What Skills Do Physician Leaders Need Now and in the Future?

MEDICAL LEADERSHIP is increasingly challenged as the nation's health care system addresses critical concerns. [1] Physician leaders face the inherent challenges of aligning their organization's missions and operations with those of the medical staff. [2] In addition, physician leaders are overseeing operations, financial concerns, and other areas beyond traditional medical staff issues.

To provide perspective on the development of medical leadership in the United States, a national panel survey was conducted. [3] The 1999 survey was a non-random sample of physician leaders in The Medical Leadership Forum, an educational and leadership development service for physicians. The entire membership of about 200 organizations and their senior medical executives was invited to participate. Fifty-four percent completed an extensive questionnaire.

The results show the medical leadership skills that physician executives consider important today, and provide a window to the future about the skills that will be important tomorrow. The results also offer a perspective on opportunities for enhancing continuing education, certification, and degree programs focused on physicians in leadership positions. [4]

Please see Figure 1 for a profile of the physicians and hospitals that participated in the study.

Survey participants spent much of their time working on medical staff management, quality assurance, and defining or communicating organizational goals. Less time was spent on contracting, financial management, risk management, operations, and budgeting. However, they expected to spend a greater portion of their time in these areas.

The quest for knowledge

Medical leaders said the knowledge they need right now centers on:

* Total quality improvement

* Quality assurance

* Clinical benchmarking

* Decision-making under uncertainty

* Strategic planning 

Priority areas for the future include knowledge of information systems, most likely related to the constant technological advances in all aspects of health care.

A parallel series of questions addressed personal characteristics. Among those identified as most valuable right now were:

* Oral communications

* Listening ability

* Team building and being a team player

* Conflict resolution

* Interpersonal skills 

* Being a systems thinker [5]

For the future, these same personal characteristics were identified as being of equal or even greater importance, with an emphasis on communications and interpersonal skills, systems thinking, and consensus building.

Medical leader in training

Another series of questions focused on three principal areas of development:

1. Leadership skills

2. Technical skills

3. Practical skills

The answers provided insight into the training needs for medical leaders. The highest priorities for training involve organizational change, communicating a vision, and systems thinking.

In the future, the need for training in these areas is even more pronounced, with high priority attached to communication skills, leading change in an organization, communicating a vision, empowering people, effective listening, building trust, building consensus, and systems thinking.

Technical skills needed now and in the future centered on information systems and conflict resolution or mediation.

Medical leader training needs for practical skills

And when it comes to practical skills, those with the highest importance now are time management, communication skills, and meeting skills. For the future, similar results were found, with the notable addition of written and oral communication skills.

What does it mean?

The survey elicited valuable information from a pre-selected sample of forward-thinking medical leaders. The participants are mature in their professional development, both as clinicians and as managers, with extensive experience and broad perspectives.

The participants think that the medical leader role will continue to gain importance and possibly assume line management responsibilities. The realities of the health care system suggest that these leaders will indeed be increasingly important. The ability to lead and provide greater alignment between medical staff and organizational goals and objectives is critical to successfully managing health care systems. The survey results will be helpful in developing new programs and should delineate educational opportunities for physician leaders now and in the future.

Stephen J. Williams, ScD, is professor and head of the division of health services administration at the Graduate School of Public Health at San Diego State University.

References

(1.) Riley, P. Health care Administration in the Year 2000: Practitioners' Views of Future Issues and Job Requirements. Hospital and Health Services Administration. 38(1993):181-195.

(2.) Guthrie, M.B. challenges in Developing Physician Leadership and Management. Front Health Services Management. 15(1999):3-26.

(3.) Medical Leadership Forum. "Medical Leadership Trends in Hospitals and Health Systems Across North America." Lacombe, LA: The Medical Leadership Forum, 1999.

(4.) Kirschman, D. Leadership is the Key to Chief Medical Officer Success. The Physician Executive. 25(1999):36-3.

(5.) Linney, G. E., Jr. communication Skills: A Prerequisite for Leadership. The Physician Executive. 21(1995):48-9.

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KEY CONCEPTS

* Physician Leadership

* Evolving Medical Leader Role

* Medical Management Education

* Technical, Leadership, and Practical Skills

* Organizational Change

The role of the physician leader is moving beyond traditional medical staff issues. A recent national survey of physician leaders shows a growing need for education on specific technical, leadership, and practical skills. The results reveal the medical leadership skills that physician executives consider important today, and provide a window to the future about the skills that will be important tomorrow. Physicians say they need training now in quality assurance, clinical benchmarking, decision-making, and strategic planning. And when they gaze into the future and see the rapid changes throughout health care, they say they'll need more training in communication, organizational change, effective listening, and systems thinking.

Profile of Physicians and Hospitals

Physicians

* 50% were vice presidents of medical affairs

* 21% were chief medical officers

* 29% were other titles

* Mean total compensations was $200,000

* Median age was 54 years old

* Median work week was 50 hours administrative duties

* Very few spent time doing clinical work

* Median 9 years in management experience

* 3 years experience in their current position

* 20.7% of respondents held an MBA, MHA, or equivalent master's degree 

* Median 23 years of clinical medical experience

Hospitals

* Median 385 licensed beds

* Median occupancy 70%

* Majority were not-for-profit

* Median of 300 physicians on staff