The Intake

Insights for those starting, managing, and growing independent healthcare practices

Practice Pulse: Choosing a physician leader in a medical practice

Here are qualities to look for in a physician leader and considerations to keep in mind when choosing one.

This post is a part of the Practice Pulse series
Graphic depicting the process of choosing a physician leader

At a Glance

  • Choose a physician leader who truly wants the job or has done it before successfully, not by seniority, default, or fiat.
  • Find a physician who can be an entrepreneur imitator, someone who doesn’t necessarily create the methods of clinical practice but makes them better.
  • The physician leader creates the practice’s vision, and it is the administrator’s job to make it happen.

The Practice Pulse is a monthly column written by Dr. Drew Sutton, a board-certified ENT physician with over 20 years of experience managing an independent practice. He covers topics about patient care, leadership, practice management, and more.

Choosing a physician leader should be based on something other than seniority, default, or fiat. Too often, practices end up with the wrong physician leader. Practices should always be open to looking further.

To be an effective physician leader means being flexible enough to move outside the comfort zone of clinical medicine. Few physicians are willing to do that, particularly if it comes with the potential risk to productivity or income. Physicians are clinically focused but do not always have a business mindset.

A practice administrator must work with the physician leader and vice versa. Together, they share a common goal of representing the best the practice offers. Practices that lack physician leaders tend to be at a disadvantage. That is why it is increasingly uncommon to find practices without one.

The right physician leader conceives the mental picture of the practice, while the practice administrator becomes the architect. Together, they provide the jet fuel that powers the engines of a successful medical practice.

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Business intuition

Intuition is the moment of truth. It is the insight of recognizing when the practice is thus far seeming to do well in the community but wants to improve. Every practice wants that extra energy, but not all practices know how to find it.

A practice needs a physician leader who shows the intuition to create new ideas and better ways of doing things. A thoroughbred horse can be the fastest, but only with the best jockey will the horse win the race. 

Choosing a physician leader should be based on something other than seniority, default, or fiat. ”

Everyone wants to find a physician with business intuition, but it is well-known that it is not something physicians learn in medical school. Practices may find it difficult to recognize visionary physicians because physicians are occupied with seeing patients and typically leave the business side of medicine to others.

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Benefits of stepping into practice leadership

Many physicians shy away from becoming leaders. They avoid increased responsibilities because they already feel that their plate is full. They may just want to stay in their clinical lane. It is also common for physicians to want to avoid blame when there are financial or management crises in the practice since they already have their patients' crises to handle. 

That may be one of the reasons why a majority of physicians are currently being employed by hospitals and large healthcare entities. Letting a trusted healthcare business with a proven record handle a physician’s business side of their practice seems like a sure bet. 

However, physicians are learning that leaving their future up to others may not always be in their best interest. After all, hospitals want to make money despite physicians. It may come as a surprise to most physicians, but hospital administrators view physician compensation and benefits as an expense, not a result of a revenue stream. 

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Looking at employed physicians

Employed physicians may be either the best or the worst choice for physician leaders in an independent practice. Practices need to search for the unsettled employed physician, one who knows there may be something better out there but doesn’t necessarily know how to go about finding it. The worst choice for a leader is a physician who joins an independent practice and wants nothing to do with administrative duties or advancing the vision of the practice.

I was that employed physician earlier in my career. When I left employment at a large healthcare organization, many of my colleagues were content where they were, but I was never happy. I could never reconcile my role as a physician without the ability to have better control over my future. 

I was not chosen by a practice to become a physician leader; I started a practice so I could be one.

Entrepreneur imitators

Physician leaders are entrepreneur imitators. Some great imitators have built terrific businesses as entrepreneurs. In medicine, imitators take what a practice is already doing and make it better. They improve profitability while enhancing efficiency; they don’t necessarily invent new methods.

A good analogy would be for a practice to find a physician version of Facebook’s Mark Zuckerberg. Zuckerberg took a simple concept and improved on it. The result was more than what anyone expected. 

The trick is to find a physician who is business-smart. ”

A practice wants a physician leader who can update the common and make it uncommon. The trick is to find a physician who is business-smart. It is not so the practice can tell them what to do but so they can provide direction for everyone else.

Once a physician figures out that they possess these entrepreneurial skill sets, they will likely seek these roles and never leave them. A practice must be on the lookout for those physicians who are always thinking about better ways to not only see patients but also run a business.

Dyad leadership

The concept of dyad leadership in medicine was born with the collaboration of physicians and nurses. It was by default rather than design. 

The relationship between the practice administrator and the physician leader is a special kind of bond. It is a co-leadership style that blends patient needs with expectations while running a business. 

It has been proven to create winning strategies ranging from small independent practices to large hospital conglomerates. Baldwin, et al in Social Science & Medicine found that hospitals achieve far higher quality scores when doctors run hospitals.1 The word “run” in this context meant that an administrative physician works with the hospital CEO as a dyad leadership team. Physicians in these settings provide invaluable perspectives while simultaneously seeing patients.

