CMO Exchange: 3 Key Takeaways

Three of the hot topics at last week's HealthLeaders CMO Exchange were physician burnout, CMOs as liaisons, and the role of advanced practice providers.

Last week's HealthLeaders CMO Exchange focused on the top issues facing CMOs, chief clinical officers, and chief physician executives across the country.

HealthLeaders convened nearly two dozen CMOs, chief clinical officers, and chief physician executives from leading health systems and hospitals, including Yale New Haven Health, UW Health, OhioHealth, and RWJBarnabas Health. The event was held at the Hotel Effie Sandestin in Miramar Beach, Florida.

Physician burnout and wellness

Physician burnout was identified as one of the pressing issues facing CMOs.

"The top concerns for CMOs are maintaining the quality and safety of patient care delivery at our hospitals, while also maintaining physician integrity," says Seth Rosenbaum, MD, senior vice president and CMO of RWJBarnabas Health's Robert Wood Johnson University Hospital Hamilton. "As we know, burnout has become a concern as well as physician attrition and the rates of physicians leaving private practice."

"Physician engagement and physician burnout are high on the list of CMO concerns," says Candace Robinson, MD, CMO of Touro_LCMC Health. "I think there are ideas on how to address physician burnout, but no good clarity on what would be most effective at this point."

Physician burnout cannot be addressed in isolation from burnout in other healthcare workers, Robinson says.

"We need to have burnout programs that are for everyone, not just physicians, because we affect each other," Robinson says. "The nursing burnout is real—there is burnout across all of healthcare. COVID had a profound impact on burnout. Looking at the data from the American Medical Association, it looks like it is getting better, but it hasn't changed too much."

CMO's role as intermediary

CMOs play an essential role as the liaison between a healthcare organization's clinical staff and administrative leadership, Rosenbaum says.

"Traditionally, the CMO has been the liaison between the medical staff and the administration," Rosenbaum says. "The CMO has been the clinical person that understands both sides of care delivery. The CMO is supposed to help mediate differences between the administration, which sets policies and procedures, and the medical staff."

The intermediary role can be challenging, according to Rosenbaum.

"Sometimes, the medical staff says taking care of patients does not necessarily follow the policies and procedures that administration is establishing," Rosenbaum says. "The CMO must make both sides understand that in the interest of patient safety and patient care, both sides are working to the same goals. CMOs need to figure out a happy medium to get the job done and to make sure that we can provide the quality of care that our patients expect."

Working in a clinical role alongside their administrative duties can be helpful for CMOs to succeed as intermediaries, according to Robinson.

"I am not just sitting in a room during a meeting with clinical staff—I am working alongside them," Robinson says. "Many successful CMOs have at least a little dedicated clinical time, which is helpful in maintaining the connection between the administration and the frontline clinical team."

Role of advanced practice providers on care teams

APPs play a crucial role in today's practice of medicine, according to Rosenbaum.

"The physicians are overwhelmed with the volume of work in the timeframe allowed to do that work," Rosenbaum says. "They feel constantly pressured to see large numbers of patients in a short period of time. APPs can help mitigate that pressure."

APPs can perform clinical duties under the direction of physicians, according to Rosenbaum.

"We can have the ancillary support of qualified independently licensed practitioners such as APPs to assist physicians on clinical duties on a day-to-day basis," Rosenbaum says. "You must be able to find APPs who are able to do the work under the supervision of a physician."

APPs have an essential role to play but there are limitations, according to Rosenbaum.

"As long as everyone is on the same page, APPs will take on an expanding role in healthcare," Rosenbaum says. "We are seeing this across service lines, whether it is in the emergency department, the hospitalist medical service, or the outpatient arena."

Staffing realities make APPs crucial for care teams, according to Robinson.

"APPs are necessary to allow us to provide access to care for patients," Robinson says. "We just do not have enough physicians to take care of all of our patients."

The physician workforce is not going to be able to see enough patients without the help of APPs, according to Robinson.

"For example, if you have a large quantity of patients coming through an emergency room setting, the physicians need to be the ones taking care of the higher acuity patients, but APPs can be taking care of patients who have a lower acuity level and manage those patients, knowing physicians are there to answer any questions that arise," Robinson says.

Physicians should provide complex care, and APPs are qualified to help physicians manage patients who have complex conditions, according to Robinson.

"Given the way physicians are trained and the amount of clinical experience physicians gain during residencies, physicians should take care of the higher acuity patients. Those are the patients that physicians should be managing," Robinson says. "If an APP encounters a patient who is seriously ill, they can help manage that patient while knowing they have a physician who is available to help them with that management."

Most care teams should be physician-led, but there are circumstances where an APP can lead a care team, according to Robinson.

"It depends on what the team is leading. It depends on what type of initiative is involved," Robinson says. "The more medically complex initiatives probably need to be physician-led. In less complex initiatives, an APP can be an acceptable leader."

At Robert Wood Johnson University Hospital Hamilton, APPs play leadership roles in areas that do not require a high level of clinical expertise, according to Rosenbaum.

"We have our observational length of stay initiative, which has leadership roles for APPs," Rosenbaum says. "There are other initiatives that have hospitalist APPs and emergency department APPs leading on throughput issues, progress notes, and documentation."

The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.

Please join the community at our LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.

Image: CMO Exchange members attend a sunset dinner cruise at last week's event.