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Two Distinct Pathways to Hospital Leadership


Thadeo Catacutan, MD, sat in a ballroom at the Gaylord Resort & Convention Center in National Harbor, Md., on a sunny spring day at HM13, just thinking about his future after spending seven years as a hospitalist at Cleveland Clinic. He wondered if additional training in business administration would provide him with the advancement opportunities and professional fulfillment he sought.

“It’s been hard to determine what I really want to do,” he said. “After seven years, is this the peak? Are there other opportunities?

“I realize that if you are not going to specialize, you have to go into a leadership career track,” he said. “Some would say you can just be a clinician, but in the long term, I don’t think that is a sustainable path. You will just burn out.”

Dr. Catacutan isn’t the only one concerned. Nearly 200 physicians joined him for an HM13 breakout session titled “Career Tracks for Hospitalists.” The session provided attendees two viewpoints on career advancement: the executive pathway and the hospital leadership pathway. And although the session’s speakers demonstrated distinct routes to senior positions, there’s a shared path for each, including:

The way you get to take on leadership opportunities is by acceptance. Say ‘yes.’ Say ‘I’m curious’ or ‘How can I make a contribution?’ You will stumble. You will make mistakes. You will be clumsy. … But it is that process that teaches you what you need to know.—Michael Guthrie, MD, MBA, executive in residence, University of Colorado, Denver
  • Weighing choices carefully. The reasons for seeking a new career path are personal and not the same for everyone. Keep that in mind.
  • Thinking about return on investment. Physicians should consider what they’re getting for their effort, whether that’s the cost of an advanced degree or the value of time spent volunteering on a hospital committee.
  • Contemplating what you like about your job. When considering a career move, remember the adage that the grass is always greener.

“The way you get to take on leadership opportunities is by acceptance,” said session moderator Michael Guthrie, MD, MBA, executive in residence at the University of Colorado. “Say ‘yes.’ Say ‘I’m curious’ or ‘How can I make a contribution?’ You will stumble. You will make mistakes. You will be clumsy. … But it is that process that teaches you what you need to know.”

Path: Advanced Training

Michael Ruhlen, MD, MHCM, FACHE, SFHM, said he needed to know how to communicate better with the administrators he regularly met with to discuss his pediatric hospitalist program.

“I found that I wasn’t always speaking the same language when I talked to administrators about the value that hospitalists brought to their individual institutions,” he said. “No matter how hard I tried, I could always walk into a room with a master’s-prepared administrator who could absolutely prove to me that my hospitalist program would cost them far more money than it would ever be worth—and they simply could not afford it.”

To address what he calls a “knowledge deficit,” Dr. Ruhlen earned his master’s degree in health-care management from the Harvard School of Public Health in Boston. Armed with new business acumen, he rose to vice president of medical affairs at Toledo Children’s Hospital in Ohio, and even served as interim president for a short time before he became vice president and chief medical officer of Carolina HealthCare Systems in Charlotte, N.C.

“Communications, public speaking, and change management was a very big component of what we were taught,” he added, “as well as performance improvement, which is where my career has drifted.”

Dr. Ruhlen said hospitalists are perfectly positioned for leadership roles in hospitals. He also said that “institutions led by physicians appear to have better performance metrics” and that physicians “owe it to our patients to try to take back medicine.”

One thing Dr. Ruhlen wished medical training would address better is population health, a topic he became “enamored” with in business school. “It’s a very interesting body of work, interesting body of language,” he said. “I think it will be critically important as we move into a realm of significant health reform.”

Path: Quality Expertise

Greg Maynard, MD, MSC, SFHM, took a different route to hospital leadership. He didn’t seek an advanced degree in business and hasn’t bounced from one job to another climbing the corporate ladder. Instead, he’s devoted his time and energy to quality improvement (QI) as clinical professor of medicine in the division of hospital medicine at the University of California at San Diego.

Dr. Maynard encouraged hospitalists to consider becoming experts in hospital quality and patient safety, a path that has led him to national recognition. “You won’t get bored,” he said. “Your career will find you.”

Dr. Maynard, who serves as senior vice president of SHM’s Center for Healthcare Improvement and Innovation, said every QI project “seems to have its time,” and he warned hospitalists that dealing with frustration is part of the job description.

“Some projects I initiated didn’t get off the ground, no matter why I did it,” he explained. “For example, transitions of care—when we started looking at it, nobody in the hospital cared. The administrators didn’t care about discharge summaries or teachback communication strategies. They only cared when readmissions came in focus.”

He and his team needed to learn to “satisfy ourselves” and change what they could change as hospitalists. The hard part, he said, was being patient.

“We knew it was coming; we just had to wait and not get rankled,” he added. “I had to learn to not take things personally. Be patient and wait for the opportunity.”

Dr. Maynard advised hospitalists to learn to “say no, or ‘I would love to but I just can’t.’” He also said hospitalists should not be afraid to ask for help.

Return on Investment

Dr. Guthrie, who received his MBA nearly 40 years ago, said times have changed and business schools have adapted to a new economic landscape. Opportunities for physicians to receive advanced training are much greater now, with physicians earning advanced degrees in public health and health administration, as well as MBAs.

Many of the top schools offer work-friendly course schedules, including night and weekend courses and plenty of online options. Some, such as the University of Massachusetts, offer a 100% online MBA program.

Listen to Dr. Guthrie discuss his path to hospital leadership and how business schools have adapted for physicians.

Still, he warned hospitalists to consider their goals along with the time, energy, and financial commitment that post-graduate work requires.

“The investment is huge,” he said.

It’s exactly what Dr. Catacutan is contemplating. Should he go back to school, pursue leadership within the walls of his hospital and executive courses like SHM’s Leadership Academy, or should he be satisfied as a full-time clinician?

“Is it really worth my time, especially with family and kids?” he asked rhetorically. “It’s a personal decision.” TH

Richard Quinn is a freelance writer in New Jersey.

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