Would You Be Happier in a Leadership Position? This Doc Wasn't

Alicia Gallegos

June 30, 2020

After practicing clinical care for 4 years, internist Suneel Dhand, MD, was ready for a change and eager for the chance to help improve the broader healthcare system.

So when the opportunity arose to direct an internal medicine program at a large hospital, Dhand gladly accepted the role. He aimed to enhance frontline staffing, expand his hospital medicine team's influence, and raise the standard of care for patients.

Almost immediately, however, Dhand knew the administrative route was the wrong path for him.

"I realized very quickly that initiating change and being a positive force, while working with multiple competing interests, is far from easy," said Dhand. "I didn't particularly feel well supported by the high-level administrators. Without resources, it's extra difficult to make things happen."

A year and half into the role, Dhand left the position and returned to purely clinical work. He now practices as a Boston-area hospitalist while writing, filming, and podcasting about medicine on the side.

"I have no intention of leaving clinical medicine," he said. "If somebody gave me a very highly compensated offer right now to come and be a hospital leader, I wouldn't do it. It's not me, and I wouldn't enjoy it."

Taking on an administrative or executive role can sound appealing to many clinicians. The Medscape Physician Compensation Report 2018 found that 42% of employed physicians were aiming for a promotion. Another physician survey by The Physicians Foundation found that 46% planned to change career paths in 2018 and that more than 12% planned to seek a nonclinical job in the next 1 to 3 years.

Interest in executive and leadership roles has also increased because of the COVID-19 pandemic, particularly as more physicians struggle financially and search for alternative compensation, said Peter B. Angood, MD, CEO and president for the American Association for Physician Leadership (AAPL).

"Because of the COVID-19 impacts on healthcare and our country as a whole, the strengths of physician leadership have been better recognized at multiple levels," Angood said. "As a result, there is definitely early interest as the ongoing impacts of COVID-19 are appreciated for how to further integrate physicians as leaders within the healthcare industry as a whole."

Administration: Not for Everyone

But as Dhand's experience highlights, administration is not the right direction for every physician. Take the case of prominent surgeon and Harvard University professor Atul Gawande, MD, who in May stepped down as chief executive for Haven, the healthcare venture backed by Amazon Inc, after just 2 years. In a statement, Gawande indicated he would be taking a less operational role with the company to devote more time to policy and activities associated with COVID-19.

Although the details of Gawande's departure are unclear, his abrupt exit raises questions. Are physicians prepared for executive positions before making the move? Who makes the best fit for an administrative job?

"It's certainly something most folks should not just jump into," said Angood. "In the same way that physicians spend an awful lot of time developing their expertise to become an expert clinician, the same philosophy for becoming an expert administrative leader should be applied. You need to put in the same amount of energy and effort to truly be effective."

The motivations behind moving to an administrative role vary among physicians, says Carson F. Dye, FACHE, a faculty member of the American College of Healthcare Executives (ACHE) and a leadership consultant. Some doctors make the shift because they have a natural proclivity for leading, whereas others want to make a greater impact on patient care and quality, Dye said. Still other physicians simply want a greater say in the everyday areas that affect them.

At the same time, there are more physician leadership opportunities than before. Positions such as chief quality officer, chief medical information officer, president of the employed medical group, and chief population health officer rarely existed 20 or 30 years ago, Dye noted.

"Moreover, nonclinical executives have begun to see the great value in having more physician leaders involved because it enhances physician engagement and provides valuable input for strategic change," Dye said. "As a result, more physicians are coaxed into considering leadership roles."

North Carolina internist Michael Lalor, MD, says leadership responsibilities landed in his lap early in his career and led to his ultimate post as a fulltime administrator. Lalor was a couple years out of residency and working for a small private practice when the owner decided to retire early and asked him to take over the group, Lalor explained.

After accepting, Lalor hired another physician, expanded the group, and later merged with a larger network.

"I loved it from the perspective of the intersection of business and medicine," he said. "It really gave me experience you don't get in training, such as the actual operations of running a medical group, contract negotiations, expansion plans, payroll, accounting. It was an entirely new experience that I really enjoyed."

Lalor also served as a medical director for a small, nonprofit hospice in the area, which spurred him to become board certified in hospice and palliative medicine. He now acts as chief medical officer for a large hospice and palliative care organization based in North Carolina.

