A Roadmap to Leadership for Young Physicians

Improving cost, quality, and outcomes is not accomplished only from the C-suite, it requires strong leadership from within operating rooms and physician offices.

Developing capable physician leaders is one of the many priorities healthcare executives name as a component to delivering a better patient experience, as well as improving costs and outcomes.

Hospitals, healthcare systems, physician groups, and insurers realize the value of having a physician champion in their corner, especially with the massive paradigm shift in healthcare right now. A strong physician leader—formal or informal—can impact process improvements, from reducing readmissions to perking up patient satisfaction scores.

Ali Rahimi, MD, director of performance improvement development and cardiovascular quality at Atlanta-based Southeast Permanente Medical Group, teaches a four-day performance improvement course that is open to anyone in a management position at a multi-specialty practice that is the contracted physician arm for Kaiser Permanente (KP) of Georgia.

"It's important to teach our young physicians the complexity of the healthcare system," he says.

A Broad Perspective
Rahimi is 41-years old, and is a fellowship-trained cardiologist, but before going to medical school, he received his master's degree in health policy and management. That education opened his eyes to the intricacies of health system performance and helped set him on a course toward becoming a physician leader who wants to develop leadership capabilities in other physicians, too.

"I wanted to get a public health perspective," says Rahimi. "I knew the medical degree wouldn't prepare me for that. I think having that public health experience gave me the underpinnings of having a better voice and being an active participant in the science of performance management."

To be a physician leader, it's not necessary to earn an additional master's degree, though many of today's disruptors and innovators have MBAs.

Rahimi says an important part of the class is the variety of participants. They include physicians, hospital case managers, operations directors, front office managers, and pharmacy techs among others.

"In order to improve performance, you have to bring everyone in; it's not filled with doctors," says Rahimi. "You have to teach them the science of process improvement, such as how to look at data. It gives them a new perspective on how they can solve a problem. That's how we go about getting better."

Once the four-day class is over, the "graduates," as Rahimi calls them, return to their departments tasked with working on performance improvement project. The course is offered twice a year and is spread out over four months—one session per month. So far, the class has graduated 35 management team members over the last three years. Rahimi says this year's next class will have 29 health system leaders attending—its biggest class ever.

Generational Hurdles
One challenge that remains, even for a large, integrated health delivery system like KP of Georgia is the generational divide between younger and older physicians.

"It's hard; it's difficult," says Rahimi. "It's like coming from two different countries."

To bridge that gap, Rahimi recommends that physicians of all ages get involved in their medical associations and local societies because it is a neutral forum.

"You have to understand where older physicians are coming from," he says. "What are our shared goals and perspectives? Having physicians in larger practices who have a sense of the challenges in the smaller practices is one way to bridge the divide, and [another] way we minimize it is we need physicians to be active in organized medicine."

According to a survey of 20,000 physicians in 2014 by the nonprofit Physicians Foundation, 58% of physicians in the U.S. are under 45, and of that group, 66% are employed by a hospital or medical group. The trend toward employed physicians is expected to continue growing, but it's not clear if physician satisfaction grows with employment, too.

Physician Burnout Heavily Influenced by Leadership Behaviors

Some physicians find shelter from administrative burdens and declining reimbursements in an employed model, which relieves the hassle of being a business-owner. But employee status can introduce a new set of frustrations, such as lack of control over patient care.

It seems the variable is dependent on the business model of the organization where a physician works. Rahimi says he intentionally sought out employment within KP of Georgia because he saw healthcare transformation on the horizon and the organization's structure supports value-based care.

"I see 14 cardiology patients a day, and I spend 30 minutes with each patient," says Rahimi. "In private cardiology practice, it's more like 25 to 30 patients a day. I'm in the minority, not everyone has this benefit, but with a system this big, there are challenges."

Physician leadership is a strategic focal point for all organizations. For example, within particular hospital service lines, physician leadership is a growing concern, says Katy Reed, a consultant with ECG in Seattle.

"The governance piece is important," she says. "A lot of organizations contend that physician involvement in the cardiovascular service line key, but they have to be interested in wearing multiple hats."

Identifying which hat a physician needs to wear may be an important issue, but so is realizing that the onus isn't entirely on the physician. Rahimi says healthcare organizations—big or small—have to realize the importance of bringing in a physician as an equal partner.

"We are just one component," he say, ticking off the other healthcare stakeholders such as lab, imaging, medical records, and hospitals that all are touch points of patient care. "That's the concern physicians have: The ownership of the risk should be shared by everyone. We recognize it's not just the physicians. It's a system issue, and we need to get better at process management."