Tuesday, August 21, 2007

Physician Leadership - The Physician Leadership Problem

In response to my post, “Action, Not Name-Calling,” which concerned physicians’ political problems about getting the word out concerning doctor and patient frustrations, a family physician, “Traveler,” posed this question and made these cogent observations,

“Where is the leadership?” He was speaking of political leadership “made up of reform-minded physicians ready to elect leaders of national stature to represent us at congressional hearings, get high profile TV interviews, write some articles for popular publications, etc., but it’s not happening.”

“Traveler” asks a great question, for which I have no good answer. But here are a few thoughts.

• When doctors speak of “reform,” we often mean reigning in HMOs, decreasing managed care hassles, solving the malpractice mess, and getting paid appropriately. Given the current political “noise” and rhetoric about high costs, the uninsured, and coverage for all, these messages get lost in the political fog.

• The AMA is doing its best to represent doctors, to offer alternatives to single-payer, to present policies offering tax credits to all Americans, to address reimbursement shortfalls, and to warn of physician shortages, but unfortunately, critics tend to the dismiss the AMA’s message because they may regard the AMA as a “union” to protect doctors vested interests.

• Ironically, the most effective spokespersons for some doctors are often conservatively-minded, market-oriented non-physicians – Grace Marie Turner of the Galen Institute, John Goodman of the National Center for Policy Analysis, Greg Scandlen of the Center for Consumer Health Choices, and Regina Herzlinger of Harvard Business School. These are people who believe in market-driven, patient and doctor centered, solutions as opposed to government mandates..

• The most quoted “reform-minded physician leaders” tend to come out of academia, large integrated organizations like Mayo, Kaiser, and the Cleveland Clinic,” or out of conservative or liberal think-tanks like the American Enterprise Institute, the Manhattan Institute, the Cato Institute, or the Commonwealth Fund rather than out the clinical trenches from the mouths of actively practicing doctors who may be too busy with their patients.

• One might think that leadership for practitioners would rise out of the ranks of physician executives and specialty society executives, and it sometimes does, but these doctor leaders tend to be tightly linked to hospitals, health plans, and specialty causes, and the messages, at least for the primary care physicians gets submerged or merged in the interests of the organization paying these executives. These interests are often worthwhile, but they may not reflect the concerns of busy primacy care physicians.

• One last note, many of the most widely admired major hospital and integrated delivery systems and increasing numbers of hospitals have physician CEOs. This isn’t by chance. These physician leaders inspire confidence among other physicians, instill a sense of mission, and understand what needs to be done to create great institutions.

I have no specific easy answers. But back in December 2003, I wrote an article in Healthleaders, a widely read health leadership website, on physician leaders I had known. . In that piece, I cited the principle traits of effective executive leaders as outlined by Peter F. Drucker in the Effective Executive (Harpers, 1966)

• They rely on courage rather than analysis to dictate their priorities.

• They pick the future rather than the past.

• They focus on opportunity rather than problems.

• They chose their own direction, rather than climbing on someone else's bandwagon.

• They aim high, for something that will make a difference, rather than something "safe" and “easy to do.”

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