Jeff Ciaramita says being an effective chief physician executive starts with listening and being present.
The new chief physician executive of the Mercy health system's Mercy Clinic says it is essential in his new role to serve as an effective intermediary between clinicians and the health system.
Jeff Ciaramita, MD, was promoted to senior vice president and chief physician executive of Mercy Clinic in October. Mercy Clinic is a large medical group with more than 4,000 providers. The Mercy health system is based in Chesterfield, Missouri, and operates more than 40 hospitals in Arkansas, Kansas, Missouri, and Oklahoma.
Ciaramita first joined Mercy in 2008 as a noninvasive cardiologist and director of cardiovascular education. He served as section chief of cardiology at Mercy Clinic St. Louis for more than five years, then became president of Mercy Clinic South in 2017. In 2019, he became president of Mercy Clinic St. Louis.
HealthLeaders recently talked with Ciaramita about his new role. The following is a lightly edited transcript of that conversation.
HealthLeaders: How can a chief physician executive serve as an effective intermediary between clinicians and their health system?
Jeff Ciaramita: At the minimum, this is one of the most critical parts of my role.
Number One, a chief physician executive can serve as an intermediary by understanding what is going on at the local level. You need to be present and to ask the questions that need to be asked.
Secondly, it is also my role to understand the overall strategy of the ministry. Our primary strategy is to keep our patients at the center of everything. If our clinicians and their teams do not understand that underlying strategy, there is no way that they will be able to understand or accept the things that we need to do to evolve, or to get them the supports that they need to deliver care in their practices.
Lastly, from a strategy perspective within Mercy, most of our strategies to deliver superior clinical care come from our clinicians. So, it is very important for us to identify early on who can help guide us in the next generation of leadership and to look at ways to innovate and to transform healthcare. I need to find ways to collaboratively use my greater than 4,000 providers and their expertise to deliver care for the health system.
HL: What are the keys to success for a chief physician executive?
Ciaramita: First, it all starts with listening and being present. You need to listen to providers. You also need to understand the workforce, which includes physicians, advanced practice providers, and the staff who support them. You need to be willing to sit down and listen to what they have to say rather than tell them how healthcare should work.
Close behind is leading innovation. Healthcare has always been evolving and the rate of evolution today is probably faster than it has ever been, so you must be willing to fail. Part of innovation is failing along the way. In healthcare, physicians have been historically driven by evidence-based medicine and first do no harm. The training of physicians today completely goes against innovation and the willingness to fail.
HL: What are the primary elements of physician engagement at a large medical group?
Ciaramita: You must be present. COVID throws a wrench into that, but engagement is only possible when you are locally present and meet with the people who are responsible for delivering the care.
The second phase of engagement comes when you not only listen up front but also provide support. Listening will only get you so far—understanding how you need to support your physicians is important. You must follow up with support.
Lastly, with every large medical group, including Mercy Clinic, engagement comes down to the practice level. The Mercy health system likes to say we have one care model, and we have many operating and clinical standards that we know can deliver high quality care. But the reality is that engagement in a large medical group comes down to the relationships and collaboration with our practice managers. The focus is individual locations and making sure that despite a singular care model that they are still being heard and understood.
HL: How can a chief physician executive help to address provider burnout?
Ciaramita: Burnout is present unequivocally and unquestionably in physicians, advanced practice practitioners, and our other staff members. Until everybody in the health system acknowledges that, we will not be successful in addressing it.
I need to truly understand what leads to dissatisfaction from a provider's perspective. Burnout could be the result of working too many hours, but it could also be the result of ongoing non-employment issues, lack of support, or performing unwanted job duties. For example, a provider might think they went to medical school to operate on patients, but they spend a significant amount of their day writing notes and charting in the electronic health record, which they never wanted to do.
I need to understand the factors that lead to provider dissatisfaction, then find the tools that can minimize those distractions or sources of dissatisfaction. We will never find that out unless we address burnout individually with every single provider in our ministry.
HL: Are there examples of what you would like to do to address burnout as a chief physician executive?
Ciaramita: I would like to expand programs and minimize the stigma of burnout. I would also like to change the perception of the term burnout—we must realize that the possibility for burnout is going to exist for every single physician. Burnout is a universalizing term to say, "There are areas of my job as a care provider that I absolutely love, and there are other areas that I struggle with." I want to help find the tools for those areas that people struggle with or those areas that create dissatisfaction to allow providers to practice at the top of their license and be able to focus on areas that they enjoy.
I also want to encourage flexibility. In healthcare, taking care of the overall health of a community is not an 8 a.m. to 5 p.m. job. So, our approach to our providers might be creating opportunities for them to deliver healthcare in nontraditional manners and nontraditional hours. From a provider's standpoint, that creates another opportunity for us to be able to deliver care in ways that provide more joy and can address burnout individually.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
A chief physician executive should provide leadership in innovation.
In a large medical group, physician engagement involves listening to clinicians and supporting them.
To help address physician burnout, a chief physician executive must understand what leads to dissatisfaction from a provider's perspective.