Health Care Executive Search Library

Inside the Executive Office: Physician Leaders Share Experiences, Advice

By Paul Esselman, Executive Vice President and Managing Principal
Cejka Executive Search

As healthcare organizations continue to seek strong physician leaders to join their executive ranks, more and more physicians are answering the call. However, transitioning from a practicing physician role to the executive suite is not just a career move, but a career change. The goals, environment, tasks, risks and rewards of an executive position are largely different from those found in clinical practice.

Unfortunately, physician leaders do not receive a ‘how to’ guide as they step into their executive position.  Instead, they must build on their natural leadership skills and abilities largely through experience on the job. What can we learn from top physician executives who have already navigated the process?

To help those undertaking  or considering an executive position, Cejka Search shares the observations and advice from seven accomplished physician leaders who serve in a wide variety of roles within the healthcare industry. Their backgrounds represent integrated delivery systems, large physician groups, academic medical centers, managed care organizations, faith-based systems and for-profit long-term hospital systems.

Each physician’s path to the executive suite is different. The experiences and advice of those who have already made the transition deliver valuable insight into the life and career transition of a physician executive.

Contemplating an Executive Career

Choosing to leave clinical practice and pursue a full-time executive career is an important decision that requires careful thought. An executive role can be tremendously rewarding for some, but may not be for others. The panelists recommend that weighing the benefits, risks and rewards can help ensure you are making the right personal decision.

Identity Shift

Although each physician leader on our panel has been successful in the executive ranks, many described the transition to their role as somewhat difficult. The shift in identity that often accompanies the move is one challenge many of the panelists encountered.

“When I left practice, it was very tough emotionally. As a colorectal surgeon, I had many long-term patients who really didn’t understand why I was giving up surgery. I even found that I sometimes missed the ‘buzz’ of patient care responsibility,” recalls John MacKeigan, MD, Executive Vice President and Chief Medical Officer for Spectrum Health System.

Glen Couchman, MD, System Chief Medical Officer for Scott & White Healthcare, had a similar experience.  “I was surprised at the strong negative reaction from my patients when I gave up clinical practice,” he said. “I also found that my colleagues viewed me in a different light. They no longer saw me as looking out for the practice.”

To be sure, many physicians have long been identified by their peers, patients, family, friends – and even themselves – by their medical profession. Making the leap to the executive office means changing professional identities in many ways.  It isn’t always easy, but it can be necessary for personal and professional growth.

“Life is a series of transitions,” Sean Muldoon, MD, MPH, Senior Vice President and Chief Medical Officer for Kindred Healthcare, Hospital Division, says about this time of change. “I needed to expand the scope of what I was doing.

Accepting New Challenges, Opportunities

The panel of physician executives noted that preparing for personal financial and work-life changes may be necessary when contemplating the transition from clinical practice. Although compensation varies, some panelists mentioned that the executive office is often not as financially rewarding as clinical practice. Other panelists note that the hours are longer in an executive role.

“One thing that physicians should seriously consider is the number of hours you spend working in the executive role,” advises Dr. MacKeigan. “While every hour isn’t filled with the amount of intensity you feel in clinical practice, it’s amazing how many days, nights and weekends you spend doing your job.”

Time and pay issues could be real concerns. But that doesn’t mean an executive position is not rewarding.

“As an executive leader you can make a significant difference in healthcare on a large scale,” explains Susan L. Freeman, MD, MS, Chief Medical Officer for Temple University Hospital. “It’s very gratifying.”

Dr. Muldoon agrees: “The reward comes from looking back and seeing what has been accomplished – knowing that you were instrumental in the role,” he says. “It’s a very different kind of victory – but it feels great all the same.”

Evidence may be building that physician leaders make a measurable impact on the quality of care delivered to patients. One preliminary study noted that among top hospitals in the United States, those that are physician-led tend to score higher on quality rankings.1  Many physician leaders may be willing to sacrifice personal time and financial gains to achieve this patient-centered success.

Developing the Right Skills

For some physician leaders, preparing for the executive office entails honing different skills. “To be effective at the executive level, you must think differently in many ways,” explains John Cruickshank, DO, MBA, CPE, Chief Medical Officer for Lovelace Health Plan. “Physicians are not typically trained in budgeting, operations, marketing, and information technology. Those are all big parts of a physician executive’s life that must be understood and appreciated.”

