The importance of physician leadership education

Medical group practices and other healthcare systems are faced with increasing administrative challenges because of changes related to an aging population, reduced reimbursements, regulatory burden, new technologies, government deficits, increased physician burnout, as well as many other contributing factors. These challenges are stressing the viability and sustainability of health systems.

Hospitals, medical schools, and physician practices, even within the same organization, commonly operate with three separate leadership structures, incentives, and goals. This lack of integration results in a structural imbalance and fragmentation that holds back advancement in the healthcare system. Given these growing complexities, it is imperative that physicians have access to resources that will prepare them to successfully lead these systems.

The need for engaged physician leadership

During the COVID-19 pandemic, medical practices have experienced heightened rates of staff turnover,1 as well as rising compensation costs and burnout- and retirement-driven healthcare turnover. The cost associated with this ongoing exodus of workers is building the case for why physicians, as leaders of the practice, must be actively involved in employee engagement to improve the physician and employee experience.

Physicians can work in several practice settings, including independent; academic; single- and multi-specialty medical groups; hospitals; and rural, suburban, and urban locations. Physicians are leaders in their field of clinical expertise, and in medical group practice and health systems they also are often looked to as leaders of the organization. Beyond their traditional role, physicians may also fill several other roles within the medical group practice: executive committee member, board/committee representative, physician partner, mentor, recruiter, manager, physician engagement and satisfaction liaison, as well as a variety of others.

As of 2019, the United States employed roughly 938,980 active physicians who completed intense training targeting the scientific principles and methodologies needed to succeed as medical providers.2 However, leadership is not central to their medical training; now more than ever, it is more valuable to provide physicians with this content to ensure the success of the physician leader and the medical practice. Thus, physician leadership education is a crucial factor and required experience for physicians who will be practicing and leading into the future. In fact, medical school curriculum is evolving to meet this critical training need and adding important concepts such as quality measurement, management, and clinical evidence appraisal.

• “Leadership is a process whereby an individual influences a group of individuals to achieve a common goal.” — Peter Northouse3

Physician leadership development as organizational strategy

The roles of physician and administrator have complementary competencies and training that create the opportunity for strong partnership that drives increased engagement and effectiveness of the teams they lead.4 For example, the background of an administrator typically includes undergraduate and graduate work with an emphasis on social sciences, strategic and operational planning, finance, human resources, organizational governance, quality, marketing, public affairs, and risk management. The physician’s background is heavily science-based with a premedical degree, medical school, residency and fellowship. This training is focused on biological and physical sciences with areas of anatomy, chemistry, physiology, biology and organ systems. Establishing a leadership dyad of a physician leader and an administrative partner offsets the gaps in each professional’s formal education. While an administrator is unlikely to obtain the necessary education to become a physician, a physician leader can develop leadership expertise that was not acquired in their medical training. Such education provides additional growth for the physician to lead the medical practice and strengthen the physician and administrative partnership.

In the current dynamic environment, leaders may struggle to assess and respond to complex challenges. A leader will falter when there isn’t a firm understanding of a problem or situation. Often this is due to:

• Personal issues such as frustration, anxiety, lack of patience, lack of confidence, etc.
• Relationship issues such as insensitivity to others, arrogance, poor working relationships, inability to build and lead a team, etc.
• Organizational issues such as lack of strategic vision, poor project management, change management weaknesses, financial challenges, etc.

 
Providing educational content that focuses on leading self, managing relationships, acquiring business acumen, as well as learning how to integrate this knowledge into practice can be beneficial. Physician leaders are looked to for their clinical expertise and leadership capabilities and are expected to drive the practice forward while ensuring high-level care for every patient. Physicians may not recognize that many of the skill sets that elevate their performance from a clinical perspective mirror those necessary to be a leader. For example, physicians routinely exercise the ability to synthesize data from multiple sources, develop a hypothesis, and determine the differential diagnosis with a plan; these skills are very similar to quality improvement skills used within a Plan-Do-Study-Act (PDSA) cycle by management teams. By including leadership competencies with structured learning opportunities, physician leaders are equipped with practical strategies to serve as well-rounded practice leaders.5,6

Some of the challenges to create opportunities for physicians to develop and practice leadership skills include lack of time, administrative burden related to documentation, cost, competing priorities, individual motivation/value proposition, etc. These challenges can be exacerbated by productivity-based compensation systems. However, the benefits to the practice are significant in having physicians in roles with more fully developed leadership competencies.

