One room. Four physician executive leaders. Expertise and insight on physician leadership

Part 2 of 6:

Key Executive Leadership Trends: Maintaining Clinical Practice as a Physician Leader

Physician leaders serve an essential role, complementing their clinical training with business education and leadership development to help ensure a balance of priorities, including quality and financial performance. But, at what level should a physician executive maintain an active clinical practice?

Lois Dister, Executive Vice President and Managing Principal of Cejka Executive Search, convened a panel of four distinguished physician executives to explore the emerging challenges, opportunities, roles and incentives that are part of a physician leader's world today.

This six-part series will explore the key findings of the survey and the insights on topics of interest to physician leaders:

1.     Highlighting Key Trends

2.     Maintaining Clinical Practice

3.     Earning a Post-Graduate Business Management Degree

4.     Determining Bonus Compensation

5.     Finding New Roles for Physicians in the Future

6.     Identifying Candidates for Key Physician Leadership Roles

Findings on this and other topic are reported in the Physician Executive Compensation Survey conducted by the American College of Physician Executives (ACPE) and Cejka Executive Search

Maintaining a Clinical Practice

For many physicians who have chosen to pursue administrative and operational leadership roles, the question of their continued involvement with clinical activities is a requirement may be a key concern.

Top Findings Include:

• Three-quarters (75%) of respondents said that their organization does not compensate them for time lost from clinical productivity.
• More than two-thirds (68%) said that they continue to practice medicine
• More than half (58%) said that maintaining clinical hours is a requirement of their job.

What are our Panelists' thoughts on physician leaders maintaining a clinical practice?

Lois Dister: The first question is, "Do I need to continue to do clinical work? And if so, what does that mean?" According to our survey, 68% of physician executives report that they continue to do some sort of medical practice and 42% say they're required to do medical practice.  Let's start with you, Dr. DiLoreto. What is your opinion on this?

Dr. DiLoreto: With respect to practice, I think it's extraordinarily important that physician leaders have clinical credibility. What we might mean by clinical credibility will change related to the nature of the position that is held. For instance, at Resurrection, we have various levels of physician leadership positions, such as service line leaders or medical directors, who generally are required to practice and spend as much as 70% of their time in clinical practice.  Once folks get to facility-level leadership positions, and I'm thinking of as an example a CEO now in one of our acute care hospitals with a lot of clinical credibility because of her years of clinical practice, that person is no longer going to be able to practice in that role. At the Vice President of Medical Affairs-levels in the larger facilities, it's going to be impossible to be able to practice. Certainly at a system-level CMO role where I am, as much as I would like to practice and miss it almost daily, there simply isn't the time to do it. Yet, I don't think it reflects on my clinical credibility in my position.

Dr. Grant: I concur with most of what David said. The couple of points that I would add are, number one: Continue to practice clinically as long as you feel like you need to practice clinically, because it's not like riding a bicycle and once you're away from it for a period of time, it's very, very difficult to go back. So, maintain the clinical practice as long as you can.  Number two: at the time that your administrative responsibilities make it uncomfortable for you relative to the quality of your clinical practice, or make it too much of a burden on your personal life to be able to maintain both, you'll know individually when it's time to stop the clinical component of your practice.

Dr. Pryor:  I agree with that. One other thing that you need to figure out is some way to establish clinical credibility, and working in the clinic is one. On the other hand, I could not continue working as an intensivist since the demands on both sides were too much. The question I had to ask myself is if I worked a half a day in the pediatric clinic, what credibility would that give me when I went to talk to an orthopedic surgeon or to a cardiac surgeon?  Probably very little, so you have to establish that clinical credibility sometimes in other ways.

Dr. Stroud:  I agree with everything we've said. I would possibly phrase the question a little differently. If someone says, "Do I need to practice clinically to be an effective executive?" I think the answer is no. As we mentioned, there are many ways to remain credible without practicing. There is still that opportunity for some practice depending on where you are in the organization and where you are in the transition. Personally, I work with residents about a half day a week, but I do that because I enjoy it. I may get a little credibility as a result, but it's really seen more as recreational time. Now, one could argue whether that's beneficial or not.  One bit of advice that I would offer comes from a thought a good mentor posed to me early on in my career: make certain that as you pursue this type of work that you're running toward something and not away from something else. If you find that you're excited about getting out of clinical practice, you may want to stop for a moment and check your values and motivation and ask yourself why that is.

Lois Dister:  I'll just add one more thing to that. When I'm interviewing physician executives I'll say, "Here's a circle of 100%:  What percent of that time are you doing clinical practice and what percent are you doing administrative practice?" The candidate will typically take the pen and carve out 75% of clinical practice time, and then they'll draw another circle and say 75% administrative. There's perhaps a burn out factor. It's very difficult to do all things well when you're doing two jobs. 

Dr. Grant:  One other point on this subject. I just had a discussion last week with a doctor who works for me and is a full-time administrator. He is coming up on his research for his boards and he could not figure out why he was going through that torture again. I told him, "Don't give it up. Reserve your options down the road because if you move to another organization, not having the board certification would be a roadblock in many organizations, whether or not it is relative to your job. "

Lois Dister:  Not maintaining your state licensure is another problem. It is really important to keep that up. 

Up Next: "What are our Panelists' thoughts on Earning a Post-Graduate Business Management Degree?"

What are your thoughts? Join our blog at http://healthcareexecutivecareers.blogspot.com/

Meet our Panel

David A. DiLoreto, MD, MBA, FACS

Executive Vice President and Chief Medical Officer, Resurrection Health Care

Currently challenged with the clinical service integration of nine independent acute care facilities, 12 nursing homes, and four assisted living centers, Dr. DiLoreto manages employed and affiliated physician networks, directs quality improvement and care management programs, and oversees resident and nurse training. He also provides clinical consulting on health information exchanges involving the Department of Defense and community health care providers.
Howard R. Grant, JD, MD

President and Chief Executive Officer, Lahey Clinic

The Board of Trustees of Lahey Clinic recently selected Howard R. Grant, JD, MD, to be Lahey's next President and Chief Executive Officer. Grant, has previously served as Executive Vice President and Chief Medical Officer at Geisinger Health System, a group practice with 60 locations and 1200 providers, including three hospital campuses. Grant was responsible, with his administrative colleagues, for operations and budgets for 27 clinical service lines, strategic planning, and physician and administrator recruitment.

Robert W. Pryor, MD, MBA

Chief Operating Officer and Chief Medical Officer, Scott & White Healthcare

Dr. Pryor and will become President and Chief Executive Officer of Scott & White Healthcare in 2011, building on the organization's success and tradition of physician leadership. As CMO of Scott & White since 2005, and COO since August 2007, Dr. Pryor has had system-level responsibility for all clinic operations and medical management. Scott & White Healthcare, headquartered in central Texas, is a physician-led, $1 billion organization employing 900+ physicians in all specialties.

Christopher Stroud, MD, MBA

Vice President and Chief Medical Officer, Aurora Medical Group

Dr. Stroud has operational responsibility for the 950-member Aurora Medical Group. In addition to more than 10 years in clinical practice as an obstetrician/gynecologist, Dr. Stroud has significant expertise is in the areas of physician recruitment and employment, physician compensation, medical group acquisition, and clinical program development and implementation.

Moderator:

Lois Dister

Executive Vice President, Managing Principal, Cejka Executive Search

Ms. Dister is in her thirteenth year with the firm. Her exemplary reputation as an executive

search consultant is based on the wide range of healthcare clients she has served, and the positive

outcomes of search assignments she has completed. Lois has worked in academics, hospitals and

health systems, medical group practices, specialty healthcare companies, and managed care.