What Got You Here Won’t Get You There – Six “Must Haves” for Physicians Who Want to Move Into Executive Leadership Positions

  |  January 20, 2015


David is the CEO of a multi-hospital healthcare system on the West Coast. Recently, he asked us to recruit for a key position:  President of the System’s largest medical group.

We were happy for the opportunity, but something didn’t seem quite right. Why, particularly in a system as physician-centric as this one, wasn’t there already a qualified successor on the inside?

As David explained, the organization had failed to invest adequately in the development of future physician leaders.  There was no shortage of interested candidates; however, none of them had the combination of skills, experience, perspective, and demeanor to step into this new role.

Physician Leadership on the Rise

The Affordable Care Act will continue to have a tremendous impact on how healthcare organizations are staffed, managed, evaluated, and incented.  As a result, there is a growing imperative for physician alignment: the effective coordination of effort between hospitals and doctors.

The days of old school administrators battling with physicians and keeping them at arm’s length from the business operations of the hospital are over. Today, enlightened healthcare systems recognize the value of deep physician involvement in strategic decisions, as well as clinical operations. Clearly, physician leadership has become a priority.

The challenge, however – as David experienced in our story above – is that many organizations and the physicians that work for them have not prepared for this shift. Doctors, while eminently qualified clinically, are often constrained by their lack of other important skills and experience. Hospitals, while eager to fill their executive positions from within, often have difficulty finding qualified physician leaders.

With that in mind, we offer six “must haves” for doctors who hope to rise to the ranks of executive leadership.

Must Have #1:  Demonstrated Engagement and Leadership

Survey after survey reveals the same thing: Doctors are working harder than ever as they strive to see more patients and generate revenue.

And so, the idea of taking on additional, non-clinical responsibilities – whether that means volunteering for committees and task forces or going out of their way to interact and collaborate with others outside of their practice area – may seem laughable. But they need to make the time or they’ll very likely be passed over when management opportunity knocks.

Steve, for example, had been practicing medicine for 30 years and was well regarded within his New England teaching hospital. So much so, in fact, that when the Chair of Medicine retired, Steve was tapped as acting Chair. Unfortunately, and even though he proved to be quite capable in this temporary role, he had no track record outside of his clinical practice of medicine.

He hadn’t participated in administrative activities; he hadn’t demonstrated an ability to influence and lead others; he hadn’t proven that he could attract and retain top talent on his team. From the perspective of the hiring committee, he was trying to make up for 30 years of lost time in a few months. As one committee member observed, “If he really wanted to be a Chair, he should have taken the initiative years ago.”

It’s worth noting as well that physicians who obtain advanced business or administrative degrees demonstrate a commitment to expanding their skills and emerging as future leaders.

Must Have #2: Broad Industry Perspective & Visibility

Future leaders have highly developed professional networks and a mega-view of their industry. They speak at conferences, join organizations, are invited to work with peers in other locations and are immersed in current healthcare issues and developments.

Leadership at the highest level requires an ability to see beyond the walls of one’s own institution. It’s what differentiates the sophisticated, mature executive and what enables them to make informed, long-term, strategic decisions. This means understanding how healthcare is evolving and paying close attention to how other organizations are managing – or not managing – in this environment.

When we interview physicians for executive roles, we look for those who can address broad, critical issues. If a candidate can speak fluently on topics like clinical integration, accountable care organizations, patient satisfaction, and the Affordable Care Act – all issues that drive the business side of healthcare – we know he/she is thinking about the big picture.

Must Have #3:  An Understanding & Appreciation of Information Technology

Today’s seasoned physicians – the ones currently under consideration for executive roles – cut their teeth in a world in which IT was not yet integrated into clinical practice. Note-taking was paper-based and transcribed into patient records after the fact by someone other than the physician.

Those days are just about gone. Today, record-keeping is done electronically and in real time, at the bedside or during the patient visit. There is no longer any separation between clinical care and information technology.

