The role of the physician executive

One common trend among hospitals today is to hire physician executives for such roles as chief medical officer (CMO), vice president of medical affairs (VPMA), or medical director. Should these executives manage the performance of physicians on the medical staff? No.

It is the responsibility of the organized medical staff to manage the performance of individuals granted privileges, not the paid medical directors. Of note, physicians who are either employed or function under a contract with the hospital are subject to management by such physician executives, but this only applies to their performance under the terms of their employment agreement or contract. It doesn't apply to aspects of their performance not addressed in these documents, nor does it apply to the rest of the medical staff.

So, where do physician executives fit into an organizational chart of the hospital and the medical staff? They are hired by and report to the CEO. In this position, they usually have management responsibilities, such as oversight of the quality program, physician contracting, or perhaps operational responsibility for departments such as the lab or radiology.

Their role regarding the medical staff is to serve as a resource to medical staff leaders in fulfilling their responsibilities. This can involve providing advice and mentoring to medical staff leaders, expertise in healthcare law or regulatory requirements, or arranging for medical staff leadership training. However, it can be a fine line between providing resources and actually stepping in and doing the work of the medical staff. Confusion about this boundary has led to heated conflicts between some hospitals and their medical staffs, so keeping the lines clear is critically important.

From this discussion we can recognize that if a medical staff is perceived as not fulfilling its responsibilities, it is the governing board that should step in and hold the medical staff accountable, not management. This can involve the board requiring external peer review of a physician or outside assessment of a program such as labor and delivery or the cath lab.

Leaders should recognize that once they find themselves in a situation such as this, there is a high risk of escalating conflict. They should do their best to revisit their organizational chart to carefully work through the delagated responsibilities and the chain of command for accountability.