The advent of managed care and capitation has demanded that the physician become more than just a leader in his or her practice. For the practice to compete in the increasingly corporate world of health care, the physician must also be an efficient and effective manager. This managerial role calls for the ability to do everything from negotiating managed care contracts to guiding the day-to-day functioning of the office. As managed care demands tighter cost control from physicians, clinical office efficiency becomes increasingly important.

For many physicians, management is not a pleasant role. They consciously “switch hats” as they move from the exam room to the manager's office. The manager's office is where tough decisions need to be made, while the exam room is where “people can be helped.” This switch in roles is too dramatic for many physicians, and they prefer to leave the role of manager to others. We see this in the large number of physicians leaving private practice and either merging with larger groups or selling their practices and becoming employees.

The problem is not so much that physicians are unwilling to learn or acquire appropriate managerial skills. Nor is it that they're ostriches hiding their heads in the sand. One of the major reasons physicians don't want to assume managerial roles in their practices is that they don't see management as being consistent with their altruistic mission. They are simply not motivated to accept this mantle since they don't derive any satisfaction from being efficient administrators. It's not that physicians don't want to be leaders; they just don't want to be administrators or managers.

You can help and manage

Before physicians can be expected to devote their time and energy to acquiring administrative skills, they must feel motivated to make this commitment. What many physicians don't see are the opportunities for altruism that lie within their responsibilities as managers in their own practices. The clinic site is on a par with the model of a family-run business, but it's rarely treated that way. In health care, the emphasis is never on the employees; it's always on the patients. Yet it's not the patients that the physician leader manages.

Physician leaders should reconsider the current paradigm of leadership in which their managerial energies are focused solely on improving patient care and the measure of success is patient satisfaction. Instead, I suggest that when physicians are in leadership or managerial roles they also focus on the satisfaction and happiness of their employees. Physician leaders can derive immense satisfaction from knowing they have created an environment in which their employees enjoy work.

How can physician leaders create that environment? Articulate the practice's mission and goals clearly and simply, and explain how the staff's work helps determine whether the practice achieves them. Give staff members a greater sense of responsibility by involving them in decision making and giving them opportunities to act autonomously. Help staff members feel a sense of achievement by recognizing good performance, especially if it's tied to promotion. Most important, make the staff feel that the practice appreciates them and their work.

In a practice environment like this, the measures of success would include levels of absenteeism and staff turnover, not only patient satisfaction. Excellent patient care should always be of foremost importance; but it should not be at the expense of the staff. Study after study has shown that improving the work-place results in improved quality of care.

As more physicians are able to see the altruism involved in being a good leader — the sense of satisfaction that can be derived from caring leadership — we will see more physicians ready to assume this role. They will no longer perceive management as being at odds with patient care but instead will recognize their unique position to enrich the lives of their patients and their employees.