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High-performing physician executives.

Physician leadership extends beyond traditional clinical disciplines to hospital administration, group practice management, health policy making, management of managed care programs, and many business positions. What kind of person makes a good physician executive? What stands out as the most important motivations, attributes, and interests of high-performing physician executives? How does this compare with non-physician health care executives? Such questions have long been high on the agenda of executives in other industries. This article builds on existing formal assessments of leadership attributes of high-performing business, government, and educational executives and on closer examination of health care executives. Previous studies looked at the need for innovative, entrepreneurial, energetic, community-oriented leaders for positions throughout health care. Traits that distinguish excellence and leadership were described by Brown and McCool.* That study characterized successful leaders in terms of physical strengths (high energy, good health, and propensity for hard work), mental strengths (creativity, intuition, and innovation), and organizational strengths (mission orientation, vision, and entrepreneurial spirit). In this investigation, a subset of health care executives, including physician executives, was examined more closely. It was initially assumed that successful physician executives exhibit many of the same positive traits as do nonphysician executives. This assumption was tested with physician leaders in a range of administrative and managerial positions. We also set out to identify key differences between physician and nonphysician executives. Even with our limited exploration, it seems to us that physician executives probably do differ from nonphysician executives.

Creativity↗

The making of a hospital physician executive.

Physicians are accustomed to having the "buck" stop with them in the clinical arena. Indeed, they resist any attempt to have it otherwise. Management has only recently come back into their consciousness as a career possibility. Management is the "buck" that now belongs to the enemy, represented by managed care, paperwork, and regulation. The thoughts in this article have grown from the author's experience over the past six years as a physician executive in a community hospital, a career that followed 25 years in clinical and anatomical pathology.

Career Mobility↗

A pivotal role for physician executives.

Physician leaders are needed to fill a pivotal role in the health care industry of the '90s. Medical education based solely on traditional scientific methods will continue to produce physicians with excellent clinical and research skills. However, study of science alone will not produce physician leaders. Effective leaders will also need to understand the tools and concepts of organization and management. These leaders will need to participate in the process of formulating and implementing policies to promote the development of economical financing and delivery arrangements while simultaneously improve the quality of care provided.

Health Policy↗

Should the physician executive be the physician's advocate?

Medical staff commonly want to know if a prospective physician executive will serve as their advocate to management. A successful physician executive must like and respect physicians. But the question of advocacy must be answered thoughtfully, because the candidate must not imply that he or she will defend any action by any physician. A three-part conditional response is advisable.

Consumer Advocacy↗

Stakeholder strategies for the physician executive.

If physician executives are to be effective in confronting the environmental turbulence and uncertainty facing their organizations, they must effectively manage their stakeholders. This article extends the stakeholder approach described in the May-June 1989 issue of Physician Executive as a tool for the physician executive in the development of practical strategies to cope with turbulence and uncertainty. We suggest four generic strategies physician executives can use: involve supportive stakeholders, monitor marginal stakeholders, defend against nonsupportive stakeholders, and collaborate with mixed-blessing stakeholders. As an overarching strategy, a physician executive should try to change the organization's relationships with a stakeholder from a less favorable category to a more favorable one. The stakeholder can then be managed using the generic strategy most appropriate for the category.

Decision Making, Organizational↗

Physician executives report high job satisfaction. Summary of findings from a survey of senior physician executives.

The role of the senior physician executive is well established in American hospitals and health systems. There is little research, however, on overall physician executive job satisfaction, their perceptions of their organizational role and job performance, or their views of the medical staffs with which they work. A recent survey of physician executives examined these and other areas. It found physician executives to be quite satisfied with their jobs. What follows is a summary of the findings. An article based on the survey will be featured in a future issue of The Physician Executive.

Data Collection↗

Stakeholder issues for the physician executive.

If physician executives are to cope with the environmental turbulence and uncertainty facing their organizations, they must effectively manage their "stakeholders." The stakeholder approach helps integrate managerial concerns that are frequently treated separately, such as strategic management, marketing, human resource management, "organizational politics," and social responsibility. The stakeholder perspective enables medical managers to relate important issues to the development of strategies for handling potentially conflicting demands for effectiveness and efficiency from various stakeholders. Medical managers should minimally satisfy the needs of marginal stakeholders while they maximally satisfy the needs of key stakeholders. To identify key stakeholders, a physician executive should critically assess each stakeholder's potential to threaten the organization and its potential to cooperate. This assessment should account for such factors as the stakeholder's relative power, the specific context and history of the organization's relations with it, the specific issues under consideration, and other key stakeholders influencing the organization.

Health Facility Administrators↗

A behavioral profile of physician executives.

