Clinician or Non-Clinician: Stakeholders Weigh in on the Best Fits for the C-Suite

Although clinical leaders often make for effective C-suite members, industry experts say healthcare organizations should prioritize leadership qualities over a specific type of background.

As the healthcare industry evolves, some organizations are looking to clinical leaders to navigate a maze of new regulations on care quality and changing payment models. But some industry consultants have concerns about this push to emphasize clinical leadership in the C-suite.

Over the last several years, healthcare organizations have increasingly turned to leaders with clinical expertise over those with business backgrounds. A 2014 white paper published in Physician Executive Journal estimated that physicians led just 5 percent of health systems at that time. By 2016, based on a sampling of 6,500 U.S. hospitals in a BMC Health Services Research study, researchers found that clinicians made up about 26 percent of board members and 22 percent of CEOs. The report also analyzed the effects of physician and clinician leadership, noting advances in the quality of care but some deficits in business operations. 

While there is little definitive evidence of whether clinicians or non-clinicians make the best healthcare leaders, stakeholders say the focus should be on finding the best overall candidate. 

Rulon Stacey, PhD (pictured at right), managing director for health systems at Navigant, sees too much focus by healthcare organizations on searching for clinician leaders. Many boards can’t express why they want a physician leader when pressed, he adds.

“They somehow feel that’s just intuitive,” Stacey says. “Boards that narrow their search to simply physicians put symbolism over substance, and they risk their patients and their organization.”

Calling the push for clinical leaders a “fad,” Stacey warns that it isn’t accurate to assume that physicians or other clinicians make better leaders because they care more about patients than do nonclinical leaders or have a greater stake in an organization’s success.

“There are many examples in the industry of late in which system boards have restricted their CEO searches to just physicians. I believe that boards that do that border on negligence,” Stacey says. “It is a silly assumption to think that without a physician as CEO, my organization won’t focus on quality.”

By limiting executive searches to clinical leaders, Stacey says organizations risk overlooking meaningful candidates. There certainly are qualified physician leaders who understand leadership and systems and the drive to improve quality. There are also many qualified nonphysician leaders who can provide that expertise.

“I believe that the distinguishing factor in selecting a CEO should not be whether a candidate is a physician,” he adds. “Rather, it should be whether this person has the leadership skills and commitment to quality to succeed in health care.”

Some physicians are knowledgeable about business and leadership, but not all are. Boards tasked with appointing new leadership must carefully consider the skills they desire in a leader and which candidates possess those skills, says Deborah J. Bowen (pictured at right), president and CEO of the American College of Healthcare Executives (ACHE).

“You have to have a certain skill set to understand how the operations work,” Bowen says. “Even more widely, I think a lot of healthcare organizations are looking to import other kinds of skills like entrepreneurship, engineering, and risk management. I think people are looking more broadly at what they need in their organizations and who are the best people to bring to the team.”

Although clinicians receive substantial training in their fields, medical schools aren’t necessarily preparing physicians to lead a hospital or health system.

“These are very complex, sometimes billion-dollar operations. You don’t run a business like that without some preparation and competencies,” Bowen says. “Clinical training alone doesn’t automatically prepare you for a job in leadership.”

“There are very specific competencies and if clinical people develop those, they can be very good leaders.”

New Challenges Demand Different Skills

Cody Burch (pictured at right), executive vice president at the healthcare executive consulting and search firm B.E. Smith, says the demand for clinical leaders is still strong and represents a common request by health systems. But clinicians may not be a fit for every leadership role.

“We have seen a tripling in volume for CFO needs year over year. I think a lot of that depends on the changing demands of healthcare providers,” Burch says. “The leadership expectations are changing, and that’s calling for new skill sets.”

Some of these changing demands arise from integration and the need for team-based and coordinated care, he says. There is a greater expectation that leaders will have a vision and strategy, agility, and the ability to communicate across the leadership team, he says.

“These changes—and the need to work across payers and physicians—all of these pieces and parts need to work well together,” Burch says. “Health care is just being consolidated across the board and requires leaders who can work across boundaries to get things done.”

Certain skills and roles are becoming more pronounced as the industry evolves, Burch says. Change management is huge, and chief transformation and innovation officers are being called to lead strategy.

“I don’t believe any of those tend to be clinical,” he adds. “A lot of organizations are also looking at nonclinical leaders. The focus is less about whether a leader’s background is clinical, financial, or operational. What’s more important is the individual’s leadership style. Today’s leaders must think outside the box, build strong relationships across their organization and community, and drive needed change.”

Seeking the Best of Both Worlds

Whether an organization appoints clinical or nonclinical leaders, stakeholders agree that collaboration and teamwork are key. Given that some skills are stronger in clinicians and others in non-clinicians, dyad and triad models offer unique solutions, ACHE’s Bowen says.

“I think the complexity of our system requires that you have more people at the table with a combined skill set to effectively lead,” she says.

“I just don’t buy into that argument that it’s going to be one or the other,” Bowen adds. “We’re having an evolution in health care, and you can’t do the work of value-based care and safety without both operational and clinical expertise.”

When organizations seek new leadership, Burch increasingly expects a focus on internal development. Seventy-five percent of clients polled by B.E. Smith reported that they plan to place greater emphasis on developing leadership talent from within, he says.

Regardless of whether leaders come from exam rooms or administrative offices, Stacey hopes the focus will shift to embracing executives who have training in leading and inspiring others.

“To hire somebody for a leadership position [based on] credentials other than leadership is concerning to me, and I think it should be concerning for the industry,” he says.

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Rachael Zimlich, RN, is a critical care nurse and healthcare writer from Cleveland.

Interviewed for this article: Deborah J. Bowen, president and CEO, American College of Healthcare Executives (ACHE); Cody Burch, executive vice president, B.E. Smith; Rulon Stacey, PhD, managing director for health systems, Navigant.