In medical school, we learned the language of medicine with its Greek and Latin roots, its abbreviations and its acronyms, and we communicate effectively with other physicians when we use it. But that training, for most of us, didn't include the language of health care, which has evolved quickly in recent years into a distinct lexicon of terms like HMO, point of service, return on investment and integrated delivery system. Add the knowledge requirements for human-resources management, financial decision making and regulatory compliance, and you find that many physicians are woefully deficient in the skills necessary to provide leadership in health care. So a dichotomy exists in our system: Physicians generally have one skill set for delivering clinical care, and managers need a separate skill set for administering the business of health care. Physicians who can bridge the gap — through natural talent or additional training — have a real opportunity to lead health care organizations as physician executives, and the rewards are significant, both in personal professional satisfaction and in organizational success.

Why physician executives?

“Administrative medicine” is a good fit for those who have insight into the doctor-patient relationship (the core product of health care) and an ability to think about operations globally. Before health care reform gained such momentum in this country, we had a triad of health care leadership: Doctors primarily cared for patients, business managers ran doctors' offices and business executives ran hospitals and insurance companies. This delineation contributed to the creation of a silo effect in health care, with each party focusing on its own division of the system, often at the expense of efficiencies in other divisions. This has led to many conflicts of interest in our system and a great deal of mistrust and misunderstanding; in fact, much of the purpose of health care reform has been to realign the interests of health care providers, payers and purchasers so that they work toward mutually beneficial processes of care delivery. But market-based reform also has shown the need to “imprint medical expertise on business dynamics” in health care, and physicians with strong leadership skills are in a position to do just that.¹

At the same time, the concept of leadership has shifted dramatically. Leaders are no longer taskmasters; they are facilitators of empowerment, motivation and maximum performance by all individuals in the organization, whether that be a clinic, a hospital, a health plan or an integrated delivery system.²

Portrait of a physician executive

What does a physician leader in one of these organizations do all day? The principal duties vary widely depending on the position and type of organization. A survey by the Physician Executive Management Center found that the most common duties of physician executives were serving as a liaison between physicians and the administration, overseeing quality management programs, credentialing providers, supervising physicians and strategic planning.³

To be effective in tasks like these, what skills should a physician executive possess? Respondents to the Physician Executive Management Center survey identified these skills most frequently:³

• Effective communication in writing, interpersonal discussions and formal presentations;

• The ability to persuade, motivate and influence others;

• The ability to lead strategic planning;

• Computer skills;

• Skills in financial administration and personnel management (areas in which physicians have traditionally relied on others for expertise).

The qualities of physician leaders may be described in various ways for various purposes. Here's another approach — a somewhat wide-ranging but still useful list of the abilities and characteristics that a physician executive needs for success:

• A concept of illness as a whole,

• An ability to build his or her knowledge,

• A vision for the future,

• A strategy for realizing that vision,

• An ability to create value (i.e., optimize the cost-quality relationship),

• A generalist mind-set,

• An ability to master change and lead the organization through it,

• An ability to shape the market by having a keen sense about customers and competitors.⁴

How might you go about developing the qualities that a physician leader needs? Opportunities for education and training in executive skills abound (see “Educational resources for physician executives”).

In a nutshell, physicians who like their daily routines to remain fairly constant, are comfortable with the status quo and are uncomfortable with change (especially when change appears to be forced on them) typically will not enjoy the role of physician executive. Conversely, those who are easily bored with routine, often propose radical change and are comfortable when someone else institutes new processes that affect their work (especially if the new processes make sense to them) will generally find satisfaction in many of a physician executive's duties.

In many ways, physicians — particularly primary care physicians who, as generalists, are trained to treat the whole person — are uniquely suited for leadership positions. In medicine, all of us have learned to deal with ambiguity. We face crisis and tension by making decisions that affect people's lives. We've learned through history-taking to listen to people, and many of us are adept at interpreting nonverbal cues. Because of our training, we're experienced in situations that require endurance, perseverance, self-motivation and self-confidence. And we still enjoy a certain measure of credibility, in health care and in society, by virtue of our status as physicians.

But is it a portrait of me?

There are differences between clinical practice and administrative medicine that pose potential problems. Changing your central focus from patients to the organization requires a number of psychological adjustments. The instant gratification of seeing a disease resolve or receiving a patient's sincere thanks is not part of management. Making people unhappy becomes part of your job; whatever decision a manager makes, someone will be dissatisfied. In becoming a physician executive, your role changes from one of independence to one of dependence, from autonomy to the need to delegate in order to get the work done. You must learn the intricacies of organizational dynamics so you can avoid the traps of working in a large system. And you must learn the language of finance.

The successful physician executive discovers that his or her approach to work must change in two other important ways. First, an effective leader persuades rather than controls; and making this change is often difficult. Second, when you move from a comfortable relationship with colleagues to a position of authority over them, those relationships change forever, no matter how hard you try to maintain them. Wariness, frustration and often contempt become factors in your relationships with other physicians.⁵

If, given these caveats, you're still interested in moving into medical administration, ask yourself the “Questions to consider before making the switch.”

To practice or not to practice?

Ten years ago, half the physicians in senior-management positions continued to have part-time clinical duties. Today, only 13 percent of that group practice medicine at all.³ This significant decrease is thought to be related to the expanded roles of physician executives as the penetration of managed care has increased.

For physicians, probably more than for members of any other profession except perhaps clergy, our identities as individuals are tied to the responsibilities and privileges of our work. How we're viewed by the community at large contributes greatly to this. We may be serving as parents, friends, neighbors, civic activists or board members, but our communities still regard us as physicians first.

Our self-identity and the community's eyes are focused on our role as healers, and for many physicians, serving in administration without carving out time to practice medicine leaves a void. Many hang up the stethoscope only to discover that they miss doctor-patient encounters — the ability to help others directly and see the difference they make in individual patients' lives. In addition, it takes very little time out of clinical practice for us to lose state-of-the art clinical skills and knowledge, especially considering the speed of advances in diagnostic and therapeutic technologies. And don't forget that your credibility with fellow physicians and the community may rapidly deteriorate if you don't maintain your role as a clinician.

It's worth a look

Opportunities for physicians to enter the administrative side of health care abound, as evidenced by the number of ads for physician-executive positions in professional journals and the increasing number of seminars being offered to train physician leaders. Health care organizations are realizing that the blend of skills and knowledge that physicians bring to management can spur great organizational change and improvement, and many physicians are finding these new leadership roles exciting, challenging and rewarding. Administrative medicine is clearly a frontier that family physicians would do well to explore — if they're willing to become bilingual in the lexicons of medicine and health care management.