Reader feedback.

Dear Editor:

Is a Physician Executive Still a Physician?

I think "The Caducean Ceiling" (Sept/Oct. The Physician Executive) is a real issue and is a perfect topic for exploration by ACPE. As with most issues, the devil is in the vocabulary.

I would take the position that a "physician" is defined by a pattern of thought, a repertoire of actions and a shared body of experiences. The key question, then, becomes whether a physician is still a "physician" after further experiences have moved him/her away from the original patterns of thought and repertoire of actions. Put another way, once a physician always a physician?

Obviously, I am not talking about licensure, credentialling or acceptability for patient care. I am talking about the morphing of what was a physician into another entity.

I absolutely believe that having actual, real, card-carrying, fire-breathing doctors is the potential salvation of our present endgame with mangled care, but an MD does not guarantee that person to use or even possess the above-mentioned qualities.

My personal experience, but hardly unique or even unusual from the conversations I have had at your courses, is that the MD does not hold you back as long as you discard the content and tone and act like any other executive/businessperson.

My dilemma is, "Do I have consent within myself to change in the adaptive ways needed?" It's not "Can I change to meet this environment?"

In short, the caducean ceiling seems evident enough to me for physicians, but a mere MD shouldn't get in your way.

Dan H. McDougal, MD

Medical Director, Antietam Health Services 

Hagerstown, Md.

Forgotten Physicians?

In our work we see two major reasons why few hospital boards decide to hire physicians as CEOs:

* One is it simply doesn't occur to them. Their consultants don't recommend this option and many board members don't have experience with physicians who are CEOs. They don't know how well it can work.

* Secondly, it costs more. The market has set the compensation level for physician executives higher than for non-physician executives. An equally educated and experienced physician executive CEO can command a higher salary than a comparable non-physician executive. So when boards do look at this issue, they see an expense instead of the investment that it really is.

Jennifer R. Grebenschikoff

Vice President, Physician Executive

Management Center

Tampa, Fla.

Book Reaches for Caducean Ceiling

When Ray Fernandez, MD, was the CEO of the Nalle Clinic in Charlotte, N.C., he and I co-authored a hook called My Pulse Is Not What It Used To Be. The Leadership Challenges In Healthcare.

In reviewing My Pulse, JAMA concluded, "its sensitivity to organizational issues would facilitate the transformation of the health care system!" And Andre Delbecq, an Honorary Fellow of the ACPE, called it a "powerful case study of a transformational physician administrator."

The simple premise of that book speaks directly to the controversy raised in the Sept./Oct. issue of The Physician Executive concerning the caducean ceiling. If a health care organization is to provide excellence in patient care, the organization must itself be treated as a patient in need of care. The human organism, which is the organization, must, at one and the same time, remain both financially viable (its life blood) and deliver uncompromised quality curing and healing (its purpose or reason for existence.)

That challenge is not, in this reader's view, being served very well by arguments as to whether or not physicians can or should be CEOs.

For example, it is true, as Leland Kaiser says, "being a CEO is all-consuming. You have very little personal or family life." But it is equally true that, given a lifetime of being on call and carrying beepers that summon them to life and death confrontations 24/7, physicians are quite prepared for that lifestyle.

It could easily be argued that someone who has never held a scalpel can never truly understand the challenges of patient care.

Might not patient care be better served by exploring ways to create and maintain an office of the CEO where a truly equal partnership between physicians and administrators existed under the same ceiling? Both the buck and the accountability for quality care stop in that office.

To this reader, all that is required is that two generally large egos be willing to learn how to function together in the service of a common goal--caring for the human organism upon whose shoulders falls the responsibility of caring for patients.

There can be no greater leadership challenge in health care.

Irv Rubin, PhD

President, Temenos, Inc.

Honolulu, Hawaii 

My Pulse Is Not What It Used To Be: The Leadership Challenges In Healthcare can be ordered by writing to [e-mail]

Dear Readers

Robert Kauer, PhD

ACPE extends its deepest sympathy to the family, friends and colleagues of Robert Kauer, PhD, who died in September. On the faculty of the College for many years, Rob taught financial decision making and other ACPE courses since 1994. His soft, gentle style in a tough-minded discipline made him an extraordinary teacher and close friend to all of us here at ACPE.

Rob was a professor of finance specializing in issues of valuation, acquisitions and the financial management of health care organizations. From 1988 until 1999, he was a full-time faculty member in the department of banking and finance at the Weatherhead School of Management, Case Western Reserve University in Cleveland, Ohio. He was also director of the school's executive MBA Program.

Prior to that, he was a visiting faculty member in finance and health finance at the Kellogg School of Management, Northwestern University, as well as at Vanderbilt University in Nashville.

In 1999, Rob became part-time senior vice president and chief financial officer for Ironrock Capital, an investment and manufacturing firm based in Canton, Ohio. In addition, he had an active consulting career where he frequently worked with a variety of organizations in manufacturing, insurance, banking, steel, automotive, health care and law.

He received his BA from Trinity College in Hartford, Conn., an MPH in health administration from Yale University and an MBA and PhD in corporate finance from Case Western Reserve University.

In tribute, a special scholarship fund has been established in Rob's name. It is the Robert Kauer Memorial Scholarship Fund, c/o Weatherhead School of Management, Peter B. Lewis Building, Room 350, Cleveland, Ohio, 44106.