The active physician executive of the future: physician executives need to step out into public view and take a leadership role despite social and political risks, one physician executive says. (Climbing to the Top).

If leading a battalion of physicians through the battle of Waterloo is your vision of physician executive leadership, stop the DVD!

Physician executive leadership roles changed over the last few years faster than the sweeping changes in health care itself. Once a physician administrator who simply encouraged doctors to talk to doctors, the physician leader is now a visionary, statesman and entrepreneur all wrapped up in one.

Formal management and financial degrees are replacing CME credits and life experience. The leadership role is evolving from the concept of "talking to the doctors" and reviewing their schedules, to one of negotiations and strategic plans.

It's also a role that is operating outside the medical group, the hospital and even the health care system. The public is once again viewing doctors as ethical, moral sources of knowledge and stability.

In times of instability--with constant threats of terrorist attacks--it's fair to ask if the physician executive's role is growing in political and global importance.

Watch your local newscast tonight. How long does it take before they talk about bombings, murders or other sinister attacks on human life?

Has anyone spoken to a local community group lately?

Along with the usual complaints about health care, deductibles, copays and networks, we also hearing questions about bioterrism, safety precautions for use in public areas against bombs and even treatment for nuclear fall-out.

Has the focus shifted? It certainly has.

I believe that the future role for physician executive leadership is not only to lead physicians, but more importantly to lead the masses.

* Who is better suited to understand complex political and social agenda's?

* Who is the best patient advocate?

* Who would then be the best advocate for the common everyday person on the street?

The time has come for physician executives to step out of the hospital and into a more public and global arena. This starts in your local county and state medical society and goes through every public office available.

"But we are not political," may be your response. You believe that the role of physician executives is apolitical because ethical, moral issues cross all political parties.

Wrong! Ethical, moral and social issues are all about politics. What changes is their individual level of importance on the ladder to achieving one's goals, as well as whose agenda are we speaking about.

The physician executive is without question a person who aspires to higher social offices.

How does one start this journey?

* First, start with your local medical society. Most are looking for new blood with fresh ideas. Usually you can advance through the ranks rapidly, assuming you attend the meetings and your ideas are not that radical.

* Next it is important to get to know your local politicians, state senators and assemblymen. If there is a city council get to know them. Do some due diligence, start with the health care and finance committees. Learn who is on them, topics of the agendas, where committee members stand on issues.

* Subscribe to the local bulletins that report agendas for different meetings as well as the report on the committee decisions' or recommendations.

* Follow all legislative decisions made by your governor concerning health care.

* Follow your Senate and House counterparts in Washington.

To be a true leader, you must first be informed of the issues and know those in authority who can make things happen.

Our country has never been in more need of leadership and direction than now; it is time for us to be part of the solution to these needs. If you still think all physician executives do is keep doctors at the hospital happy, then it is time to clean off your desk, take a walk around the community and hear the concerns of today's patients.

Robert Aquino, MD, MS, PhD is president and chief executive officer of capitol Health Management, Inc. in Astoria, N.Y. He can be reached by phone at 718/423-0808 or by e-mail at [e-mail].