When I assumed my role as CEO of Children’s Specialty Group, someone asked me if I was still going to be a doctor. Aside from the old dictum “once a doctor, forever a doctor,” the question raises an interesting consideration. It sometime feels as if being a clinician is antithetical to being a leader, that doctors and nurses care for patients, while administrators look after organizations (and often in an uncaring manner, at that). According to an article I read recently, “When Clinicians Lead,” leadership by doctors and other providers is critical to the success of health care organizations and the medical system as a whole. Yet there are important, albeit surmountable, barriers to greater involvement by clinicians in leadership roles.
The article cites a variety of evidence of the importance of clinical leadership. Several studies have demonstrated an association between higher levels of clinician involvement in management and hospital performance.
So why is there a reluctance for clinicians to assume more leadership roles in hospitals and other health organizations? The article mentions several. Clinicians have a certain amount of skepticism about the value of administrative and other leadership activities, in contrast with the obvious value of direct patient-care activities. Many physicians, accustomed to an evidence-based approach, find the “evidence” for leadership effectiveness to be insufficiently rigorous. (I confess that I myself have a hard time with the average Harvard Business Review article’s largely anecdotal approach.) Second, there are weak positive incentives and some disincentives to clinicians’ assuming leadership roles. Especially in an academic setting, clinical leadership is rarely helpful in promotion or career advancement, and may take time away from more value-added professional activities. Monetary compensation for administrative time may be less than that for clinical activities. And a physician leader risks being seen as having “gone over to the dark side.” All this for the promise of endless meetings, reports, etc. Finally, leadership development opportunities tend to be sparse for clinicians, leading many to believe (correctly or not) that they are unprepared for such roles.
If we are to do more to encourage clinicians to assume leadership roles – and I would argue that we need to do exactly that – we need to address these barriers. Within CSG, our Professional Development Committee is working to identify leadership development resources available both internally and externally, and we hope to invest some funding to support such activities for individuals who are willing to take on leadership roles. But no amount of training is going to do much if people are unwilling to participate, so let me address the skepticism. I can tell you that personally, I have found administrative leadership to be as rewarding as the clinical work I continue to do. As a doctor I impact one patient and family at a time; as a leader, my reach can be much broader. It is also important to recall that leadership comes in many forms. At one level are the institutional leaders, those with formal titles, and whose leadership is largely in the administrative realm. Next are service leaders – such as medical directors, or committee chairs – individuals with a more localized focus on a specific area. Finally, there are the frontline leaders, many without any formal title, but the ones everyone knows to go to when something needs to get done. The time commitments, required skill sets, and duties obviously vary tremendously. But all of these roles are crucial, and all are best filled by the doctors and other providers who are at the core of what we do.