Debra Beaulieu for HealthLeaders Media., March 31, 2016
Two physician leaders share key lessons learned about how organizations can partner with physicians to foster leadership best practice among aspiring clinical administrators.
Many scientists believe that the rapid expansion of a very hot, dense, single point in space nearly 14 billion years ago spurred the formation of the 100-billion-galaxy-universe we know today.
When Sutter Medical Group merged with three affiliate groups in January 2011—exploding its physician count from 353 to 514 almost overnight—the Northern California organization experienced a Big Bang of its own.
And as if coping with the four-way culture collision and related aftermath didn’t create enough of a leadership challenge for the newly formed multispecialty group, a year into the merger, there was another change.
Samuel J. Santoro, DO, FACOG, who had been serving as the group’s board member, OB/GYN department chair, and division vice president, accepted the position of chief executive officer for one of SMG’s affiliate groups.
“While this was an amazing opportunity for Sam, it really highlighted our vulnerability in the medical group,” Lee Anne Wong, MD, SMG’s director of recruitment and retention, told attendees at the American Medical Group Association’s annual conference earlier this month. “We had several excellent physician leaders who wore several hats each. We didn’t have an identified pipeline of individuals who were ready, willing, and able to fill those empty seats. And we didn’t have a good way of identifying future potential leaders.”
Wong and her colleague, Sue Gotelli, director of physician leadership development for Sutter Health, the system to which SMG belongs, shared their story at the conference believing many organizations across the country would relate.
“I think a lot of people have had the same experience with rapid growth of medical groups and mergers and acquisitions,” Gotelli told me by phone after the conference. “What people realize is that the bigger the group, the more structure you need to keep it running well, both from a management perspective and a leadership perspective.”
As the Sutter team worked to address its difficulties with physician leadership development and succession, the lessons learned were of somewhat cosmic proportions as well. I’ve narrowed them down to five themes:
- Physician Leader Roles Have Multiplied
Physicians have more opportunities to get involved in leadership or administrative medicine today than in years past, Gotelli says, thanks in part to the healthcare industry’s intensifying focus on population health management.
“Payment models are changing and looking at how we treat populations of patients with specific clinical conditions, so there’s a need for a lot of service line leaders,” she says. “There’s also a big movement in patient safety and [need] for clinical quality leaders such as chief medical officers, which a lot of physicians aspire to. Some physicians are actually interested in operations and roles are opening up for them as well.”
- Succession Planning Can Begin at Recruitment
Along with expansion of leadership opportunities, the timeframe in which physicians can begin their leadership track has also widened. Increasingly, physicians interviewing for jobs right out of training express interest in opportunities to grow and develop as leaders, says Wong, a practicing pediatrician and recruitment leader.
“I don’t think the obstacles that were true a generation ago are true now for incoming new practicing physicians,” Gotelli adds. “I think they’re actually interested in leadership. They want to have a bigger voice. And we have a need for leaders at all levels.”
- Leaders Are Made, Not Born
Among many more seasoned physicians, however, participating in the administrative side of medicine isn’t something they’ve contemplated—and they often feel unprepared to pursue opportunities that arise, according to Gotelli.
“They stumble a little bit until they realize there is actually science behind leadership development, that there are known things people can do and practice to get good at it,” she adds. “And when they really understand this is not something you’re just born with, that you can work on it, I find physicians to be great students who can put [leadership] concepts into application very quickly.”
To help aspiring leaders foster these skills, Sutter Health offers formal leadership education that focuses on ‘four Es’ of development: exploration, experience, exposure, and education.
“One of the best ways organizations can help physicians or any leaders grow and develop in their leadership roles is to give them experiences to put their leadership skills to action,” Gotelli says. “I think organizations that take this seriously are looking at proactively creating opportunities for people to get exposure and experience.”
- Best Practices Aren’t Just for Medicine
Physician leaders need not just skills development, but also ongoing support and resources. When clinicians become medical directors or service line leaders, they need precise job descriptions, information about how to perform tasks, names of people available to help, and more, according to Wong.
One way SMG began better supporting its was with the creation of a monthly ‘bounce it off’ session, during which division vice presidents and medical directors gathered to talk about what was going well with their roles and where they needed help.
“We are used to talking about clinical best practice, but we don’t always talk about leadership best practice,” Wong says. These sessions, more formally renamed Sutter Medical Group Leadership Meetings, provide leaders with not just networking opportunities, but also teambuilding opportunities.
Importantly, the meetings help physician leaders recognize they’re not alone. “I think sometimes in our leadership roles we feel like we have to have all the answers, and rarely do we have all the answers,” Wong notes.
- Money Matters, to a Point
Although Wong and Gotelli’s presentation didn’t address compensation for leadership work specifically, audience members, many of whom were physicians, were curious about whether Sutter’s physician leaders got paid for their administrative work.
The answer, according to Gotelli, is yes, but the amount isn’t necessarily representative of leaders’ full efforts. “It’s very important to offer financial incentive,” she says. “And I agree with [physicians] who say it’s sometimes a thankless job. Especially for folks that are in subspecialties where the compensation is a little higher, it’s difficult to attract them to leadership roles because they’ll invariably lose money doing it.”
Most of the physician leaders at SMG maintain a full clinical practice and receive additional compensation relative to a 0.2 to 0.4 full-time equivalent, Gotelli says. “It’s very, very difficult to keep all those balls in the air, and another thing we need to do better is to compensate physicians adequately for the time they’re spending on leadership roles,” she says.
What truly motivates almost all of the physician leaders she’s worked with, however, is the ability to impact greater numbers of patients by being a leader than through one-on-one care alone.
“Most successful physician leaders I’ve seen have had some sort of aha moment,” Gotelli says. “It’s a bit of a leap of faith. You can’t really explain it to someone until they experience it.”