Effective leaders of healthcare organizations have been associated with improved patient and financial outcomes.
Likewise,
physician leaders of healthcare organizations have been associated with improved medical outcomes.
2Physician-leaders and hospital performance: Is there an association?.
Rising pressure to achieve these better medical outcomes, with increasingly limited financial resources, has thus created an acute need for more physician leaders.
What is necessary is a focus on the development of
effective-physician leaders through an emphasis on leadership education to, hopefully, achieve the best outcomes. Cardiovascular and thoracic anesthesiologists are uniquely positioned to become effective leaders by virtue of their training and participation in complex team dynamics.
“To be a physician is to lead.”
The practice of medicine inherently involves leadership.
Yet most doctors in the United States are not taught leadership skills in medical school.
Often without any formal training and within the first years of graduate medical training, resident physicians in all specialties are expected to lead multidisciplinary teams of junior residents, nurses, social workers, and physician assistants, as well as other care personnel.
These initial leadership ventures occur both through structured patient care, on rounds, and during crises as they arise, in leading a team during resuscitation from a cardiac arrest. Although it is self-evident that leadership skills can change outcomes during the complex process of cardiac resuscitation when seconds count, evidence shows that leadership skills improve patient outcomes in seemingly routine circumstances as well.
Similarly, anesthesia residency and cardiovascular and thoracic fellowships rarely include leadership training in their curricula.
Many physicians take on formal significant leadership responsibilities, whether at the departmental, institutional, or health-system levels during their careers, with each step increasing the scope of management and responsibility and, thus, the need for effective leadership skills.
Most physicians get promoted to these leadership roles because of their clinical acumen and expertise, but that experience alone does not guarantee that they will be effective leaders. Leadership skills are not innate and require more than charisma and emotional intelligence.
The unique set of skills that are necessary to be a strong leader needs to be learned.
It is imperative to cultivate anesthesiologist physician leaders. Many believe that hospitals and healthcare organizations with strong and effective physician leadership deliver higher quality care, with better clinical outcomes, patient satisfaction scores, and financial performance, and are associated with less physician burnout and higher job satisfaction.
This has long been speculative, and published evidence to support this hypothesis is scant. A 2009 cross-sectional study compared the top 100 US hospitals for each of the 3 specialties of cancer, digestive disorders, and cardiology and heart surgery, as identified by
US News and World Report's “Best-Hospitals” highly cited rankings of quality, as to whether the 300 chief executive officers of these hospitals were physicians or nonphysician managers.
2Physician-leaders and hospital performance: Is there an association?.
The study found a strong positive association between the ranked quality of a hospital and whether the CEO was a physician or not (p < 0.001). Despite the study limitations, most importantly that this association did not prove that physician leaders outperform nonphysician leaders of hospitals, it is consistent with such claims and highlights the need for further study.
Speculation regarding the mechanisms behind this observed physician leadership phenomenon include the deep intuitive knowledge regarding the core business of the organization (healthcare) that may come from involving individuals with clinical expertise in decision-making and in setting institutional strategy.
5- Goodall AH
- Kahn LM
- Oswald AJ.
Why do leaders matter? A study of expert knowledge in a superstar setting.
Additionally, as the number of nonphysician administrators in the American healthcare system has increased rapidly in recent years, many physicians and other front-line staff express frustration by the bureaucratic intrusion and loss of autonomy brought on by policies imposed by those they perceive as disconnected from the realities of clinical care.
This is a likely contributor to physician burnout.
Given these factors, developing physicians as leaders is almost certainly a good strategy for the future of the medical profession and healthcare in general.
A program from the Mayo Clinic, whereby clinicians assess their physician supervisors on a Leader Index survey, demonstrated that for every 1-point increase in a leader's score, there was a 9% improvement in professional satisfaction and a 4% decrease in burnout among frontline doctors across all departments.
7Annals story slam - innovations: Practices that build trust - The leader index.
Creating trust throughout the organization is one of the most important challenges of effective leadership, and this may be easier for physician leaders.
Furthermore, there is the enhanced credibility that a physician leader who has spent years as a clinician is perceived a role model. This likely has beneficial effects on recruitment and staff satisfaction.
9Physician as hospital chief executive officer.
Although, at one time, it was routine for hospitals to be led by doctors, the increasingly complex healthcare landscape and the training required to lead such organizations have caused that to change. Gunderman and Kanter reported that in 2009, of the 6,500 hospitals in the US, only 235 were led by physicians.
10Educating physicians to lead hospitals.
Although a few residency and fellowship programs now offer leadership training tracks, these are targeted toward those explicitly interested in healthcare management positions.
Leadership education and training need to be expanded and should be integrated formally into medical and residency training curricula in order to groom physicians for leadership roles.
Formal leadership curricula should focus on the fundamental sets of skills shown to make effective leaders by developing expertise in leading teams, managing challenging situations and employees, coaching and developing others to become leaders, and resolving conflicts. There are well-established courses that teach effective team coordination, communication skills that enhance the provision of effective feedback and inter-professional communication, and developing innate emotional intelligence to create inspirational leaders. Additionally, in today's healthcare landscape, physicians need literacy in organizational strategy, healthcare financial accounting, and regulatory and governmental health policies in order to understand the business of running a healthcare organization. Finally, physicians must be educated on the principles of operational management and safety and quality improvement.
11- Lucas R
- Goldman EF
- Scott AR
- et al.
Leadership development programs at academic health centers: Results of a national survey.
A popular alternative leadership model in healthcare that aims to harness the positive attributes of both physician and nonphysician business executives is to team them together in leadership roles. There are challenges with this “dyad model,” as it has the potential to create inefficiencies, duplication of administrative resources, and delays in decision-making due to the lack of clarity in reporting relationships. Furthermore, it can create conflict among leaders with different priorities. Rather, it is preferable to develop a career path for younger physicians with leadership potential and to create a pipeline so that a cadre of physicians emerges that is able to lead large healthcare organizations effectively.
As academic cardiac anesthesiologists, much time is spent at the intersection of surgery, perfusion services, cardiology, critical care, nursing, perioperative administration, pharmacy, and laboratory, among other areas. Scientific training informs cardiac anesthesiologists’ interpretation of emerging evidence and provides perspectives that are distinct from those of nophysician administrators. Although there are many pathways to leadership for physicians, generally there is a dearth of training in healthcare administration skills. As academic health systems are the best positioned to evolve into high-reliability organizations, one must promote physician leadership training by advocating for teaching the requisite skills to students, residents, and fellows. This will ensure a brighter future for healthcare if the right physician leaders are in place to promote value in care delivery.
This editorial is based on a presentation by David L. Reich, MD, at the 2022 Annual Meeting of the Association of Cardiac Anesthesiologists.
Intramural departmental funding was received for this project.
Conflict of Interest
None.
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Article info
Publication history
Published online: November 25, 2022
Footnotes
This editorial is based on a presentation by David L. Reich, MD, at the 2022 Annual Meeting of the Association of Cardiac Anesthesiologists.
Intramural departmental funding was received for this project.
Copyright
© 2022 Elsevier Inc. All rights reserved.