Potential curriculum topics

While not every physician leader needs to acquire a master’s degree in business or healthcare administration, several sources are available to identify topics and delivery approaches that could be covered in a physician leadership curriculum, including local and national business schools offering MBA, MHA and certificate programs, other academic organizations offering physician leadership education such as the American Medical Association,7 the American Association for Physician Leadership,8 the American College of Healthcare Executives9 and the Medical Group Management Association.10 Physician leadership education can be integrated into existing frameworks that the organization is using with a focus on strategy, operational issues and topics, and interpersonal leadership capabilities.

There is an emerging significance to reimagine healthcare for the future to prepare participants for bolder changes. Leadership education that is focused on achieving results and utilizing action research and opportunities to share experiences is more likely to achieve desired goals with measurable results. Programs can be a blend of online, face-to-face and virtual knowledge transfer, while also incorporating self-assessments so participants understand the unique strengths and weaknesses in their leadership approach. The curriculum can be provided in a variety of formats depending on the availability and time constraints of the physician leader target audience. These may be on-site or off-site; webinars or seminars; courses or assigned readings, or they may be integrated into management meetings. The content should focus on leading self, enhancing relationships, business acumen (including organizational excellence), the principles of leadership, and developing the necessary leadership skill sets that will be relevant now and in the future. An investment in individualized learning and support through executive and professional coaching can potentially be a part of the curriculum as this oftentimes is significantly impactful.

Many approaches are available to building a physician leadership development education program. Examples of curriculum approaches could include:

1. Adopting an integrated leadership model, such as the figure above,11 integrating critical aspects of lifelong success in a practical approach with specific behavioral strategies that incorporate individual leadership attributes along with best practices for leading teams to achieve organizational priorities.
2. Building a program around the domains of the Body of Knowledge for Medical Practice Management, which represent the sum total of information about the profession documented in a rigorous and psychometrically sound approach leading to board certification by the American College of Medical Practice Executives:
   1. Financial Management: To successfully maintain financial systems to ensure a profitable practice (coding and billing, cash flow management, budget management, accounting, financial analyses, etc.)
   2. Human Resource Management: To better utilize human resources to achieve and enhance organizational performance (staffing plans, staff recruitment and retention, training and development, compensation, performance evaluation, etc.)
   3. Organizational Governance: To ensure effective governance and leadership through policies and strategic direction (legal structures and governance; mission, vision, values implementation, etc.)
   4. Operations Management: For building an effective business plan and managing daily operations (process improvement, project management, supply chain and asset management, information technology, marketing, and community relations, etc.)
   5. Transformative Healthcare Delivery: Navigating the latest innovations for care, payment, organizational models and emerging technologies (population health, value-based care concepts, telehealth, health equity, etc.)
   6. Risk and Compliance Management: For protecting the organization from medical malpractice and adverse legal events (risk mitigation, adverse event management, federal and state laws, accreditation, etc.)
3. Selecting topics related to organizationally defined strategies, from known leadership models or relevant to current challenges, such as:

• Change management12
• Financial management13
• Physician-administrator partnership14
• Cultivating joy15
• Lean leadership16
• Process improvement17
• Cultivating psychological safety18
• Inclusive leadership19
• Succession management20
• Coaching and mentoring21
• Innovation22
• Digital mindset23
• Strategic leadership24
• Organizational culture25

Conclusion

Mayo Clinic is a physician-led organization that has a long history of strong partnerships between the physician leader and their administrative partner, starting with physicians William and Charlie Mayo and their administrative partner, Harry Harwick.

Late in his life, Dr. William Mayo identified three conditions he considered essential to the future success of Mayo Clinic:
1. Continuing pursuit of the ideal of service and not profit.
2. Continuing primary and sincere concern for the care and welfare of each individual patient.
3. Continuing interest by every member of the staff in the professional progress of every other member.26
 
Effective physician leadership is essential to addressing the challenges previously described and will support organizational success in key performance metrics. A Society for Human Resource Management (SHRM) article, “Building Better Leaders,” notes that companies within the top third of financial performance are twice as likely to have high-quality leaders as those in the bottom third.27 The forces facing healthcare leaders can derail the teams and health systems they lead. Fortunately, there are defined bodies of knowledge that can inform, empower and inspire leaders to delve deeply into the nuances of strategic thinking, change management; transformational leadership; diversity, equity and inclusion (DEI); financial management; process improvement; other leadership topics and, ultimately, joy and well-being. Physician leaders will also find professional satisfaction in having their input influence their practice environment, their interaction with patients, and their contributions for the success of the health system. Furthermore, physician leaders can uniquely identify and address the barriers and frustrations they face in complex healthcare systems. As such, it is critical to ensure physicians have the leadership skills to draw upon in transforming healthcare.