Chicago-area family physician John Jurica, MD, made his way up the executive ladder through a series of steps. Jurica says he felt drawn to committees and projects that addressed population health and quality issues. Tapping into this interest, he became medical director for Riverside Medical Center in Kankakee, Illinois, followed by vice president of medical affairs and then chief medical officer for the hospital.

Along the way, Jurica volunteered with nonprofit organizations, served on hospital boards, and completed a master's degree in public health.

"The more I got into it, the more I liked it," he said. "I was wanting to be involved in helping larger numbers of patients in a different way, work on big problems, affect the community, and work on multidisciplinary teams."

Today, Jurica is medical director and part owner of two urgent care centers. His career journey inspired him to create the VITAL Physician Executive blog, which offers advice about becoming a physician executive. He also hosts a podcast devoted to nonclinical careers for physicians.

Jurica said he hears a range of reasons for seeking a change from clinical care, including disillusionment with medicine; high debt; outside interests; and burnout.

"A number of physicians have said, 'I really don't enjoy medicine anymore,' " Jurica said. " 'The paperwork is onerous, I'm working long hours, I have to see more patients, and I'm getting paid the same or less. It's just not what I thought it would be.' "

Although burnout prompts some physicians to pursue administrative roles, Angood cautions that this is like entering a rebound relationship after leaving a bad relationship. Making the move merely because of dissatisfaction with your current position can set you up for disappointment, he said.

"Too often, physicians who are frustrated with the complexities of clinical care will view administrative roles as a parachute for themselves out of that situation," he said. "If they don't understand the nuances of administrative work, they run the risk of moving into a role that will ultimately provide them a different level of dissatisfaction, rather than the higher level of satisfaction they were seeking. It is all about trying to ensure a good match in terms of expectations in order to obtain optimal outcomes."

Who's right for an administrative job?

Nearly any type of personality can make a good fit for an administrative post, says Jurica.

"If you look at most leadership teams, they usually have a team of people that have different personality types that complement one another," he said. "You can be an extrovert, an introvert, Whatever kind of breakdown in personality you have can be successful."

Certain attributes, however, are more helpful for executive positions, according to Dye, including comfort in dealing with ambiguity, a willingness to make difficult decisions, an aptitude for interpreting nonverbal cues, and the ability to demonstrate confidence, but not arrogance.

"Someone who is collaborative and cooperative, a good listener, and has a compelling vision for change in healthcare also makes a great leader," he said.

The ability to balance and manage the needs of different groups is also key, said Heidi Moawad, MD, a neurologist, career consultant, and author of Careers Beyond Clinical Medicine.

"Sometimes the needs of one group steps on the toes of the needs of another group," said Moawad, who provides career resources for physicians at nonclinicaldoctors.com. "You have to be someone who isn't so overwhelmed by pleasing everyone. You have to think fairly about the needs of all the groups involved, not just the loudest group."

Is there a specialty best suited to an administrative role? Executive recruiters typically encounter more primary care physician candidates when conducting physician executive searches, according to Dye. This is likely because primary care doctors are usually the lowest paid of all specialties, and their pay scale may better fit with that of hiring organizations, he said. Higher-paid specialists, on the other hand, may be deterred from pursuing executive roles because of the possibility of lower pay. In addition, primary care physicians typically have traits that align well with administrative/executive functions.

"The nature of their clinical practice means that they are able to see the broad spectrum of the continuum of care and understand the system better," he said.

Jurica stresses, however, that strong leaders can come from any specialty and that many medical backgrounds can fit an administrative or executive position.

"It's more related to interests, desires, personality, and experiences over time as to whether they fit that role or mature into that role," he said.

Just because you're a great clinician doesn't mean you ll make a good administrative leader, Lalor says. Physicians can often fall into executive or leadership positions because they're considered the best or most productive clinician in a group, he explained.

"The skill set is not 100% the same," he said. "Not everybody is necessarily suited for it. They kind of fall into it and then have great missteps in their earliest experiences."

Will you miss your former responsibilities?

Some physicians who enter the administrative realm really miss the clinical world and the satisfaction of helping patients directly, adds Dye. He hears from many physicians who miss the "short-term nature" of clinical practice, meaning encountering a patient, determining an intervention, and moving on to another patient.

