After practicing clinical care for 4 years, hospitalist Suneel Dhand, MD, was ready for a change and eager for the chance to help improve the broader health care system.
So when the opportunity arose to direct an internal medicine program at a large hospital, Dr. Dhand gladly accepted the role. He aimed to enhance frontline staffing, expand his hospital medicine team’s influence, and raise the standard of care for patients.
Almost immediately, however, Dr. Dhand knew the administrative route was the wrong path for him.
“I realized very quickly that initiating change and being a positive force, while working with multiple competing interests, is far from easy,” said Dr. Dhand. “I didn’t particularly feel well supported by the high-level administrators. Without resources, it’s extra difficult to make things happen.”
A year and half into the role, Dr. Dhand left the position and returned to purely clinical work. He now practices as a Boston-area hospitalist while writing, filming, and podcasting about medicine on the side.
“I have no intention of leaving clinical medicine,” he said. “If somebody gave me a very highly compensated offer right now to come and be a hospital leader, I wouldn’t do it. It’s not me, and I wouldn’t enjoy it.”
Taking on an administrative or executive role can sound appealing to many clinicians. The Medscape Physician Compensation Report 2018 found that 42% of employed physicians were aiming for a promotion. Another physician survey by The Physicians Foundation found that 46% planned to change career paths in 2018 and that more than 12% planned to seek a nonclinical job in the next 1-3 years.
Interest in executive and leadership roles has also increased because of the COVID-19 pandemic, particularly as more physicians struggle financially and search for alternative compensation, said Peter B. Angood, MD, CEO and president for the American Association for Physician Leadership.
“Because of the COVID-19 impacts on health care and our country as a whole, the strengths of physician leadership have been better recognized at multiple levels,” Dr. Angood said. “As a result, there is definitely early interest as the ongoing impacts of COVID-19 are appreciated in how to further integrate physicians as leaders within the health care industry as a whole.”
Administration: Not for everyone
But as Dr. Dhand’s experience highlights, administration is not the right direction for every physician. Take the case of prominent surgeon and Harvard University professor Atul Gawande, MD, who in May stepped down as chief executive for Haven, the health care venture backed by Amazon, after just 2 years. In a statement, Dr. Gawande indicated he would be taking a less operational role with the company to devote more time to policy and activities associated with COVID-19.
Although the details of Dr. Gawande’s departure are unclear, his abrupt exit raises questions. Are physicians prepared for executive positions before making the move? Who makes the best fit for an administrative job?
“It’s certainly something most folks should not just jump into,” said Dr. Angood. “In the same way that physicians spend an awful lot of time developing their expertise to become an expert clinician, the same philosophy for becoming an expert administrative leader should be applied. You need to put in the same amount of energy and effort to truly be effective.”
The motivations behind moving to an administrative role vary among physicians, said Carson F. Dye, fellow and faculty member at the American College of Healthcare Executives and a leadership consultant. Some doctors make the shift because they have a natural proclivity for leading, whereas others want to make a greater impact on patient care and quality, Mr. Dye said. Still other physicians simply want a greater say in the everyday areas that affect them.
At the same time, there are more physician leadership opportunities than before. Positions such as chief quality officer, chief medical information officer, president of the employed medical group, and chief population health officer rarely existed 20 or 30 years ago, Mr. Dye noted.
“Moreover, nonclinical executives have begun to see the great value in having more physician leaders involved because it enhances physician engagement and provides valuable input for strategic change,” Mr. Dye said. “As a result, more physicians are coaxed into considering leadership roles.”
North Carolina internist Michael Lalor, MD, says leadership responsibilities landed in his lap early in his career and led to his ultimate post as a full-time administrator. Dr. Lalor was a couple years out of residency and working for a small private practice when the owner decided to retire early and asked him to take over the group, he explained.
After accepting, Dr. Lalor hired another physician, expanded the group, and later merged with a larger network.
“I loved it from the perspective of the intersection of business and medicine,” he said. “It really gave me experience you don’t get in training, such as the actual operations of running a medical group, contract negotiations, expansion plans, payroll, accounting. It was an entirely new experience that I really enjoyed.”
Dr. Lalor also served as a medical director for a small, nonprofit hospice in the area, which spurred him to become board certified in hospice and palliative medicine. He now acts as chief medical officer for a large hospice and palliative care organization based in North Carolina.
Chicago-area family physician John Jurica, MD, made his way up the executive ladder through a series of steps. Dr. Jurica said he felt drawn to committees and projects that addressed population health and quality issues. Tapping into this interest, he became medical director for Riverside Medical Center in Kankakee, Ill., followed by vice president of medical affairs and then chief medical officer for the hospital.
Along the way, Dr. Jurica volunteered with nonprofit organizations, served on hospital boards, and completed a master’s degree in public health.
“The more I got into it, the more I liked it,” he said. “I was wanting to be involved in helping larger numbers of patients in a different way, work on big problems, affect the community, and work on multidisciplinary teams.”
Today, Dr. Jurica is medical director and part owner of two urgent care centers. His career journey inspired him to create the VITAL Physician Executive blog, which offers advice about becoming a physician executive. He also hosts a podcast devoted to nonclinical careers for physicians.
Dr. Jurica said he hears a range of reasons for seeking a change from clinical care, including disillusionment with medicine; high debt; outside interests; and burnout.
“A number of physicians have said, ‘I really don’t enjoy medicine anymore,’ ” Dr. Jurica said. “ ‘The paperwork is onerous, I’m working long hours, I have to see more patients, and I’m getting paid the same or less. It’s just not what I thought it would be.’ ”
Although burnout prompts some physicians to pursue administrative roles, Dr. Angood cautions that this is like entering a rebound relationship after leaving a bad relationship. Making the move merely because of dissatisfaction with your current position can set you up for disappointment, he said.
“Too often, physicians who are frustrated with the complexities of clinical care will view administrative roles as a parachute for themselves out of that situation,” he said. “If they don’t understand the nuances of administrative work, they run the risk of moving into a role that will ultimately provide them a different level of dissatisfaction, rather than the higher level of satisfaction they were seeking. It is all about trying to ensure a good match in terms of expectations in order to obtain optimal outcomes.”