Eric Howell, MD, SFHM, is the first to admit how quickly it happened. Shortly after he became a hospitalist in 2000 at Johns Hopkins Bayview Medical Center in Baltimore, lower- and midlevel managers began to notice the quality of his daily clinical work. They reported their observations up the line, and soon Dr. Howell was rewarded with a small leadership role. He succeeded in that role, was given more responsibility, and in six short years he had worked his way up the management chain, becoming director of the medical center’s HM division.
“In hospital medicine, it’s fairly common to see young physicians stepping up into management,” says Patrick Cawley, MD, SFHM, a former SHM president who now directs the hospitalist program at the Medical University of South Carolina in Charleston and serves as medical director of the Medical University Hospital Authority. “The bottom line is they are there and they are getting noticed.”
On average, it takes about five years for a hospitalist to move into management; the average time for physicians in more established medical fields is 15 years or more, Dr. Cawley says. Part of the reason for the quick management rise in HM has to do with demographics. Because most hospitalists are younger, there is greater occasion for younger physicians who want to be in management to advance, says Timothy Keogh, PhD, an adjunct associate professor in the Department of Health Systems Management at Tulane University’s School of Public Health and Tropical Medicine in New Orleans, where he also directs the Master of Health Administration Program.
Another reason is that because hospitalists work in the hospital every day, they have innumerable opportunities to make an impression, Dr. Cawley says. They also know hospital culture, which gives them an advantage. “This is why hospitalists often get leadership positions,” he says. “Only by knowing the culture can you change the culture.”
Take the First Step
Although hospitalists are well positioned to assume management positions, it doesn’t mean an opportunity is going to fall into your lap. The best recipe for getting recognized—and promoted—is “doing the job you are currently doing really well,” Dr. Howell explains. “You have to do a good job on the basics.”
Often, physicians have their eye on a long-term goal and forget to focus on succeeding at their present work, Dr. Howell adds. That includes building relationships with lower- and mid-level managers like charge nurses, unit directors, and social work managers. That said, hospitalists who want to advance have to be proactive, Dr. Keogh says.
“Leadership is not only about hard work; leadership is about seeing the big picture and going above and beyond,” says Dr. Keogh, who is a member of the SHM Leadership Academy faculty.
The best place to show initiative is on a committee, and the easiest place to start is on a quality-improvement (QI) committee, Dr. Cawley says. If hospitalists are successful in that capacity, they can move on to peer review and credentials committees. From there, the next steps could be becoming first an officer, and then president, of the hospital’s medical staff.
“If you have the leadership skills, you can move up relatively quickly,” Dr. Cawley says. “Some people don’t need a lot of leadership training because they have it innately. But this isn’t true of the vast majority of people.”
The good news for the vast majority of hospitalists seeking a managerial role is that opportunities for training abound.
Fellowships are a good idea, but it’s critical that hospitalists interested in management choose the right one, Dr. Howell says. Select a fellowship program that focuses on areas important to the hospital—say, QI projects, patient-care initiatives, and system improvement.
Hospitalist Paul Grant, MD, considers the one-year HM fellowship he completed at the Cleveland Clinic Foundation an asset because he was able to gain expertise in perioperative medicine. The fellowship has served him well at the University of Michigan Health System in Ann Arbor, where he is director of perioperative medicine and consultative medicine.
“The fellowship really gives me an advantage,” says Dr. Grant, who notes he would like to assume a larger management role in the future.
Upward-thinking hospitalists should know something about budgeting, Dr. Keogh points out. Taking a budgetary course or two at a local community or technical college will not only provide a hospitalist the basics needed to understand and prepare budgets, but it also will demonstrate their willingness to master new skills that are important at the next level, he says.
An advanced degree, such as an MBA, a master’s degree in public health (MPH), or a master’s degree in medical management (MMM), can set hospitalists apart from their colleagues, Dr. Keogh says. These courses teach hospitalists how to excel at communication, how to implement change, and how to develop effective strategies.
Hospitalists can gain management-related skills from leadership courses tailored to physicians and healthcare professionals. SHM hosts two Leadership Academies per year (www.hospitalmedicine.org/leadership), and the American College of Physician Executives (www.acpe.org) and the American College of Healthcare Executives (www.ache.org) also offer leadership training, Dr. Cawley says.
You might want to consider communicating with upper-level managers (e.g., CMO, chief of staff, or vice president of medical affairs), but proceed cautiously, because there are right ways and wrong ways of reaching out. If you have a suggestion, ask to meet with an upper-level manager face to face to present the idea.
“Leadership is personal,” Dr. Cawley explains. “I think e-mails aren’t as effective as coming to sit down and converse.”
E-mail, however, can be used effectively to report on your project’s success. For example, Dr. Howell says he sent an e-mail about quality indicators to the president of the Johns Hopkins health system. When things went well—as they usually did—the president saw it. When things didn’t go as well, Dr. Howell put together a corrective action plan and e-mailed it along with the indicators to show he was aware of the situation and already had a plan in place to fix it.
“A lot of times [hospitalists] won’t be able to get to the next level and they’ll wonder why,” Dr. Cawley says. “They need to ask somebody they trust to give them an honest evaluation of what they’re doing well and what they may need to improve.”
Hospitalists must be open to constructive criticism, as honest assessments of your work aren’t going to be 100% complimentary. At times, they will be critical.
“Dealing with the feedback can be difficult, but ultimately it helps the hospitalist progress,” Dr. Cawley says. TH
Lisa Ryan is a freelance writer based in New Jersey.