Wanted: a new breed of physician drivers for healthcare's nitroglycerin trucks.

Nobody said it better than did Jeff Goldsmith in a prescient article earlier this decade: The current generation of health care executives, medical school deans, and physician leaders are caught in the transition from an atomized entrepreneurship to an organized, collegial physician culture. Fostering collegiality-a scarce commodity in the current clinical environment-is the essential task in creating an integrated health care enterprise. In the explosive climate of many medical communities today, the task of leadership is akin to driving a nitroglycerin truck along a bumpy road. Leaders without the political skills to sense the bumps before they hit them will never know what hit them. (Goldsmith 1993) As the millenium approaches and in the wake of all too many healthcare "organizational explosions" since Goldsmith's classic article, Mike Guthrie's account of physician leadership and management reverberates with experience and insight-and not surprisingly. My first acquaintance with Mike was in the mid-1980s, when he was president-elect of the American College of Physician Executives (ACPE). By then his evolution as what I call the "fully evolved physician executive" was well under way. He had been both a practicing clinician and a hospital vice president for medical affairs (VPMA). What especially drew my attention at this first acquaintance, however, was that he had already acquired his MBA degree. With this additional qualification he had transcended the typical medical staff liaison role of the VPMA to become vice president for business development of a successful Colorado hospital on whose system board I then served. In this decade he has moved on to become a hospital CEO in one of America's most dynamic markets and now occupies a major leadership role in a national multihospital/system consortium. Suffice it to say, Mike speaks with genuine authority on physician leadership. As a physician who has held modest leadership roles during my active practice/ hospital medical staff experience and who has focused for the last 18 years on consultation and learning facilitation to physician leaders, I can fully endorse many of Mike's key points: Yes, "leadership of physicians is unique because of the social and cultural differences among physicians." This reality most certainly creates "unique obstacles to success" as designated physician leaders attempt to move their colleagues in what the latter frequently perceive as dubious directions. A wellspring of potential physician leadership currently exists. Individual institutions-if they have the true will to do so-can take a variety of pathways toward developing this leadership potential. Additionally Mike's concept of "a self-- confident, articulate, and supportive physician who can keep the trust of other physicians in the organization while articulating and implementing the vision and the objectives necessary for the organization to succeed" is not a pipe dream. The actualization of this definition is a necessity if healthcare is to bring forward the best of what the medical profession has achieved to the present and integrate this history with the organizational and systems concepts so vital to the healthcare system now emerging. Indeed, this goal might well be the core job description of the majority of physician leaders serving in roles within medical group practices, physician networks, hospitals, and health systems. Why can I so strongly support this definition? Because I believe that medicine is experiencing a true industrial revolution, as it was termed by the physician leader of one system in a volatile market. Our profession is moving from the context of a craft-based endeavor that physicians-individually and collectively-largely dominated, to a systems-based enterprise in which collaborative leadership between clinicians and professional managers is absolutely essential if we are to move the best that American medicine has achieved to its next level of development. …