For eight years, the top doctor at the 496-bed Northwest Community Hospital in Chicago was, in fact, a doctor—but with an asterisk. Besides being a non-practicing doctor, he couldn't practice because his medical license had expired in 1999.
In June, Leighton Smith, MD, left his position as chief medical officer and vice president of medical affairs. The C-suite knew he wasn't a practicing physician, and the top brass didn't seem to care.
The local media, however, raised questions after the fact, about whether having a CMO who wasn't a practicing physician in some way compromised the hospital's patient care efforts.
Smith's lack of a license surfaced during a Northwest doctor's internal appeal of a review, and Smith resigned shortly thereafter. Hospital executives disclosed they knew about his lack of a license when he was hired. Like many other states, Illinois doesn't have licensing rules for chief medical officers.
Now that Smith has left, Northwest Community Hospital officials are looking for a replacement. In the view of the American Medical Association and others, a licensed physician should be the hospital's chief medical officer, says Arthur D. Snow Jr, MD, chair of the organized medical staff section governing council of the AMA.
Having a license, ensures that physicians receive continuing medical education with the assurance that "the doctor's knowledge and skills remain intact," according to the AMA. Snow is a licensed physician based at Shawnee Mission Medical Center, near Lenexa, KS.
It may surprise some, but the CEO at Northwest Community Hospital tells me that they are looking for the best candidate, and sure enough, if it isn't a licensed physician, so be it.
"As we search for a new CMO, we are evaluating the broadest possible range of physicians," Bruce Crowther, CEO, tells HealthLeaders Media, which is reporting the Northwest plans for the first time. "All of our finalists will possess leadership skills to advance our mission and meet state qualifications for the position, which does not require a medical license for what is an administrative position."
"Major hospitals today require chief medical officers who can lead large teams of physicians in producing the highest-quality care and the most effective delivery of services," he adds.
So, despite the controversy over Smith, the hospital is looking for a physician, but not necessarily one with a current medical license. On one level, Crowther's decision shows a stubbornness and reluctance to give in to criticism about Smith.
By not having a licensed physician in a leadership role, however, the decision may continue to generate criticism of the hospital over issues such as patient care and malpractice that critics say could be impacted without a licensed physician in charge.
On another level, the CEO's decision reinforces the evolving nature of healthcare, in which some hospitals are looking as much at the business component of hospital leadership, as well as at the clinical piece. Crowther is clear on that.
"We are analyzing physicians who also have training in medical management, including those who have MBA degrees," he adds. "Our next CMO will have superb credentials and share our operational vision for excellence and teamwork in a patient-centered environment."
The AMA has several guidelines for the position of hospital medical director, including those in managed care positions, Snow says. While some guidelines simply address "the role of the hospital director and not what his qualifications should be," others say that a physician who is involved in making clinical decisions or involved in peer review procedures "shall hold an unlimited current license to practice medicine," he says.
"Clearly, if that is carried over to a hospital, the (CMO) should be a member of the medical staff and meet all of the qualifications of those he is interacting with," Snow adds.
Although the AMA believes licensed physicians should be in CMO positions, the organization acknowledges that there's a demand for physician leaders with increased business acumen.
More physicians are pursuing degrees beyond MD, including masters of public health, also juris doctor, and MBAs, "just to practice medicine," Snow says. Among the reasons: a more complicated healthcare terrain, especially with larger group practices "that are put together like hospitals, single specialty and multispecialty groups. They want somebody to lead that group, and for a physician to do that, it is best to have som business training," he adds.
An increasing number of physicians are getting MBAs in addition to their medical degrees, the New York Times reported last year. Since the late 1990s, the number of joint MD/MBA programs in the nation has increased from under 10 to 65, according to the Times, which noted that the "trend is being driven by the need to become more entrepreneurial and savvy as the business of medicine grows more complicated."
Smith, the former CMO at Northwest Community Hospital, apparently is now in business for himself, too. He denies that his employment ended because he is not licensed, but declines to comment further, citing a confidentiality agreement, according to media reports.
Currently listed as president of Leighton Consulting Inc. on Linked in, Smith describes himself as a "physician executive with over 25 yeas of progressive leadership in a variety of complex and diverse healthcare settings. Proven abilities in program development and improvement through teamwork, with a focus on customer service, quality patient outcomes, medical staff relations and managing institutional priorities."
When Smith was hired, leadership at Northwest believed they had found what they were looking for. At Northwest Community Hospital, the CMO is "responsible" for clinical excellence, operational effectiveness and the management of more than 1000 physicians who care for 450,000 patients a year, the CEO Crowther says.
Despite the controversy since Smith's departure, "in recent years, we have built one of the most respected medical staffs in the area," Crowther adds. He mentions a list of them: "recognition from U.S. News and World Report for six different medical specialties and the highest award from the Joint Commission, the nation's predominant healthcare accrediting body."
By not disclosing Smith's lack of a license, however, Northwest didn't help itself in being "transparent" about its medical operations. The local media says that the hospital is in a fight with rivals to gain a larger share of its market, including the fact the hospital hasn't posted an annual operating gain since 2008.
While Northwest Community Hospital evaluates who will be its next CMO and may continue to spur debate about qualifications for that position, some hospital systems don't have a CMO to begin with.
Snow's hospital, the 445-bed Shawnee Mission Medical Center, part of the Adventist Health system, only hired its first CMO nine months ago. "That came about because the CEO had perceived there would be difficulties implementing computerized physician order entry systems, and our hospital electronic medical records," Snow says. "It's a very difficult process and very difficult for physicians."
The new CMO, Larry Botts, MD, "will help us continue our tradition of open communication with our medical staff so that we can ensure we're providing the highest quality care possible for our community," said Shawnee president and CEO, Samuel H. Turner, Sr. said in a statement.
For the record, Botts is a licensed pulmonologist.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
