Hospitals ramp up physician training for leadership roles

Interest grows as health systems employ more doctors and prepare them for increased responsibilities as part of health system reform.

By — Posted Feb. 23, 2012

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Hospitals are no longer waiting for physicians to get themselves trained for leadership positions.

Some are providing in-house leadership education, hoping that increasing numbers of aligned physicians will do more than clock in, provide good patient care and then clock out. Hospitals seek independent physicians connected with the institution for training as well as those they employ.

"It's clear that we need physicians to do more than just run the medical staff," said James Rice, PhD, project director for the consulting firm Management Sciences for Health, who has written several reports on physician leadership issues. "But for physicians to go into leadership and management roles, serve on committees for the medical staff, take on part-time medical directorships, run accountable care organizations, be on process improvement teams, a new set of competencies has to be developed."

No numbers track how many institutions host physician leadership academies, fellowships, workshops and institutes, and programs may come and go depending on a system's needs and physician demands. However, the American College of Physician Executives says its staff taught physician leadership courses for about 200 days in 2011. In previous years, the organization averaged 100 days. As of February, ACPE had 117 days booked for 2012 and expects to beat 2011's numbers.

In-house programs can come from different sources. Sometimes hospitals bring in outside experts from organizations such as ACPE. Other times, programs are created in partnership with a local academic institution or emerge from a system's resources.

The programs vary widely. Some require a year or two of monthly attendance at weekend courses. Others take a few hours annually. Some take applications, while others are open only to nominations. Most provide continuing medical education credits, and some translate to academic credits. Some physicians receive a modest honorarium for participating. Many programs are open to all physicians in a community, but some are open only to those who are employed. Physicians usually don't have to pay.

New roles expected for doctors

Hospitals are setting up programs to ensure they have physicians ready to fill positions that probably will become increasingly important as health system reform rolls out. Participants usually are expected to go on to join hospital committees and take on other appropriate roles.

Hospitals' interest in training physicians as leaders has grown as more doctors have become their employees. A total of 91,282 physicians and dentists were employed full time by community hospitals in 2010, an increase from 62,152 in 1998, according to the American Hospital Assn.

"Physician leadership has become a competitive differential to the hospital, and it's a definite edge over a hospital that does not have it," said Rick Guarino, MD, senior vice president and chief medical officer at Nash Health Care in Rocky Mount, N.C. "When physicians are leaders of the health care team, everything is better for the patient and the staff and the administration."

Nash, a five-hospital system with 403 beds, launched its physician leadership development program in September 2009 and graduated 15 MDs and DOs in September 2010. Twelve finished the course in 2011, and seven are working on it now.

James Nevin, MD, an emergency physician in Indianapolis, was invited to the St. Vincent Health physician leadership education program that started in April 2007. St. Vincent has 20 hospitals and health centers in central Indiana. The leadership program is about eight years old, and 200 physicians have passed through it.

Already the chair of the independent emergency physician group that provided care in St. Vincent facilities, Dr. Nevin, 59, used the skills acquired to become president of the system's 1,800-physician medical staff.

"It was really eye-opening for me," he said. "The skills learned took me to that next level."

Dr. Nevin finished his term at the end of 2011, left clinical medicine and now runs his own consulting firm. He is working on projects for St. Vincent to improve the running of the medical staff so the institution can establish an effective ACO. He's considering going back to school for an MBA but is unsure about making the time commitment.

"Doctors no longer have the luxury of practicing in their own little cocoons," he said. "The course gave me the skills to help out and move into an encore career."

Completing training can add to a physician's prestige but is no guarantee of a leadership position, experts said. Most such programs seek to groom a pool of physicians from which health systems can recruit. Although most of the programs charge nothing, the trained physicians are expected to use their leadership skills even if the courses don't lead to a new position or career.

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