What Is a Physician Executive Anyway?

I've noticed a lot of angst and hair pulling deciding the appropriate role of doctors in managing or leading a clinical enterprise. Some doctors see being a physician executive as a "get out of jail free card,” relieving themselves of having to see patients to generate their incomes. Others take a more high road approach, claiming they can leverage their ability to make changes at the institutional level.

If you are thinking of doing some personal rebranding and transforming yourself into a physician executive, or assuming an administrative or leadership responsibility with a different title, here are some things to consider:

1. The precise definition of "physician executive" is vague and nebulous. Hospitals and search firms are looking for them, doctors want to be one, but the defining knowledge, skills and abilities, roles, and responsibilities seem to be at odds.

2. Like physicians and technologists, some doctors are from Venus and administrators are from Mars

3. There is increasing tension between corporate values, represented by hospital or organizational leaders, and patient and physician- centric values, represented by medical staff leadership

4. Too often, the focus is on managing knowledge technicians, not evolving staff into leaders, intrapreneurs and ‘leaderpreneurs’

5. Innovation is too often career suicide

6. The differing compensation models and amounts for doctors and administrators create resentment. Doctors get paid mostly fee for service reimbursement to see patients and an "administrative stipend". Administrators get bonuses and upside kickers allowing them to share the upside of innovation or ‘financialization’. Maybe it's time to pay doctor leaders like football coaches who turn around a losing team into a playoff contender.

7. Exchanging the white coat for pin stripes often means having to leave the reservation with all that comes with it. In many cases, it means sacrificing tribal ties and loyalties.

8. The attractiveness of being a physician executive is driving wasteful and ineffective business education programs, degrees, certificates, and professional associations

9. When it comes to institutional loyalty, engagement and alignment, there is a big doer-decision maker gap

10. Physician leadership contributes to organizational success.

One solution to closing the gaps is to give doctors some PEARLS. The Commonwealth Fund defined 6 attributes of an ideal health system:

• Information Continuity Patients’ clinically relevant information is available to all providers at the point of care and to patients through electronic health record systems.

• Care Coordination and Transitions Patient care is coordinated among multiple providers, and transitions across care settings are actively managed.

• System Accountability There is clear accountability for the total care of patients. (We have grouped this attribute with care coordination, since one supports the other.)

• Peer Review and Teamwork for High-Value Care Providers (including nurses and other members of care teams) both within and across settings have accountability to each other, review each other’s work, and collaborate to reliably deliver high-quality, high-value care.

• Continuous Innovation The system is continuously innovating and learning in order to improve the quality, value, and patient experiences of health care delivery.

• Easy Access to Appropriate Care Patients have easy access to appropriate care and information at all hours, there are multiple points of entry to the system, and providers are culturally competent and responsive to patients’ needs.

Achieving these goals requires the right balance of clinical and business leadership and there are many examples of high performance sick care organizations. Many are physician led. However, others are having a hard time finding the right leadership balance. As a result, some physician executives find themselves with a noose around their neck, not a stethoscope.