“When you get someone who knows what quality looks like and pair that with curiosity about new ways to think about leading, you end up with the people who are able to produce dramatic innovations in the field.”1
In medicine, a physician is trained to take charge in emergent situations and make potentially lifesaving efforts. However, when it comes to leading teams of individuals, not only must successful leaders have the right skills, they also need time to dedicate to the work of leadership.
To better understand current approaches to dedicated hospital medicine group (HMG) leadership time, let’s examine the 2018 State of Hospital Medicine (SoHM) Report. The survey, upon which the Report was based, examined two aspects of leadership: 1) how much dedicated time a leader receives to manage the group; and 2) how the leader’s time is compensated. Looking closely at the data displayed in graphs from the SoHM Report (Figures 1, 2, and 3), we can see that dedicated administrative time is directly proportional to the size of the group.
In my current role as a regional medical director in the Dallas-Fort Worth market, I oversee some programs where the size is greater than 30 full-time equivalents (FTEs), and requires a full-time administrative physician leader to manage the group. Their daily administrative duties include, but are not limited to, addressing physician performance and behaviors, managing team performance metrics, dealing with consultants’ expectations, attending and leading various committee meetings at the hospital or the system level, attending and presenting performance reviews, leading and preparing for team meetings, as well as addressing and being innovative in leading new initiatives from the hospital partner system.
Although physician leaders are paid more for their work, the 2018 SoHM Report reveals a decline in the premium year over year. One of the reasons for the payment decline that I have encountered in various groups is that their incentives for leading the group are based on performance, as opposed to receiving a fixed stipend. Another reason is the presence of dedicated administrative support or the inclusion of a performance improvement staffer, such as an additional nurse or advanced practice provider, in the group.
Evidence suggests that organizations and patients benefit when physicians take on leadership roles. Physician leaders play critical roles in providing high-quality patient care. How can the Society of Hospital Medicine help? Management degrees and leadership workshops have become a common pathway for many physicians, including myself. SHM provides one of the most thorough and relevant experiences through the SHM Leadership Academy. The focus of the Leadership Academy is on developing a broad set of additional leadership competencies across a spectrum of experience.5 As hospitalist physicians are often expected to fulfill a broader leadership void, we must pay attention to developing the leadership skills depicted in Figure 3. Hospital medicine is an ideal “proving ground” for future physician executives and leaders, as they often share the same characteristics required for success.
The leadership paths available in my organization, Sound Physicians, were recently highlighted in a New York Times article.3 Sound Physicians employs more than 3,000 physicians across the country, and has a pipeline for doctors to advance through structured rungs of leadership – emphasizing a different mix of clinical, strategic, and business skills at each stage, from individual practitioner to the C-suite. The training includes in-person and online courses, as well as an annual conference, to help doctors develop management and leadership competencies, and learn how to apply these skills within their organizations. Since introducing its leadership development program, the company reports less turnover, higher morale, and better growth. I personally have gone through the leadership training provided by Sound Physicians, and reflecting back, it has been a transformational experience for me. Leadership is a journey, not a destination, and as physicians we should strive to learn more from the health care leaders around us.
The administrative workload for hospital-based physician leaders will increase with the arrival of value-based programs and alternative payment models promoted by the Centers for Medicare and Medicaid Services. Lead hospitalist duties are not limited to daily operations, but can extend to leading the strategic vision of the hospital or health system. The 2020 SoHM Report will reflect these changes, as well as provide further information about how to manage and set expectations for physician leaders, based on group size and employment model.
Dr. Patel is a regional medical director with Sound Physicians. He manages more than 100 FTE hospitalists and advanced-practice providers (APPs) within multiple health systems and hospitals in the Texas market. He also serves as a member of the SHM Practice Analysis Committee and as a vice president of SHM North Texas Chapter.
1. Angood P and Birk S.Physician Exec. 2014 May-Jun;40(3):6-20.
2. Rice JA. Expanding the Need for Physician Leaders. Executive Insight, Advance Healthcare Network, Nov 16, 2011. Available at: http://healthcare-executive-insight.advanceweb.com/Features/Articles/Expanding-the-Need-for-Physician-Leaders.aspx.
3. Khullar D.. New York Times. 2019 Nov 21.
4. Beresford L. The State of Hospital Medicine in 2018..
5. Harte B.. Hospitalist. 2018 Nov 29.