Both leaders must accept that they are co-leaders, each providing vital contributions. In today’s healthcare marketplace, a practice faces many challenges, including:

  • Continued practice cost pressures
  • Payer mix shifts
  • Physician shortages
  • Declining patient volumes
  • Cuts in ancillary revenue
  • Cuts in professional service fees
  • Increased rules and regulations

Understanding these hurdles but failing to keep up can leave many practices vulnerable to loss of financial stability and few patients. A physician leader can work with the administrator to provide the necessary perspective to take up the slack.

Does a practice need a physician leader?

Yes, a physician leader will set the practice apart, but only if it is the right person.

The goals of having a physician leader are:

  • Improved clinical quality
  • Better patient care standards
  • Seamless physician workflows 
  • Better staff behavior
  • Increased physician productivity
  • Excellence in compliance and risk management

In independent practices, the physician leader acts as a medical director more than a businessman. The administrator engages other lead staff to gather intelligence. But in reality, both do both. 

Physicians tend to tell other physicians what they want to hear and complain to administrators. Staff tends to tell administrators what they want to hear and complain to physicians. Physician leaders and administrators must identify and confront this cycle in a successful practice.

A physician leader must learn how to avoid gaming structure within the practice. This means that they and the administrator have to avoid contradicting each other. Sometimes, no means no. 

Physician leaders will help avoid the misconception that the practice administrator is the “Evil Empire.” Administrators must avoid feeling subordinate to their physician counterparts just because they are physicians. 

A physician leader must learn how to avoid gaming structure within the practice. ”

At one point, my practice administrator told me I was intimidating from a business standpoint. That comment caught me off guard, opening my eyes to my need to treat her as an equal and make sure I affirm to her that we are co-leaders.

The physician leader and administrator will define the practice culture. My office staff and physician colleagues called it the “practice vibe.”

Qualities to look for in a physician leader

My first practice chose its physician leader solely on seniority, fiat, and him being the default choice. While I liked the physician as a person, he wasn’t an effective leader. He interpreted his job as being the shift boss in a steel factory and ordered people around, including associate physicians like me. That taught me what a physician leader should not do.

That physician’s clinical prowess had absolutely nothing to do with business savvy. He saved patient lives, but he couldn’t comprehend the dynamics of running an exemplary medical practice.  

The practice should look for someone who has an additional business degree or background, but it is not a prerequisite. Or even better, the practice should seek a physician who has previously acted in the role of a physician leader in another practice or at a large healthcare organization. While it isn’t a guarantee, it is a good indicator of picking the right physician.

The physician leader should be a systems thinker, not just a problem-solver. ”

The physician leader should be a systems thinker, not just a problem-solver. For example, even though I never felt comfortable with using an ultrasound machine for diagnosing thyroid disease, I embraced how it was used in the right hands by my colleagues. 

Learning everything about ultrasound and the business aspects gave me the confidence to support the purchase of several machines for the practice, even though I would never touch one in my daily clinical activities. That decision gave me the self-confidence I needed from a business perspective. As it turned out, these machines were incredibly profitable and the right decision.

The physician leader FOMO

FOMO is Fear of Missing Out. The physician leader must be comfortable with seeing fewer patients since they will spend time on administration and practice planning. Fewer patient encounters inevitably translate into smaller clinical revenue for leaders.

The potential financial discrepancy between the leader and other colleagues can be a sore spot, particularly when determining income and dividing profits. The owners of the practice must agree on the relative value of the physician leader when considering the practice as a whole.

There are 2 components to the physician leader’s value: their clinical and administrative contributions. Many practices will make sure the physician leader is not penalized for their lower revenue due to seeing fewer patients.

There are 2 components to the physician leader’s value: their clinical and administrative contributions. ”

Along with the challenge of determining a physician leader’s compensation is the issue of attending and taking time for education, special business training, and attending courses. Practices must plan for bearing not only the financial burden of these activities but also anticipate clinical coverage when the leader is absent.

Some practices will reward physicians for their leadership roles. I was paid a small monthly stipend for my administrative work in the practice. These decisions can be very personal to the physician owners; each practice has to make its determinations.

White tile syndrome

One of my attending physicians in residency introduced me to the white tile syndrome of private practice. What he meant was that there would be a time when I would be in the operating room, look up from my surgical field, and see only white tiles. 

Sure, there will be operating room staff, but no other physician colleagues. There would be no color.

I realized that practices as a business can suffer from white tile syndrome too. Without the support of proper leadership, the practice faces a sterile environment of white tiles devoid of business energy.

The physician leader and administrator create the color of the tiles. They ensure that the physicians and practice staff never feel that when they look up from their desks they are only seeing white tiles.

References

1Baldwin KS, Dimunation N, Alexander J. Health care leadership and the dyad model. Physician Exec. 2011;37(4):66-70.

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Drew Sutton

Dr. Drew Sutton is a board-certified ENT physician. He has vast experience in treating all aspects of ENT, with particular interests in disorders of the ear and nasal and sinus disease. During his career, he started and managed an independent, single-specialty medical practice in a large metropolitan area.

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