In late 1993, ACPE and Tyler & Company, a national health care executive and physician search firm based in Atlanta, Ga., jointly conducted a survey of physician executives to determine their most likely behavioral patterns. It is the first of a two-part survey that, when complete, will create a multifaceted profile of the "ideal" physician executive as seen through physician executives' eyes and through the eyes of hospital management. Questionnaires based on the DiSC method of behavioral analysis were mailed to 750 randomly selected members of ACPE. More than 170 responses were received. The survey results showed that the majority of physician executives have strong communications skills, are people-oriented, and are strong leaders. The majority of respondents are self-motivated and industrious and are driven by accomplishments. The second part of the survey, which will be conducted later this year, will poll hospital CEOs and boards of directors about their preferences for behavioral patterns in their executives. Comparisons and consistencies will be analyzed between the two surveys to develop a comprehensive profile of the "ideal" physician executive, and the results will be reported in Physician Executive.

Adult↗

Getting a firm grip on the realities for physician executives.

Today, physician executives can be found in every health care setting-group practices, hospitals and academic medical centers, insurance companies, drug companies, airlines, the government, and more. But before physicians land these positions, they must negotiate the often difficult passage from clinician to manager to executive to business-minded leader. To manage this transition successfully, physicians must be aware of and understand some basic realities of management positions. The nature of these realities and how physicians interested in management can deal with them are the subject of this article.

Career Mobility↗

Global view offers good news for physician executives.

Do all physician executives have much "catching up" to do in relation to their non-MD colleagues? A comparison of the role of the physician executive versus the non-MD executive/administrator provides a big picture view and signals new opportunities for physicians in the evolving health care system. Physician executives have only recently become invested in the health care executive suite and are less wedded to old methods and "classic" ideas. They are more likely to be able to adapt to new circumstances, jettisoning traditional approaches that have outlived their usefulness. But each group-physician executives and their MHA- or MBA-credentialed, non-MD colleagues- has much to offer to or learn from the other. By retaining those skills that are applicable, while also adapting the useful characteristics of the "traditional" health care administrator, a physician executive can increase the likelihood of success today.

Career Mobility↗

Physician leadership. How do physician executives view themselves?

Most physician executives today have acquired substantial management training and experience, and many have worked with and relied on the expertise of mentors for their career guidance and development. Physician executives are actually becoming executives who happen to be physicians. They view themselves first as leaders, then as physicians, and finally as managers. That is a remarkable transformation in perception. To chronicle this process, Witt/Kieffer, Ford, Hadelman & Lloyd conducted a national survey this spring among senior physician executives in both payer and provider organizations. The data provide a "snapshot" of their role, and may also suggest some future scenarios for the industry. The primary reasons for choosing to pursue a management role noted by most participants include a desire to be part of the health care solution and an interest in management and leadership challenges.

Altruism↗

Don't be an accidental physician executive.

How can physicians begin crafting a career with intention and careful thought? Before you go leafing through The Physician Executive or the New England Journal of Medicine's Positions sections, you'll need to conduct a thorough career evaluation of where you are and where you want to go. There are more career tracks in more types of organizations available to you as a physician executive than ever before. There is also considerable turbulence, creating unexpected opportunities. The times have never been better for aggressive, energetic physician executives who want to move up and out.

Career Choice↗

Selecting a physician executive.

Selecting a physician executive can be a complex task. The process is complicated by the explosive demand for qualified physician executives. Although the number of physician managers has grown since 1979, the demand still outstrips the supply of physicians with track records. Also, many organizations have never had a full-time person serving in the capacity of Medical Director or Vice President of Medical Affairs, so the process of recruiting this person is new to them.

Personnel Management↗

Physician leadership. Physician executives share insights.

Senior physician executives were asked to share their insights about how the medical management field has evolved. The Physician Executive Management Center, a Tampa, Florida-based search firm, has been surveying senior physician executives each year for the past decade. This year's report on physician executive compensation and duties in hospitals, managed care organizations, and group practices provides an excellent picture of the growth of the profession, as well as a broad perspective of anticipated changes for the future of medical management. The respondents addressed the following questions: What are the skills necessary for success? How have their jobs changed over the years? Have they made the right choice in pursuing medical management careers?

Hospital Administrators↗

Role stress among physician executives.

On the one hand, physician executives are clinicians who place value on professional autonomy. As clinicians, the best interests of the patient drive their decision making and their value system. On the other hand, as managers, physician executives serve as agents of an organization. Because of the differences in the two cultures, some physicians have called the physician executive position a "no man's land" To address these issues and answer the questions that surround them, the authors developed a survey that was mailed to a random sample of the membership of the American College of Physician Executives. Parts of the survey served in other studies of role conflict and role ambiguity. Parts of the survey are new, developed specifically to analyze the physician executive role. The findings are reported in this article.

Adult↗