocate and vouch for you. As Kimberly Bell, MD, MMM, TeamHealth’s West Division hospital medicine regional medical director, explains, “You need someone inside who can say, ‘I know Dr. Bell and have faith in her. I support and sponsor her consideration, so let’s give her a chance.’ ”
Titilola Britto, MD, MBA, president of hospital medicine for Aurora Health Care, likewise recommends that hospitalists cultivate more than just mentors. “Seek out your own board of directors—and also find people outside health care that you can bounce ideas off and get some perspective.”
Negotiate up front for the resources or authority you need to do your job. Thomas McIlraith, MD, a past chair of Mercy Medical Group’s hospitalists in Sacramento, points out that there came a time during his leadership stint that his administrative dyad partner felt she was being undercompensated and wanted to leave. Fortunately, he could go directly to the top of the organization and get her the raise she needed.
Also keep in mind, Dr. McIlraith says, that “your ability to negotiate is the highest when you are starting the job. Leaders should say, ‘My dyad partner is essential to my success. I need the authority to make sure they support me in my success—and if they are not working out, I need the authority to say I need a new one.'”
David J. Yu, MD, MBA, who has held leadership positions in both hospitalist groups and health systems, agrees. “One thing I realized is you really need to be able to select your own team, especially if you are in a dyad structure,” he says. “It’s imperative that you have a say in who that partner will be.”
Listen and learn before you leap to make changes or otherwise roil the waters. “Your situational awareness is pretty minimal” when you start a new job, says Dean Dalili, MD, MHCM, president of hospital medicine for Envision Healthcare. Unless you are “walking into a firestorm,” new executives should “try to avoid taking any significant actions in their first 90 days.”
Look the part. It may seem trivial, but Dr. Britto says aspiring hospitalist leaders can disadvantage themselves by not dressing like an executive. “Wear a blazer when you go to a meeting, not a white coat and scrubs.” Paradoxically, while physician executives are hired in part because of their clinical skills, “people don’t take them as seriously as executives when they’re wearing a white coat.”