Start early to groom doctors as group leaders

A column about keeping your practice in good health

By Mike Norbutcovered practice management issues during 2002-06. Posted Dec. 26, 2005.

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Unless you have just started a practice or recently merged, chances are the roles are pretty well established in your group. You have senior partners and junior partners, veteran doctors and young additions to the medical staff.

And you probably have a physician or two who handles the business aspects of the practice, while the others concentrate on their clinical work.

There's a certain comfort level that goes with settling into roles. But it's just as important to prepare others, especially the younger physicians in your practice, for leadership positions in the future.

Leadership development is a critical practice component that goes beyond succession planning. You're not just looking to fill a spot when a doctor leaves or retires. This instead addresses how to ensure that the practice remains financially strong when its president decides it's time to hand over the reins.

"Historically, we haven't paid as much attention to leadership development as we needed to, but these characteristics are important," said pulmonary critical care specialist James K. Stoller, MD, executive director of leadership development and vice chair of medicine for the Cleveland Clinic Foundation. "There's nothing worse than having derailments."

The group can come unglued as a result of an unplanned event in the practice or because of poor planning. While the former reason may be understandable, the latter adds unnecessary risk during an already challenging time of transition.

Instead, experts say groups need to identify their rising stars early and start grooming them to run the practice someday. Waiting only adds to the risk, they said.

How you go about grooming your leadership candidates depends largely on the size of your group. Cleveland Clinic, for example, has a structured annual program, where candidates are nominated by their department heads and traverse a nine-session course that covers everything from organizational behavior concepts to business strategies. The course, which is spread over nearly a full year, creates "a cadre of available, trained, high-potential" physician leaders, Dr. Stoller said.

"Some people have an intrinsic feel and are natural leaders," he said. "But much of it is learned behavior."

The problem is that physicians in smaller groups might not have the time to learn. Or they're overwhelmed at the start of their careers, as a group starts to unload information on them during board meetings to bring them up to speed.

"It used to be somebody would come on board, and ultimately, they would kind of grow into it," said James E. Hammond, a health care consultant based in Appleton, Wis. "Now, when they get on board, at the first meeting, they're already knee-deep in it. Instead of going on a path toward leadership, some turn away, because it's just too much."

Compensating the group leader is another issue that might act as a deterrent as well.

Most likely, a physician would not earn enough from the time spent on business duties to cover his or her potential earnings from clinical work. But doctors who have that innate desire to be a group leader probably wouldn't be dissuaded by that issue, consultants said.

Groups can prepare by finding the time to groom their leadership candidates slowly. The key is to cultivate a physician's knowledge in areas where he or she is passionate, said health care consultant Cindy Eddins Collier, founder and CEO of Columbus, Ohio-based Valuation Solutions. Then, you can give a physician more responsibilities in those areas as they grow more comfortable, she said.

For example, if you find a rising star who takes an interest in business issues, you can assign that physician to head a committee when an issue arises that needs investigation, Collier said. You also could ask younger physicians to present information related to the practice's financial statements at board meetings, she said.

"The simplest way to get them involved up front is by collecting data and presenting it," Collier said. "I encourage getting new physicians comfortable by reviewing their financial statements on a monthly basis."

There also are myriad options for management classes, either formal or informal. From business programs at local universities to classes sponsored by organized medicine and even health plans, physicians don't have to wait for a senior partner to offer to train them.

And with more physicians interested solely in clinical work these days, you need every opportunity to develop the leadership talent you recruit, said Molly Katz, MD, a gynecologist with a four-physician practice in Cincinnati.

"It takes time away from your practice, but if you're interested, and if the group wants to groom someone, it's a good idea," said Dr. Katz, who is president of the Ohio State Medical Assn.

"A wise senior partner will recognize that the times are changing, and we need to be aware of what's available now."

Mike Norbut covered practice management issues during 2002-06.

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