"Decisions are made and the physician gets to see the result of those decisions," he said. "One physician remarked to me that she lived her clinical life in '15-minute segments' and that her executive world had many issues that went on for years, making it very frustrating to her that she was not really making progress."

For physicians such as family physician Krista Skorupa, MD, who straddle both the clinical and administrative spheres, obstacles can arise in the form of time and balance. Skorupa splits her time between practicing family medicine and acting as vice president of medical practice for the M Health Fairview Primary Care Service Line in St. Paul, Minnesota.

"Most people will tell you it's the balance that's one of the hardest things," she said. "You always feel like you're doing one job not as well as you could because you're trying to do two jobs at 100%."

Skorupa said she has been fortunate to work for organizations that have provided the time and compensation for both jobs. But she warns that some institutions expect physicians to excel at dual clinical and administrative roles, yet fail to allot enough time or compensation for both.

Doctors going the executive route should also prepare for their work relationships to change ― some for the worse.

Some peers may perceive a physician's trek into administration as going to "the dark side," Angood said. Attitudes from colleagues may change, and not everyone may be accepting of your new role, he advised.

And as Dhand experienced, conflict can stem from having to act as an intermediary between staff physicians and administrators. In his director position, Dhand had to relay administrative policies to his physician colleagues. The task was challenging because Dhand did not necessarily agree with the policies and felt they burdened already overworked physicians.

"I believe almost all physician leaders feel this way," he said. "They walk in the same shoes as clinicians and know what a tough job it is. Yet, we are part of the system and have to follow rules and protocols. When you are the one giving bad news, you frequently become the fall guy."

Is administration right for me?

To decide whether administration is right for you, start by talking to other physicians in the industry and asking questions, says Skorupa.

"I strongly encourage mentorship and network," she said. "I learned a lot by just asking physicians who were in different leadership roles, 'Tell me your story. How did you get to where you're at?' It's been hearing those stories that helped me craft my own."

Consider joining committees within your local hospital or among your national specialty organization to evaluate whether the work interests you, Moawad advises.

"Getting some experience is important to see if it's right for you," she said.

Another way to measure your interest is by taking on a part-time job in physician leadership, Dye said. This allows physicians to try out leadership without leaving clinical practice behind.

"Dyad roles where physicians are paired with a nonphysician partner can also be helpful to physicians who are wanting to move slowly into leadership," he said. "Typically, the physician partner in a dyad model also continues to practice clinically part time and thus does not lose that connection with medicine."

In addition to getting some leadership experience, you may want to consider formal training in executive leadership. Many specialty societies offer formal coursework related to leadership, as do some hospital organizations. Physicians can also find numerous courses and programs through AAPL, including the organization's certified physician executive credential.

ACHE has a spectrum of career resources for healthcare professionals, including courses, competency assessments, and executive career coaches. Medscape's Physician Business Academy also offers a course in leadership called How to Become an Effective Leader, which covers the attributes needed to become an effective leader and how to learn and develop relevant skills and traits.

Some physicians heading down the administrative road pursue more formal degrees, such as an MBA, MHA, or MMM, adds Jurica. A business degree is not required, but degrees do have advantages, he said.

"The most important factor in preparing a physician for this career shift is taking on progressively more challenging duties managing people, running important projects, working with budgets, and honing your leadership skills," he said. "However, there are benefits to having a degree. It provides formal education in these areas. Pursuing such a degree demonstrates a commitment to your leadership career and can be helpful when competing with other physician leaders for an attractive position."

The reality is that more hospitals and health systems are recognizing the value of having physicians in leadership and executive functions, Angood said. Data show that health systems and hospitals with physician-leaders perform better.

"This is because physicians not only have strong leadership and administrative capabilities, but they already have a strong sense of the clinical environment and how best to deliver good clinical care. It's a double benefit nonclinical administrators are unable to match."

As for Dhand, he doesn't regret his stint in administration, despite finding out the path was not his calling.

"My experience was an eye-opener; I'm glad I did it," he said. "I would change certain things looking back, like having lower expectations and understanding that change takes time. It's also okay to be unpopular. I'm much happier now, though, only doing clinical medicine and have found fulfilment through other nonclinical ventures."

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