Does this hurt efficiency in the short term and require physician reorientation? Possibly.  However, any physician who continually grouses about the EMR and related shifts to an electronic world will be quickly dismissed as an individual who simply doesn’t appreciate the realities of 21st century medicine and the healthcare business that supports it. He/she is unlikely to show up on any short list of leadership candidates for the organization.

In contrast, physician “super users” who are able to model use and advocate for leveraging IT are invaluable partners for any hospital or health system.

Must Have #4:  Demonstrated Business Acumen

Health care leaders are called upon to recognize and manage business challenges every day. And while clinical experience plays an ever-increasing role in bringing about physician alignment within healthcare organizations, the business side is equally important. Future top executives, therefore, must have experience managing and developing staff, overseeing operations, developing strategic plans, and supporting growth.

Perhaps most important, they must have profit and loss responsibility for one or more significant business units. Those might include diagnostic imaging, the cancer service line or some other area with a significant P&L budget and true operational responsibility. Without this, moving into an executive position is extremely unlikely.

Consider the example of Janet, a 48-year-old vascular surgeon who was highly regarded in a large Chicago hospital. When the CEO moved on, Janet – then Chief of Surgery – applied for the position.  She had many of the necessary boxes checked on her resume, but no business track record to speak of. She hadn’t managed a budget, and she hadn’t managed more than a handful of people at any one time.  All of her experience was quality-related, not business-related. Because of this, she didn’t get the job.

And so on the advice of a senior colleague, she left to become CMO at a smaller hospital. Two years later, she moved up to COO; three years after that, she became President. Now, given her strong soft skills, extensive medical experience, and demonstrated business qualifications, she’s in a position to apply for senior executive roles in nearly any healthcare system in the country.

Must Have #5:  Professional Presence

It’s not unusual for a highly trained, well-respected physician to feel insulted if he/she discovers they were passed over for a senior executive role based on a lack of charisma or presence. After all, many accomplished doctors have risen through the clinical ranks based on their intellect, work ethic, and skill, not their ability to network at a community fundraiser.

But like it or not, that’s the reality – these leadership positions require a healthy dose of “soft skills.”

We recently interviewed a physician to be the Chief Medical Officer at a large New England hospital. He was extremely capable in many important areas.  But he was decidedly “flat,” in terms of his conversation, his style of dress, and his overall energy.  In short, he was missing what’s often referred to as “podium presence” – a trait that plays an important role in such a visible, public-facing position.

The good news?  Like most competencies, professional presence and presentation skills can be developed. For physicians willing to invest the time and effort, programs such as Toastmasters and Dale Carnegie can make a notable difference.

Must Have #6. An Ability to Listen & Collaborate

We recently brought in a candidate for an open CEO spot; he was Chair of Cardiology at an academic medical center in the Midwest.  He was ruled out after the first interview.

“What did I do wrong?,” he asked later. I told him that he was perceived as not listening. He didn’t respond directly to questions; he dominated the conversation; and he worked to control the interview from start to finish.

It’s no wonder that this disconnect frequently occurs with physicians. After all, they are trained to be experts, to have the answers, to make split-second, life-or-death decisions.  And that makes perfect sense – as patients, we don’t want a doctor who has to consult with ten other members of the medical staff every time there’s a decision to be made.
And yet, for top executives in today’s healthcare organizations, that’s exactly what’s expected. Hospitals, by their very nature, are collaborative. Top leaders have an ability to reach across the table and ask for help to collaborate, to influence, and to persuade. In many ways, it’s an orientation that is diametrically opposed to the classic “lone wolf” medical expert who performs so well in clinical settings.

Successful leaders, whether physicians or administrators, are those who despite their many abilities and accomplishments are able to listen and hear the points of view of others and to work together in getting things done.

More Progress Still to Come

Physician alignment is fast becoming a key aspect of the success of healthcare systems. For these organizations, that means tapping promising physicians early in their careers and actively grooming them as future business leaders.

For physicians, the challenge remains one of taking a long-term view of their move into the executive ranks. That means taking responsibility for gaining the requisite experience and skills – soft and otherwise.  That way, when opportunity knocks, they’ll have what is expected to step up and succeed.