Developing physician leaders in today's hospitals.

The business of delivering healthcare in our nation's hospitals is becoming increasingly complex. Hospitals are developing multidisciplinary teams of executives to manage and lead their healthcare institutions, and physician executives are key members of these leadership teams. Physicians are needed in today's hospitals, not only to serve as clinicians, medical directors, and members of medical committees, but to assist other hospital executives with strategic planning, managed care contracting, medical records billing code compliance, cost-benefit analysis for developing or changing the size of clinical programs, and a host of other medical administrative leadership issues. Many hospitals are now carefully mentoring and developing physician leaders to assume future positions of senior leadership in those healthcare institutions. Dr. Guthrie accurately describes the unique challenges in developing physician leaders. Physicians generally have limited management training, are accustomed to a different job culture, and a have high degree of socialization primarily with other physicians. Physicians are also trained to excel as solo practitioners, whereas healthcare management requires close collaboration and teamwork. Physicians use qualitative data and expect quick results once a decision is made; often business decisions are not based on perfect data and require long-term planning and analysis. Communications between physicians and hospital leaders are frequently cluttered with mixed messages, such as the importance of balancing the budget versus the delivery of patient care, and often hospital decisions may work to the economic detriment of individual physicians. Physician leaders working with hospital leadership can help bridge this gap to minimize miscommunication and enhance understanding. Problems and Opportunities Dr. Guthrie points out the distinct advantages for the hospital that develops physician leaders. Successful physician leaders understand the patient care process from the viewpoint of a clinician and share common concerns with the physicians with whom they practice. Once physician leaders have a clear understanding of how the hospital organization works, they can better recognize how they can affect the hospital's entire healthcare delivery process, rather than just how to help one patient at a time. Dr. Guthrie correctly points out that a physician's leadership development takes time and involves a behavioral change on the part of the new physician leader. Physician executives have to learn the language-including the jargon-of business, the principles of management, the applications of financial management, managed care contracting, communications, and a myriad of other management skills. Dr. Guthrie identifies several approaches to developing physician leaders including on-the-job training, mentoring, external degree training, and certificate programs. Professional organizations such as the American College of Physician Executives, Medical Group Management Association, and the American College of Healthcare Executives also offer training programs. One Hospital's Experience In 1994, the Johns Hopkins University School of Medicine and the Johns Hopkins Hospital recognized many of the problems and opportunities described in Dr. Guthrie's article. Johns Hopkins's Institutions began developing formal and informal approaches to developing future physician leaders in the business of medicine. In 1995, a formal program was developed that led to a certificate degree obtainable in 11 months. This 12-credit program is held on the medical campus and enables physicians to obtain a graduate certificate in the business of medicine. The program was further developed to allow the physician to continue on to earn a Master of Business Administration (MBA degree with a concentration in Medical Service Management. The master's program courses include clinical practice improvement, medical economics, medical informatics, long-term care organizations, strategic planning for healthcare organizations, marketing of medical organizations, and a capstone course on the business applications in a medical care organization. …