Advanced Degrees

Dr. Cruickshank and others on the panel believe one of the best ways to obtain this knowledge is through advanced education in business.  Most of the executive panelists acquired a master’s degree in business administration (MBA), public health (MPH) or medical management (MMM) and believed it helped equip them for the business demands of the job. In fact, more and more universities now recognize the value of physicians acquiring important management skills. The Association of MD-MBA Programs reports that over 50 universities in the United States now enable medical students to acquire a medical and business degree simultaneously2.

In addition to learning necessary management skills, obtaining an advanced business degree can also raise earning power. According to the American College of Physician Executives’ 2011 Physician Executive Compensation Survey3, chief medical officer respondents with a post-graduate business management degree earned about 15 percent more than those without one.

Finding a Mentor

The physician executives also stressed the value of work-related skills, such as effective team leadership and  communication, which cannot be taught in the classroom.  Executives often have natural abilities in these areas and hone them through experience. Many also advocate finding a mentor for greater professional growth.

“I’ve had excellent mentors throughout my executive experience that have helped me grow in my career,” explains Paul Silka, MD, Chief Medical Information Officer for Cedars-Sinai Health System. “Through them I’ve learned that healthcare is a team sport. I carry this with me always.”

Another way to fine-tune executive skills is to gain leadership experience slowly instead of making the leap all at once. “Taking on larger roles in associations or leading a project or committee can help aspiring physician executives gain valuable skills necessary before diving in,” advises Dr. Couchman. “This graduated experience can also help you make the decision whether a leadership role is right for you.”

Succeeding on the Job

Once a physician makes the leap to the executive office, what does it take to be successful? Many panelists believe it is important to tap into the resources around you.

Learning from Others

“What surprised me most when I became a healthcare business executive is the incredible talent that was available as a resource to me,” comments Dr. MacKeigan. Dr. Silka agrees. “Healthcare is full of smart, talented and dedicated individuals; as leaders we must trust and listen to them.”

Listening to others and considering their opinions represent a shift from evidence-based clinical work.  Considering other perspectives and learning from them is a key aspect many of the panelists say is a mark of a successful leader.

“Don’t be afraid to be humble and learn something new from others,” says Bryan Becker, MD, MMM, FACP, Senior Associate Dean for Clinical Affairs at University of Illinois – Chicago. “It’s great to be right, but it probably doesn’t matter. It’s more important to work with people and gain consensus and trust.”

Dr. Silka adds: “As a young, energetic leader, I wanted to fix everything with my solution. As I matured, I’ve learned and appreciated that there can be multiple solutions to a problem.”

Collaborative Decision Making

Most of the physician executive panelists commented on the need to approach decision-making and authority with a thoughtful, collaborative effort. They believe that successful leadership stems from involving others as a team and having buy-in to major decisions or direction.

“Rather than telling people what to do, lead by influence,” says Dr. Freeman. “Establish an informal authority with clear, concise communication and clear expectations.”

Dr. Cruickshank agrees. “Set the compass of the organization by articulating values and common objectives. Take the time to tell employees where you are going but not how to get there.”

Embracing Risks

Becoming a physician executive can lead to tremendous personal and professional rewards. But it carries some risk as well. Many of the panelists cautioned that the average length of an executive position is fairly short.

“It’s easy to feel vulnerable in this job. As a clinical provider, you see patients until you retire or die,” comments Dr. Couchman. “In this job you can be voted out for doing the job you were hired to do.”

Dr. Muldoon states it a different way. “Just like a professional sports coach, getting fired is part of being a physician executive. Move or morph!,” he says.

But there are ways to embrace this risk and overcome it successfully. Dr. Muldoon has maintained his executive position successfully by “reinventing himself” every few years. This has entailed taking on a new role or challenge in the organization or developing a new skill set.

Others believe that health care organizations have begun to hire smarter – finding the right individual for the job instead of hiring only for the medical credentials and hoping leadership talent will emerge. When physicians are matched into executive positions for their leadership skills and experience, longevity may increase.

Clearly, work in the executive suite is not easy. But for those with a passion for leadership, it is worth it.

“We are at a time in history when we can truly make a difference. The bar is raised for all of us and we can show what we are capable of,” explains Dr. Becker. “Don’t be afraid of what’s happening with the change in health care. Embrace it.”

1 ”Physician-Leaders and Hospital Performance: Is There an Association?” A Goodall. Social Science & Medicine. August 2011, vol. 73, no. 4, pp. 535-9.

2 ”MD MBA Programs.” Association of MD/MBA Programs. http://mdmbaprograms.com/5.html

3 ”2011 Physician Executive Compensation Survey.” American College of Physician Executive and Cejka Search. 2011.