Health systems have many choices to make. An important one is whether physician leadership development is a strategic lever. In addition to the leadership topics previously identified, organizational values in action, foundational and critical skill sets for the future, professionalism, the physician-administrator partnership, basic and advanced leadership skills, and stewardship are examples of the variety of topics that can be covered in physician leadership development programs. The shape of the leadership development curriculum can be scaled to the available resources.

Physician leaders face significant challenges. Leadership development can be impactful, increasing the likelihood of organizational success and shaping the expression of the culture. With enhanced employee and physician engagement, investing in physician leadership development is a defining variable for attaining this vision.

Acknowledgments

The authors acknowledge Mayo Clinic’s physician leaders, who provided the inspiration for this article, and the assistance of Ethan Grove in editing.

Notes:

1. MGMA. “Mitigating the many costs of turnover by investing in leadership.” MGMA Connection. April 2022. Available from: mgma.com/leader-invest.
2. American Medical Association. (2019). Physician Specialty Data Report. Available from: bit.ly/3ImkaiF.
3. Northouse P. Leadership: Theory and practice, 8th edition. Sage Publishing, Thousand Oaks, Calif., 2019, 5.
4. France TJ, Menaker R, Thielen KR. “The importance of a radiologist-administrator partnership to future healthcare.” J Am Coll Radiology, Dec. 2018.
5. Hopkins et al., “Designing a Physician Leadership Development Program Based on Effective Models of Physician Education.” Health Care Manage Rev, Oct.-Dec. 2018; 43(4); 293-302. Available from: bit.ly/3InCWWG.
6. Stoller JK. “Developing physician leaders: Does it work?” BMJ Leader, 2020; 4:1–5.
7. American Medical Association: www.ama-assn.org.
8. American Association of Physician Leadership: www.physicianleaders.org.
9. American College of Healthcare Executives: www.ache.org.
10. Medical Group Management Association: mgma.com.
11. Menaker R. “Leadership Strategies: Achieving Personal and Professional Success.” Journal of Medical Practice Management, May/June 2016.
12. Menaker R, Leland J, Naumann K, France T. “Leading, guiding, and nurturing through change: An essential capability for healthcare leaders.” Medical Group Management Association, MGMA Connection, Jan. 2021.
13. Menaker R., Witte RJ., France TJ. “Principal principles: Critical accounting and financial concepts for healthcare leaders.” Medical Group Management Association, MGMA Connection, April 2020.
14. France TJ, Menaker R, Thielen KR. “The importance of a radiologist-administrator partnership to future healthcare.” J Am Coll Radiology, Dec. 2018.
15. Berkland B., Wieneke K., Menaker R., Brunholzl C. “Strategies to Cultivate Joy in the Workplace.” American Society for Health Care Human Resources Administration, June 2020.
16. Naumann KE, Menaker R, Leland JR, Tibor L. “Saving Time: Lean Strategies for Leaders. Medical Group Management Association, MGMA Connection, March 2019.
17. Stellmaker JA, Nordland MR, Leland JR, Menaker R. Engler N.B. “Utilizing Lean management to increase value for patients and staff in an academic medical practice.” Medical Group Management Association, MGMA Connection, Jan. 2022.
18. France TJ, Matt-Hensrud NN, Menaker R, Peters MT. “Cultivating psychological safety: Activating humanness in healthcare.” Medical Group Management Association, MGMA Connection, July 2020.
19. Menaker R, Saliba K, Albertie M, Swanson T. “Inclusive leadership in healthcare: Because no one is big enough to be independent of others.” Medical Group Management Association, MGMA Connection, April 2022.
20. Engler BN, Menaker R, DeBusman G, Rhodes LJ, Schletty AA. “Succession management: An essential strategy for organizational success.” Medical Group Management Association, MGMA Connection, Oct. 2020.
21. Erickson L, Djonne M, Duncan E, Menaker R. “Coaching and mentoring: Methods leaders can use to develop talent.” Medical Group Management Association, MGMA Connection, April 2021.
22. Pisano GP. “The Hard Truth about Innovative Culture.” Harvard Business Review, Jan.-Feb. 2019.
23. Furr N, Shipilov A. “Digital Doesn’t Have to Be Disruptive.” Harvard Business Review, Jul.-Aug. 2019.
24. Schoemaker P, Krupp S, Howland S. “Strategic Leadership: The Essential Skills.” Harvard Business Review, Jan.-Feb. 2013.
25. Menaker R, Wampfler E. “Shaping a Culture: Implications for leaders.” Medical Group Management Association, MGMA Connection, July 2022.
26. Berry L, Seltman K. Management Lessons from Mayo Clinic: Inside One of the World’s Most Admired Service Organizations. McGraw Hill, 2008.
27. Meinert D. “Building Better Leaders.” SHRM, April 27, 2019.