Many of the issues confronting healthcare organizations require physician involvement and understanding, and the physician executive is a tool to achieving physician participation. Physician leaders can become the mediators between physicians and organizational management, minimizing miscommunication and maximizing agreement and understanding. Yet few doctors seem willing to stand up and speak positively for the plans and proposals that will move the institution forward, and healthcare executives are often frustrated by physician leadership that fails to articulate and implement the vision and objectives of the organization.
Understanding physician leadership and exploring the challenges in managing and leading physicians require an understanding of the physician mindset-a completely different mindset than that of the typical healthcare executive. Beginning with a discussion of the unique situation faced by physicians in leadership positions, this article attempts to define the obstacles faced by both the physician and the executive in developing the role of physician executive. After reviewing the opportunities open to physician executives for improving leadership ability, the author presents the essential characteristics and core skills for effective leadership. The second half of the article suggests ways in which an organization can reemphasize physician leadership development within an organization from selection of potential candidates to creating training and networking opportunities and offering appropriate incentives.
"Well, that was a mess!" Hal Smith said to himself as he drove out of the parking lot at midnight. The meeting of the executive committee of the medical staff had gone on way too long-five and a half hours. "Why was Dr. Perry so difficult about this project? He sure had plenty of forewarning it was coming." As CEO of St. Mary's Hospital, Hal had worked for three months on this with his staff and had carefully prepared for the initial presentation to the medical staff. Dr. Perry, the chief of staff, had given input and advice about how to introduce the project. "And Jim Evans was no help!" thought Hal, "What am I paying that guy for?" Dr. Evans had joined Hal's management team about six months before as vice president for medical affairs. "He should be part of the program by now. We sure were blind-sided," Hal thought. The reaction to his proposal had been unexpectedly and significantly negative from all the physicians. " I don't know what we can do with such weak physician leadership," thought Hal, and not for the first time.
THE IMPORTANCE OF PHYSICIAN LEADERSHIP
For many health system executives, the term "physician leadership" is an oxymoron. Does such a thing actually exist? How can we work with the physicians, upon whom we depend so significantly, to improve the situation of our health system in our market, when the doctors seem so negative and so conservative? So few doctors seem willing to stand up and speak positively for those plans and proposals that will move us forward.
This refrain is repeated in small and large hospitals all around the country. Where are the leaders we need? Where are the visionary physicians who can help our boards and executive management convince the rest of the practicing physicians that what we are proposing is the right way to go? Physicians seem so independent; can they ever get organized to help us improve the care we deliver? How can we move on without the support of these physician leaders and without engaging practicing physicians in the vision of the health system (Shortell 1991)?
The purpose of this article is to explore the challenges of developing physician leaders within health institutions and is especially focused on community hospitals and group practices, where most of the medical care in the United States is delivered. My premises are that:
1. Leadership of physicians is unique because of the social and cultural differences among physicians. …