Why Physician Leadership Transitions Sometimes Fail

The success of a leadership transition can hinge on a physician’s ability to build rapport with non-clinicians.

Many physicians learned medicine under the “see one, do one, teach one” model, which suggests that after witnessing a procedure once, physicians should be able to perform the procedure and then teach it to others. Although this model is no longer considered a best practice, it reflects the “sink or swim” mentality that still pervades medical education as well as the appointment of physician leaders, says Frank D. Byrne, MD, FACHE, president emeritus at SSM Health St. Mary’s Hospital in Madison, Wis.

This “trial by fire” approach sets new physician leaders up for failure. “It is important not to repeat the mistakes of the 1990s—namely putting physicians in leadership roles without providing any training, mentorship, or support,” says Byrne (pictured at right), who is also the senior executive adviser at a healthcare venture capital fund in Madison. “The leadership team needs to take time to integrate a new physician leader, particularly if they come from outside the organization.”

Insufficient training and support is just one of the reasons why physicians fail to make successful transitions to new leadership positions. Unrealistic expectations from the physician and the administration also can stymie transitions, Byrne says. For example, physician leaders may be asked to juggle a full clinical workload while they take on administrative roles. Byrne disagrees with the notion that all physicians in leadership roles should continue their clinical practice, as suggested by two physicians in the Annals of Internal Medicine. ^a

“I have seen several instances where physicians do this and wind up with two or more full-time jobs,” he says. “These physicians are not happy with their performance in either the clinical or administrative realm, and worse yet, their personal life suffers as well. When I have hired part-time physician leaders in the past, I have made it clear that there will be guardrails around their administrative obligations.” 

Physician leadership transitions also can be derailed if physician leaders do not engage with nonclinical leaders. Working alongside administrators takes many physicians out of their comfort zone, says John W. Henson (pictured at right), MD, FACHE, chief of oncology services at Piedmont Healthcare in Atlanta. Henson points to his own experience: When he took his first vice president role, he did not understand how to speak the same language as his non-physician colleagues, which put him at a disadvantage. He recommends that physicians join professional organizations that allow them to interact professionally with administrators.

Lily J. Henson, MD, FACHE, the CMO at Piedmont Henry Hospital, Stockbridge, Ga., says physicians need to engage administrators to build credibility outside of their specialty. “When I’m speaking with our CFO, COO, and CNO, I find that it isn’t enough that I’m offering the physician perspective—I have to be able to look at issues from the perspectives of the staff, nursing, finance, and operations,” she says. “Wearing just the physician hat—which is what we are used to doing—doesn’t give you enough credibility with members of your executive team if you don’t understand or can’t articulate the arguments from a finance or a strategic perspective, for example.” 

Collaboration also is essential for CMOs who might not have budgets and thus need to work with the CNO or other leaders to get projects completed, she says.

Emotional intelligence, which is the ability of individuals to recognize their own and other people’s emotions, can be another deficit for many aspiring physician leaders. Reading books on emotional intelligence can help physicians feel more prepared to interact with different types of professionals. John Henson recommends Primal Leadership by Daniel Goleman, PhD, and All the Leader You Can Be by Suzanne Bates.

“A lot of physicians who come into positions like this have never thought about how they come across to others or how they interpret others’ reactions to them,” he says. “I know that’s true because I still struggle with it myself.”

Onboarding Successfully

Once physicians take a new leadership role, it is essential that they forge relationships with their new team. Social events such as welcome receptions and physician appreciation dinners can help new physician leaders establish rapport with staff.

“If you only interact with someone when you have an issue to resolve, you don’t have a relationship,” Byrne says. He recalls his own experience as an outsider coming to SSM Health St. Mary’s 13 years ago. “They didn’t know me as a physician, so I didn’t have that launch pad,” he says. “My onboarding process had to include spending time with both the clinicians and non-clinicians to establish my credibility in both spheres.”

During a leadership transition, incoming physicians should learn the culture of their new organizations. Identifying a mentor can help physicians navigate a new culture and can provide an opportunity to receive constructive criticism. “We tend to develop blind spots to what we aren’t good at, so it is important to find someone you trust who can give you gentle feedback,” Lily Henson (pictured at right) says. 

When selecting a mentor, physician leaders might want to consider a non-physician, Byrne adds. “A non-physician can serve as an interpreter, which can be valuable to physicians who have led a fairly cloistered existence within their clinical silos,” he says. 

Positive Leadership Styles

Physicians should take care not to be micromanagers in their new roles—even if refraining from micromanagement can be challenging for physicians who feel insecure about their new leadership abilities.“As a leader, you need to be able to motivate those underneath you,” John Henson says. “If you do people’s jobs for them, that is a big de-motivator. New leaders need to be masters of knowing how to motivate different types of people.”

Finally, Byrne says having colleagues address him by his first name instead of as “Dr.” has helped break down barriers with nonclinical staff and has eliminated hierarchies over the course of his career. “I never wanted people to feel reluctant to tell me something that I should know,” he says.

Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.

Quoted in this article:  Frank D. Byrne, MD, FACHE, president emeritus, SSM Health St. Mary’s Hospital, Madison, Wis., and senior executive adviser, HealthX Ventures, Madison, Wis.; John W. Henson, MD, FACHE, chief of oncology services, Piedmont Healthcare, Atlanta; Lily J. Henson, MD, FACHE, chief medical officer, Piedmont Henry Hospital, Stockbridge, Ga.

This article is based in part on a presentation at the 2017 ACHE Congress in Chicago.

Footnote

a. Detsky, A.S., and Gropper, M.A., “Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care,” Annals of Internal Medicine, Oct. 4, 2016.