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The Physician CEO: Learning to Lead

As we’ve written often about, South Carolina (and America) is experiencing a medical care crisis where patient well-being is no longer the priority. Over the past weeks, we have made several observations and suggestions regarding possible solutions to address our current situation.


Most recently, we made the plea for doctors to step up, to become the leaders who deliver us from crisis.



Physician caretakers have the best vantage point from which to reform medical care. They understand patient well-being. They know first-hand the strengths and failings of the medical care system. And they are the most logical choice to lead us.

There is only one problem. Doctors are the most inexperienced leaders in the entire medical care environment. Leadership is not part of their training.


Last week we proposed the creation of the “physician CEO”—the doctor who not only leads their professional practice operations but also ‘leads’ patients through their medical care journey. We showed Figure 1 (below) as the model. This week, we will continue the discussion with a review of some basics. What is a Chief Executive Officer (CEO) and what does a CEO in other disciplines do?


The CEO is usually the ranking leader in the enterprise.


Figure 1

Therefore, the CEO, first and foremost, is a leader, and usually a master leader. Leadership expert John Kotter tells us that leaders exist to drive change. They lead other leaders who lead the leaders of processes. This is different from managers. Managers cope with (organizational) complexity, leading the leaders of processes. Leaders, therefore, lead people to create a different reality where managers lead processes—processes by which that different reality happens.


Using Kotter’s definition, we can see that doctors have traditionally not been leaders. They functioned more as managers. They oversee and perform processes. They cope with the complexity of patient care, the electronic medical record, congested hospital schedules and complex surgical operations. By becoming the physician CEO, we are asking doctors to evolve, to lead people who lead the leaders of processes. This is a giant leap. To start, doctors must become master delegators; to oversee teams who do the actual patient care. As such, the physician CEO often does not directly participate in patient care. They delegate tasks—especially menial tasks like populating the electronic medical record—to qualified team members. The physician CEO instead takes on the tactical and strategic roles that all other master leaders assume.


The daily tactics of master leaders in other disciplines are well established and are shown in Figure 2:

Figure 2

To quickly summarize, first, leaders devote tremendous energy in developing their collective, defined as the entire enterprise to include their teams, their operations and their processes. While leaders usually do not directly involve themselves in the daily complexity of the enterprise, they are still responsible for it. Their fingers must be on the pulse of what needs to be done and on the abilities of the team members chosen to perform any given task. Team development, therefore, is paramount.


Next, leaders make the important decisions.


In fact, experienced leaders should be master decision makers. When making decisions, they measure the risks involved, and take responsibility for the outcomes that result. From there they can direct team members toward the actions that need to be taken.


Finally, leaders do what they are designed to do.


They tactically drive change. They assess the satisfaction and dissatisfaction of the current situation, envision a better state and take steps to overcome the resistance that results in change. Accordingly, the best leaders are master salespersons. They firmly espouse the motto: “The world belongs to the person who can sell it.” These skills are fundamental and necessary for all change agents.


The daily tactics of physician leaders are the same as leaders in other disciplines, regardless of the setting, be it clinical, business or professional. Remember, leaders lead the leaders of the leaders of processes. They are always one step removed from the action. If there is a team member as qualified as the doctor to perform whatever task is needed, that task is delegated. Obviously, there are times when the doctor is the only team member qualified to perform a task (e.g., the distal vascular anastomosis of a bypass procedure, auscultation of a complex heart murmur, the palpation of an abdominal mass, the assessment of abdominal pain, etc.). In these situations, the doctor performs the task. In all other instances, the task is delegated.


The strategies used by master leaders in other disciplines are also well established. They are shown in Figure 3:

Figure 3

As seen, the most effective leaders strategically start by focusing on vision and purpose. Vision and purpose create shared beliefs among team members. The consequent relationships that result constitute team culture. From there, purpose and culture drive performance (change). For master leaders, strategy is never simply about performance. It is always about vision/purpose and culture. Vision/purpose and culture will then deliver performance. This is the same for the physician CEO. Master physician leaders develop a shared vision from a clinical, business and professional perspective. This creates culture that drives performance. In doing so, doctors lead the leaders who lead the processes that result in changing patients, the profession and state of medical care.


Leadership experts Robert Anderson and William Adams characterize this saying: “The inner game (purpose & culture) always run the outer game (performance).” In doing so, physician CEOs stay above the detailed complexities which are delegated to qualified team members.

When acting as physician CEOs, doctors ideally spend 100% of their time thinking strategically (purpose creates culture that drives performance) and acting tactically (developing the collective, making decisions and driving change)—even while caring for patients. But what does it mean for doctors to spend 100% of time thinking about strategy and tactics when working as clinicians, professionals and businesspeople?


Over the next weeks we will explore these in detail. In the meantime, if the goal is to lead the direction of medicine to where patient well-being is the priority, those leading must be the doctors, and those doctors must learn to act as physician CEOs.


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