Becker's Hospital Review

40 POPULATION HEALTH 40 CEO / STRATEGY Why demand for physician leaders is growing By Kelly Gooch A s a practicing OB-GYN in the 1980s, Lawrence Antonucci, MD, didn't necessarily aspire to become CEO of a health system. He said that was not a common career path for physicians at the time, except at top-per- forming organizations such as Cleveland Clinic and Rochester, Minn.-based Mayo Clinic, which have always been led by phy- sicians. But Dr. Antonucci said he has in- creasingly seen more physicians in these leadership roles. "I think it became apparent that over time physicians with the right training and expe- rience could learn a lot about hospital op- erations and bring with them that clinical experience and that front-line experience," said Dr. Antonucci, who has served as pres- ident and CEO of Fort Myers, Fla.-based Lee Health since June 2017. Increased interest in physician leaders Over the last two or three years alone, glob- al executive search firm WittKieffer has seen an estimated 20 percent increase in hospitals and health systems wanting physicians in- cluded as candidates in their CEO searches. Linda Komnick, managing partner and prac- tice leader in the physician integration and leadership division at the firm, attributes this trend in part to healthcare's shi from volume-based care, which focuses on the number of patients seen, to value-based care, which focuses on care quality. WittKieffer conducts more than 400 healthcare executive searches annually, and about 15 percent of those are CEO searches. In the vast majority of CEO slates, hospitals and health systems are looking for physician leaders who've had experience in improving quality through managed care and population health. Ms. Komnick said that wasn't the case 15 years ago, when a physician would go to managed care, then face difficulty getting into health system leadership operations. Additionally, she's seen younger physicians increasingly seek MBAs and master's degrees in population health management to prepare for potential hospital and health system lead- ership roles. And she's seen quality commit- tees of hospital and health system boards be- come even more important to organizations. "is is an exciting time for physician leaders. ere is a wealth of opportunity out there," she said. "How do these people move up? You see people starting on committees, med- ical staff, [and] moving into more leadership roles such as CMO, chief physician executive, [then] taking on operational responsibilities, getting that seat at the table, involved in lead- ing clinical strategy." Saul Weingart, MD, PhD, president of Prov- idence-based Rhode Island Hospital and its Hasbro Children's Hospital, said increased employment of physicians by hospitals is an- other factor in the increase in physicians as hospital and health system leaders. Hospitals employed 44 percent of physicians in January 2018, up from 43 percent in January 2017 and 26 percent in July 2012, according to a study from the nonprofit Physicians Advocacy In- stitute and Avalere, published in 2019. From July 2012 to January 2018, the number of hos- pital-acquired physician practices also grew from 35,700 to 80,000, the study found. "When I started practicing years ago, physi- cians wanted to be le alone to do their job, and their ideal circumstances was where they had relatively few administrative burdens and could see patients," said Dr. Weingart. "But over time, increasingly folks have become employed, and instead of being solo opera- tors and entrepreneurs, they've become part of corporate enterprises. And I think there's a sense among many clinicians that it's helpful to understand the administrative challenges of the organization so you can play a role in overseeing and directing your own work." Still, he acknowledged that not all physicians see hospital and health system leadership as an interesting career opportunity, and that there are multiple pathways that can be taken by physicians who desire these positions. Leadership paths for two physicians Dr. Weingart's career started on the quality side of the industry, in research, and gradu- ally moved to administrative roles. He said he started as a primary care physician in an academic setting and did research on quality and patient safety. "A lot of the quality improvement projects I did turned out to be important clinically be- cause they improved patient experience or patient flow, or reduced medical errors and harm, so I was gradually able to take on more leadership roles in the quality area," said Dr. Weingart. He served as vice president for quality and patient safety at Dana-Farber Cancer Insti- tute in Boston, then as CMO and senior vice president of medical affairs at Boston-based Tus Medical Center and Tus Children's Hospital. He also was professor of medicine, public health and community medicine at Tus University's medical school. He began his current role as president in February. For Dr. Antonucci, with Lee Health, the path toward leadership began as a practicing OB-GYN, then led to him co-founding Phy- sicians Primary Care, a large multispecialty physician practice in Florida's Lee County, in 1983. He became chief administrative officer of Lee Health's Cape Coral (Fla.) Hospital in 2007. He was appointed COO of hospital services for Lee Health two years later and took responsibility for physician services in early 2010. He was then named COO of Lee Health in 2011 before taking on his current role in 2017. Expectations of physician leaders No matter what path physicians take, once they get to the leadership role, such as CEO, there are certain expectations in today's healthcare environment. For example, Dr. Antonucci said one of the big- gest challenges for physician leaders, especially those just beginning their leadership role, can be learning to work as a team member. "In a clinical scenario, you're as a physician, you're the one with the answers, you have the solutions, you make the diagnosis, you prescribe the treatments," he explained. "In healthcare leadership, you've got experts in human resources, you've got experts in IT, in other areas, and you have to tap into them and recognize you don't have all the answers. Your job as a physician leader is to ask the right question so those answers can come forward." He said he believes it's important for physi- cian leaders to acknowledge members of the leadership team who are not physicians are critical because they bring expertise to the table physicians don't have. "It works best when everyone is transparent about what they know, what they don't know, and can come to decisions collaboratively through open and transparent discussion," said Dr. Antonucci. Dr. Weingart agreed. He said physician lead- ers should have the ability to create and com- municate a vision for the organization and feel comfortable managing people who are outside the physician's domain expertise. n

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