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The Steps to Transition from Doctor to Physician CEO (Part 1)

As we have established previously, balancing medical care starts with having autonomous doctors. To be autonomous, doctors must think like CEOs -- master leaders who take responsibility for medical care. But, in the context of leadership and management, doctors are usually relegated to the role of manager. They oversee processes such as patient care, practice business operations, teaching, research and administration. In each of these instances, the doctor engages in specific tasks. They examine patients, populate the electronic medical record, print prescriptions and perform procedures. They write grants, go to the lab, analyze results, and produce research manuscripts. They participate in teaching rounds, give lectures and assess trainees. They make call schedules, participate in quality improvement initiatives, assess morbidity and mortality, and hire/fire office personnel. They are expected to be managers. -- the overseer of tasks. 

 

This is not a criticism. It is just an observation. 


Consider the academic position of department chair. Department chair is a terrific platform from which to lead. Still, most department chairs run their departments as managers. They are the overseer of processes. In fact, chairs are often chosen based on their success as managers. The best researchers, clinicians and teachers—the best taskmasters—are often rewarded by being named chair. Their job performance as chair is usually determined by how well the doctors in their departments perform their tasks. Do they hit quality targets? Do they meet performance metrics? Do they achieve scholarship thresholds? Department chairs usually act as medical administrators. And administration is synonymous with management not leadership.


When doctors go to work as leaders (physician CEOs), they approach their day completely differently. Instead of thinking about how they will see the 40 patients scheduled in clinic or how they must make rounds before going to the operating room or how they must stay late to finish medical records, all of which are tasks, they approach their day, from the perspective of purpose, culture and performance. “How am I going to motivate and empower my team so that 40 clinic patients are seen, rounds are completed before surgery and medical records are completed in a timely fashion.” Notice the difference. The physician CEO leads people performing tasks. They do not necessarily perform the tasks themselves. Unfortunately, the work environment for doctors is not currently set up this way. Becoming a physician CEO will require a transition that is challenging, even existentially threatening.


To successfully navigate the transition, let’s break the challenge into three steps. 


  • First, how do we transition the doctor’s focus from performing tasks to setting purpose?

  •  Next, how do we reconcile the performance of processes with the creation of culture? 

  • Lastly, how does the doctor ensure that tasks are being adequately performed? 

Like all master leaders, physician CEOs lead with purpose – a vision that motivates action. Purpose is the motivation behind why we exist and why we perform. For physician CEOs, that begins with a basic question. Why are doctors even necessary? Notice how the doctor’s role, nowadays, has been subjugated and replaced in many cases by Advanced Practice Providers (APPs). Virtual care, propagated by the COVID 19 pandemic, has enabled patients to fill drug prescriptions and seek medical opinions without seeing the doctor. Membership with the retail giant Costco, for example, now gets members access to Sesame Care online (a virtual care service)—obviating the need for the doctor. In their current role as medical managers, doctors have allowed the medical care environment to produce less expensive alternatives. So why do we need doctors? Seems all we need is a Costco membership?


But this is not medical care. This is chaos. In our current state, no one seems to be in charge. No one owns medical care. This must be our first challenge and our first opportunity. We need doctors to lead; to own medical care, even when they do not have the authority to make all the decisions. That means they must feel ownership of the doctor-patient relationship/patient well-being, ownership of the regional system of healthcare and ownership of the medical profession.  Ownership mentality does not require authority. It means working with others to achieve a desired vision. As we have previously suggested, physician CEOs need to approach medicine as leaders of team members leading medical care. That includes APPs, nurses and the availability of health facilities, universities, scientists, administrators, other professional colleagues and even patients (who become part of the team). When doctors act as leaders, they no longer compete with APPs and Costco for patients. Competition is the mindset of transactional managers. Ownership is the integral mindset of master leaders -- ownership that coordinates and oversees care using APPs and retail medicine as their de facto “management team.” 


So why do we need doctors? We need doctors to own medical care. When physician CEOs come to work, they lead the tasks of the day with a sense of responsibility. That does not mean that they are the ones to perform all these tasks. They own the responsibility that these tasks will be done by the most qualified member on the team. That is their purpose as leaders.


Next time, we will tackle the next two steps that transition the doctor from manager to physician CEO -- culture and performance.

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