Practice Management

Business Blueprint

Perhaps you’ve put in a few years of clinical practice in an HM group. Suddenly, your group needs a director—and everybody stepped back, except you. You now find yourself thrust into an unfamiliar world of bottom-line thinking, budgets, schedules, spreadsheets, decision-making, conflict resolution, recruiting, contract negotiations, and other managerial responsibilities. You’ve tried to learn how to perform most of these duties on the job. But you’ve learned that assuming direct responsibility for the fate of a hospitalist group with millions in annual billing requires skills that weren’t taught in medical school. And you’re struggling.

Maybe you’re a hospitalist residency program director in a teaching hospital setting, and you would like to transition into other hospital administrative leadership roles, such as chair of a medical staff or credentials committee, department chair, vice president of medical affairs, chief medical officer—maybe even CEO. But where do you begin?

The good news is that hospitalists are well positioned for such advancements, there is a core set of skills required for these various leadership positions that you can learn, and there are several places you can turn to for training. The trick is figuring out which skills and aptitudes you already possess, identifying those you need to strengthen, and selecting the training venues that best meet your goals. Your options vary widely, and include simply reading books on management to get up to speed quickly, investing in leadership training seminars and short courses, and pursuing advanced-degree programs in business leadership.

“Over the next 10 years, the single largest source of new CMOs might be hospitalists,” says John Nelson, MD, FACP, MHM, medical director of Overlake Hospital in Bellevue, Wash., and cofounder, past president, and past board member of SHM. “As many specialties focus more of their practice in the ambulatory care setting, that leaves behind those of us who will stay—e.g., hospitalists, radiologists, ER doctors, anesthesiologists—and who think of the hospital as their principal place of work. Of those doctors, hospitalists are probably the most interconnected and networked with all other doctors and all levels of hospital staff. That’s why hospitals are looking toward hospitalists for leadership.”

There is a growing need for HM to develop leaders, Dr. Nelson says, “not just for their own practice, but for various leadership activities within their hospital.”

Start at Self-Assessment

Hospitalist leadership is not for everyone, and you need to find out if you’re making the right decision by pursuing it. For one thing, you’ll need to facilitate consensus among physicians—a notoriously challenging group of professionals who are autonomous by training, conditioned to believe that they always wield veto power and that they don’t have to play by the rules established for everyone else, Dr. Nelson says.

Dr. Wright

Most daily leadership activities are much more open-ended and far less structured than physicians are used to, entailing simultaneous projects that need to be prioritized, says Dr. Nelson, who splits his time about 30% clinical and 70% administrative. He is a champion for his hospital’s technology initiative, medical director of his institution’s hospitalist practice, physician lead of its palliative-care program, principal of Nelson Flores Hospital Medicine Consultants, and a columnist for The Hospitalist.

How can you find out what you’re good at, what your weaknesses are, and what skills you need to build? There are several personality assessment instruments with which you can appraise your compatibility with leadership culture, says Julia S. Wright, MD, SFHM, FACP, senior medical officer for Canton, Ohio-based Hospitalists Management Group. And there are good self-assessment workbooks to test whether you have an inclination toward leadership, says Mary Jane Kornacki, MS, a partner in the Boston-based consulting firm Amicus Inc. You also can have a personal leadership assessment performed professionally (see “Leadership Self-Assessment,” p. 27).

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