Medical Staff Physician Leadership 2010 and beyond

Throughout 2009, this column has discussed some of the potential medical staff models to replace the self-governing medical staff, such as physician executive management, physician employment, and joint ventures. Whether the self-governing medical staff model continues to exist or is replaced by some of the many other models being proposed remains to be seen. Whatever model(s) survives, the need for strong physician leadership will only become greater.
    
We assume that the same skills that make excellent clinicians also contribute to making great physician leaders. This is not necessarily the case. In fact, the skill sets differ significantly. Let’s take a look closely at what makes a great physician and what makes a great physician leader.
    
To be excellent clinicians, we are taught in medical school and residency how to conduct history and physical examinations. Within minutes, we create a differential diagnosis list, prioritize the most likely possibilities, and decide on a course of action that includes further work-up and a treatment plan. We do this quickly, almost instantaneously, and we usually do it all by ourselves. We don’t hold prolonged meetings, or try to convince others about our actions—in fact, most of the time we don’t even discuss it with others clinicians. We are taught how to be the lone decision-maker. All in all, it’s a very autocratic process.
    
To be excellent physician leaders, we must learn an entirely different set of skills that medical schools and residency programs don’t teach. This set of skills includes interacting as a team and not just as an individual. As physician leaders, we cannot make unilateral decisions and force them on other members of the medical staff, administration, or the board. We must learn to plan an agenda, run effective meetings, build consensus, and slowly change the medical staff culture. We must learn to work behind the scenes, praise others in public, and accept the blame when things don’t go well. We must work tirelessly and expect hardly any thanks. We must be diplomats serving the needs of others but not be union reps or politicians bringing our own agendas to the table. We eventually find ourselves going back to school in a sense, taking leadership, credentialing, and quality courses. And finally, we realize that this is more of a team sport and our goals cannot be accomplished single handedly.
   
The transformation from excellent clinician to great leader is not easy. Few physicians ever advance to the position of president of the medical staff, and fewer still will be great leaders. Great physician leaders are not necessarily smarter than others on staff, but they have devoted more time to medical staff issues than others, studied medical staff leadership more diligently, and have more experiences to share.

Joseph Cooper, MD, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.