Hospital and health system leaders are quickly recognizing the shortage in business training that they face in their physician ranks, especially at the leadership level. But there's a difference between recognizing a deficiency and determining what, if anything, to do about it.
Do you promote someone into a clinical leadership position -- such as a chief medical officer -- without that training, with the idea that the physician will go on to get an MBA while on the job?
Physicians are highly motivated and smart, but often, doing their job and asking them to get another advanced degree is understandably too much. Are there other, less intensive ways for these physicians to get the business and leadership training they need? Or do you simply refuse to put anyone in that position who doesn't have the business degree or training already?
Both approaches are risky. There simply is a ton of competition for physicians who already have leadership training and experience, putting all but the most financially well off institutions at a disadvantage in attracting candidates from such a small pool. If you put someone in who doesn't have the training, who's to say how successful they will be at convincing their fellow doctors to follow evidence-based medicine guidelines, or to work in teams, for example?
Jeff Collins, MD, is one of the latter group. He had no business or leadership training before being promoted to a position that he says really should require it. Collins is CMO of the eastern Washington region at Providence Health & Services, a 28-hospital system based in Spokane.
"In 2006, the previous vice president for medical affairs retired and I was recruited by the medical staff," he says. "On Friday I was an internist and Monday I was the CMO."
Providence had developed a leadership academy program internally that helped doctors in positions like Collins' to get a little training in management. At the same time, Collins was encouraged by a colleague to apply to a program developed by GE and the Health Management Academy that provides training and mentoring to high potential, health system-level physician leaders to prepare them for assuming top leadership positions within their health systems. The program features some of the Six Sigma principles that made the GE management style synonymous with business efficiency and leadership development. Collins was among the first group of physicians to go through the program.
The group of seven "students" met twice a year with GE "teachers" for structured didactic sessions to learn about marketing, strategic planning, and finance, he says. They worked to define a project and worked on it over two years. Through the process of working on the problem -- in Collins' case, medication reconciliation -- the group defined interventions and followed up with data.
"At first, it seemed a little bit Mickey Mouse," says Collins. "But very helpful was that it reinforced a discipline to approaching projects. People like me never saw an opportunity I didn't like. It's easy to get swept up in enthusiasm for fixing problems, but essential to solving them is refining goals and measuring success."
I usually shy away from long quotes, but Collins gave me perhaps the best, most concise explanation of what has happened with society's implied contract with physicians that I've ever heard, and it shows quite concisely how business training can help physicians understand how they fit into the big picture of healthcare costs and outcomes today:
The bargain we had with society is that physicians acted on the basis of best science or best evidence. Society said, 'you know what's best, so you decide.' That led to very little discussion on risks and benefits with patients because we were presumed to know what's best. Medicine has become distanced from the application of best evidence. As the public has become more aware of that, including government and insurance companies, we have more regulations, which further decreased our autonomy. What that says is that over time, individuals' clinical autonomy became a cause of suboptimal performance relative to clinical science. That led to wide variation, which brought the attention of insurance companies and led to their managerial control with guidelines, protocols and regulations. That's been a source of frustration. Paradoxically, in the pursuit of autonomy, we've lost it, and to reframe that, we have to function in ways that will reduce variation around best practices. Even though I believe medicine is collaborative undertaking, physicians have the responsibility for what goes on. As healthcare has become more complex, that model really doesn't work anymore and physicians aren't good followers. The task is challenging, but we can learn a lot from other industries."
Collins completed the program in April 2010, and credits it with helping him become more "appropriately focused," he says. "It's sort of like thinking ahead on how we'll know we'll be successful."
He says the program isn't perfect, but it's a good alternative to the demands placed on physicians by an MBA program. One nuance about physician business and leadership training is that it's essential for changing the way physicians, who are at the heart of every decision on care, approach healthcare.
"Transformation is going to require physician leadership and we just don't have it," he says. He stresses that business and leadership training as healthcare moves to a team-based approach is essential not only for CMOs, VPs of medical affairs or medical directors. The need for the ability to blend leadership and management knowledge with the understanding about patient care that physicians have is essential for committee chairs and quality directors, among other titles, as well.
"They're doing more of this in medical schools, but that will help the next generation," he says. "More systems devoting time and resources to physician leadership, but the prevailing attitude among physicians is that this is something you do when you retire. There's almost a stigma. It's not highly valued among physicians yet."
But that's changing, because physicians and health systems are learning much more about how myopic it is to continue to see the individual physician -- not the care team or evidence -- as the final arbiter of medical interventions.
Philip Betbeze is the senior leadership editor at HealthLeaders.