Having had the experience of studying more than 20 of the largest and most advanced integrated systems in the country, I have gained a new respect for physician leaders. I can't think of a single advanced integrated system that doesn't have a strong physician leader, or a team of physician leaders. It is almost part of the definition of an integrated system.


The conventional wisdom that physicians make poor leaders is wrong. Based on our experience with organizations such as Marshfield, Mayo, Scott & White, Kaiser Permanente, Dartmouth, Billings, and Geisinger, the leaders are visionary and in touch with the needs of the markets they serve. Plus, they have the respect of physicians, mostly employed, in their organizations.

Many hospitals employing physicians consider themselves to be integrated systems. Although employing physicians is usually a step in the right direction, until some physicians emerge as leaders of an organization and are accepted as such, I don't consider such an organization to be an integrated system. Those hospitals and health systems pursuing an integration strategy-as many are-are often not ready to take the most important step: identifying and elevating one or more physicians to top leadership positions.

How do the advanced integrated systems make physician leadership work? A common approach is the paired leadership model: Administrators act as partners with physicians and free physicians' time to spend on matters of strategic importance. But even with this model, the physician leader is the final decision maker. In various degrees, this is the way all of the advanced integrated systems mentioned earlier function. In my view, the results are impressive.

What about the CFO function? In advanced integrated system, this role is usually not paired with a physician, but the individual, of course, reports to a physician CEO or a physician-dominated executive committee. My experience suggests that the CFO has even more influence in an integrated system than in a hospital. Physician leaders rely heavily on their CFO in all matters (not just finance) relating to the future of the organization.

So what? Hospitals and health systems with a more traditional organizational structure that are moving toward becoming integrated systems need to encourage strong physician leadership throughout the organization, including top management.

Dean C. Coddington is a senior consultant, McManis Consulting, Denver, and a member of HFMA's Colorado Chapter.

Publication Date: Friday, September 20, 2013