It is no secret that many clinicians are burnt out and resentful. Recent studies have concluded that only 20% of physicians are engaged (Kaissi, 2014; Sweeney-Platt, 2016). Older physicians complain about administrative burdens, electronic medical records and lack of autonomy, whereas younger ones are dissatisfied with their work-life balance and incomes (AMA, 2017). As a result, some physicians are transitioning into management positions because they think management will be easier, more lucrative or because they want to change the system from the inside, according to Dr. Todd Thames, staff physician at Grand Rounds Inc. and Adjunct Professor at Trinity University (Thames, 2017).
About 96% of health systems have a system-level physician executive, with the majority of these executives having been in their positions for two years or less (Advisory Board, 2016). Health systems pay their physician executives generously, with median compensation at about $350,000 per year (AAPL, 2016). However, once in executive positions, physicians face significant challenges. Many health systems just throw them into administration with no formal management education or leadership experience. They wrongly assume that just because the physician is an excellent clinician or researcher, he/she will automatically become an excellent leader.
As a Professor of Healthcare Administration and Executive Coach, I have worked with many physicians who have found themselves stuck in transition: their clinical training and experience have ill-prepared them to the new realities of administration and leadership. “What makes the situation even more challenging is that other practicing physicians do not see you as one of them anymore, while non-physician executives do not see you as one of them yet,” says Dr. Richard Marple, Chief Medical Officer at Stone Oak Methodist Hospital and Northeast Methodist Hospital (Marple, 2017).
In the face of these challenges, what can physician executives do to get unstuck and fulfill their potential as high-performing healthcare leaders? Here are some suggestions that physicians could benefit from considering:
Seek a Masters’ degree in Healthcare Administration (MHA)
Physicians go through long years of formal education and residency, so the idea of going back to school may not be that appealing. However, if you are serious about a career in leadership, then a graduate degree is a must. Physicians are used to being the experts in their specific area, so the lack of knowledge in the technical components of management can create pressure and stress. Even physicians who already have some experience serving as a clinical department chair or director of a clinical area often find themselves severely lacking in terms of basic management and financial competencies. An MHA from the right program can help those clinicians gain a more comprehensive understanding of the wider healthcare system, while gaining crucial skills in strategic thinking, accounting, economics and organizational behavior. Each physician comes in with a deep knowledge of their specific area, or tree, but an MHA allows them to grasp the whole system and be able to see the entire forest.
Participate in a Physician Leadership Program (if possible).
Many progressive health systems today are offering in-house leadership development programs or contracting with external consulting companies. In the past, many of these programs consisted of “periodic seminars, intermittent speakers and lightweight instructions” (AAPL, 2015) with only a modest effect on performance (Straus, 2013). However, recent programs are starting to focus more and more on action-learning through problem-solving and special projects within the organization (Duberman et al, 2015). Most new physician leaders do not have a deliberate leadership style, other than the autocratic style of “my way or the highway” (Lee, 2010; Winters, 2013; Minor, 2017). A report comparing physician and business executives concluded that physicians’ leadership style included behaving like a subject matter expert and not engaging in consulting others, while their thinking style was action-oriented with a strong desire to move towards solutions quickly. Business executives, on the other hand, are more flexible and explore different options before acting (Campbell, 2007). So if your organization offers a leadership program, make sure that you are considered for participation. Not only will you gain valuable leadership skills, but you will also get the opportunity to meet many of the current and up-and-coming leaders in your organization, which will significantly facilitate your transition.
Work with an Executive Coach
In the old days, executive coaches were hired by health systems to work exclusively with so-called “problem physicians” who engaged in disruptive and abusive behaviors. While these rescue missions are still necessary in some situations, most executive coaching today is done to help physicians maximize their leadership potential by gaining a better understanding of themselves and improving their management of others. When I work with physician leaders in transition, one of the first things that I do is have them take a personality assessment such as the Birkman Method and an emotional intelligence test such as the EQi 2.0. For most of them, that is the first opportunity in their career to take the time to better understand themselves and their own leadership style.
Dr. Eric Appelgren, anesthesiologist and previous Vice-President of Operations and Clinical Services at St. Anthony’s Medical Center in St Louis, asked his organization to hire an executive coach for him when he transitioned into his new position. “The Executive Coach helped me work through some important things that I was going through,” he explains. “For example, as a physician, you are used to getting instant feedback every single day from patients, family members and nurses. In management, that daily feedback or affirmation goes away. You don’t get anything for weeks or months- it is huge. I didn’t see that coming and it was frustrating. Some will back off from administration because of that. For me, it was shaking the patients’ and their family members’ hands before and after surgery. I had 20 years of training that allowed me to take care of them and make them feel better. They thanked me all the time. It becomes like a drug, you get addicted to that feeling. The coach helped me recognize that feeling and work on ways on which I can get gratification in my leadership position” (Appelgren, 2017).
In addition to discussing feelings and taking steps to deal with them, it is well documented that coaching can result in measurable improvement in behaviors and outcomes. In one study, 96% of organizations reported to have seen individual performance improve since coaching was introduced, and 92% reported seeing improvements in leadership and management effectiveness (Coaching Counts, 2007). In another study, coaching contributed to the development of important competencies such as leadership behavior (82%), building teams (41%), and developing staff (36%) (Parker-Wilkins, 2006). Moreover, the effects of coaching are far-reaching: it can impact individual skills and behavior, team performance, and organizational outcomes. About 77% of coached executives indicate that coaching had a significant or very significant impact on at least one of nine business measures, with productivity (60% favorable) and employee satisfaction (53%) topping the list (Anderson, 2001).
The importance of smooth physician transition into leadership positions in healthcare cannot be overstated (Goodall, 2011). Physician executives who are serious about their intention to change the system from the inside can benefit from formal management education, leadership development and executive coaching.
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Dr. Amer Kaissi is a Professional Speaker, Executive Coach and an expert on Leadership, Humility & Ambition, Assuming Positive Intent, Psychological Safety & Accountability, Growth Mindsets & Resilience.
