HFMA VIEWS

MarieAnn North, MBA, FACMPE
Navigant Consulting, Inc.

I have on several occasions found myself partnered with physician administrators who were failing as an executive. Without exception, these physicians were respected clinicians, extremely bright, and generally liked by patients and peers. They were well meaning and hard working, so why did they fail?

Perhaps it was that no one pointed out that the skill set that had successfully brought them to this point in their careers was diametrically opposed to the skill set necessary to take them forward! Allow me to cite several examples:

• Physicians treat one patient at a time. CEOs focus on the big picture.
• Physicians make decisions with incomplete information. They must prescribe and treat before tests are back. “Good clinical judgment” is used. CEOs can say “I don’t know” and take the time to gather information and consult with others.
• Physicians act quickly, dealing with the crisis at hand - the situation may be life threatening. CEOs must be methodical and build support first for their ideas.
• Physicians depend on highly accurate data (MRIs are better than x-rays). CEOs understand that “directionally correct” may be good enough.
• Physicians tend to be non-confrontational with colleagues. CEOs often must argue their point to convince others and get buy-in.
• Physicians are used to a system with a clearly defined hierarchy (doctor, resident, and intern). CEOs function in a dynamic environment tapping into talent regardless of what’s on the organizational chart.
• Physicians must satisfy individuals (patients, referring physicians, chiefs and chairman, etc.). CEOs must be fair and consistent (and hopefully ethical) which means you can’t make everyone happy all the time.
• Physician roles tend to be clearly defined. As the CEO, “it’s all my job.”
• Physicians have a distinct role on the care team. CEOs share power.
• Physicians must avoid mistakes – they can be deadly. CEOs must allow others (and themselves) to make mistakes and learn from them.
• Physicians must do their best to “save everyone.” CEOs must recognize all employees (and strategies!) are not salvageable.
• Physicians can have instant gratification – the patient got better/the surgery is completed. CEOs delay gratification (assuming there is any) and move on to the next task without final outcomes.
• Some patients actually say “thank you” to the physician. For the CEO, all in all, it’s a thankless job.

Our organizations may be better served by rewarding physicians for clinical excellence and allowing them to be physicians (do what they do best and are trained in!) rather than imposing “executive” positions on them for which not many of them are suited.