The work of a chief medical officer is a substantial departure from full-time clinical work, so the decision to become a CMO is one that the wise physician leader contemplates with a very measured and thoughtful approach. The wrong timing in making this career pivot can sour the aspiring CMO on leadership work to the extent that they are lost forever to the administrative side of medicine; perhaps never to contribute to what might have been a long and impactful career guiding a hospital or medical group.
When considering whether the time is right to start on the CMO career path, think about the following questions.
DO I HAVE THE NECESSARY EXPERIENCE?
Most chief medical officers have a few gaps in their experience when they take on their first CMO job. Much like the “practice of medicine,” they don’t graduate from medical school and residency having managed every possible ailment or injury. A CMO won’t know everything, but there are some basic job functions that would be best learned before landing the job.
Personnel Management
Chief among these aspects to be learned is managing physician behavior and putting in place clinical performance improvement plans. If you haven’t had a job in which you were accountable for managing a colleague who was struggling clinically or behaviorally, then you probably aren’t ready for your first CMO job. Fortunately, there are a multitude of ways to get this experience.
Department chair, member of the peer review committee, or medical director in charge of a clinic or service line are all positions in which you have accountability for the clinical quality and professional behavior of your peers and in which you are called upon to help a colleague who is “under-performing.” In addition to practical experience learned in one of these roles, the aspiring CMO should take part in formal didactic training in managing performance and behavior.
Taking a course in crucial conversations or similar structured classes is a complement to on-the-job training. Watching and learning from a more senior physician leader is an even better path. “See one, do one, teach one” is not just for clinical procedures — it’s a fine way to learn how to manage the performance of clinicians.
Medical Staff Affairs
If it is a hospital CMO role you aspire to, a strong background in medical staff affairs is important. To be successful as a hospital CMO, you must have a firm grasp of the bylaws, credentialing and privileging policies, peer review policies, and accreditation processes.
The best experience in these areas probably comes from serving as president of the medical staff or the elected medical chief of staff. Performers in these roles often work hand in hand with the CMO and are a great recruiting pool for the hospital executive who wants to find experienced leaders who have proven themselves with their peers.
But being a chief of staff is not the only way to get this experience. Serving as a long-standing member of the medical executive committee, chairman of the peer review committee, even a department chair can provide this experience. Honestly, just studying the bylaws and policies can get you part of the necessary background, and it is this practical application of those policies and procedures that reinforces them with you as a leader.
Change Management
The last area of experience that I believe is essential to an incoming CMO is in process improvement and change management. Having run a quality committee or a patient safety committee that was tasked with changing an existing process to achieve improved or higher performance is an invaluable experience.
Learning to understand data and metrics, setting up a performance improvement plan that has timelines, assigned accountabilities, and expected outcomes is incredibly helpful when you are responsible for the quality and safety of an organization.
Other areas where some experience would be useful include informatics, pharmacy and therapeutics, and utilization management.
Almost all applicants have experience gaps that can typically be filled on the job; however, managing the performance of a clinician, having a strong background in medical staff affairs, and having experience with performance improvement are important enough to be included in the minimum qualifications of the aspiring chief medical officer.
Formal Training and Education
There are firmly held opinions on the question of formal training and education. For the purposes of this article, be aware that this is an important question for each individual that needs to be answered as part of the discernment process for whether the timing is right for you to take your first CMO job.
Mentor/Coach
One of the best predictors of success for the aspiring CMO is whether they have a mentor and coach. As with the topic of formal education and training, this is such a critical issue.
Peer Group
The role of CMO can be a lonely one if entered into without forethought and planning. As a CMO, you are not quite an administrator, but you are no longer viewed as a clinician or clinical leader. The CMO is somewhere in between, and as such, can be left feeling like they no longer have a “tribe” or cohort. As a CMO, it is important to have a peer group of “like-minded” CMOs; sharing ideas and initiatives, venting frustrations in a confidential setting, and having a sense of professional connection are all benefits of a peer group.
Many CMO positions have this sort of peer group built into their organization. As more and more hospitals and medical groups coalesce and consolidate into regional and national organizations, other CMOs in different geographic areas will have similar responsibilities and will be those peers.
Most organizations see the value in creating a forum where these leaders with similar accountabilities can connect periodically in person or virtually. It’s a chance to share ideas and strategies. A peer group with whom to commiserate, brainstorm, and share strategic priorities and objectives in a shared vocabulary that is unique to your organization establishes a sense of community.
Stand-alone hospitals and medical groups may not have a built-in peer group, in which case, leaders may need to look for camaraderie through professional societies, leadership forums, or professional development courses.
Most CMOs I have worked with eventually build both a formal and informal group of peers — a formal group of peers related to the organization itself and an informal group of peers with whom they’ve worked in the past and who may now be with another hospital or health system. Either can be effective; having access to both is ideal. The key point here is that one of the tests of readiness for the CMO job is whether you have access to a peer group who can make the job more manageable and more enjoyable.
IS THE ORGANIZATION READY FOR A CMO?
This one is a bit tricky because there is a chicken-and-egg phenomenon here. You may not be ready for your first CMO job if the organization isn’t ready for a CMO. Taking a CMO job that is newly created and without clear accountabilities, clear measures of success, or a well-functioning executive team is setting yourself up for failure.
Before you accept your first CMO job, ask questions such as: Is the organization ready to have a CMO? Is this the first time the hospital has had a CMO? What happened to the last CMO? Is there a clear reporting structure and set of job responsibilities? Are resources available to accomplish those responsibilities? Who will be direct reports? Will the position have a budget? Will the CMO have an administrative assistant?
I won’t say it is impossible to step into a mess and turn it around, but it’s probably not the best environment for your first CMO position. Readiness is based on understanding whether a particular CMO job is adequately resourced, scoped, and supported for you to be successful. You aren’t ready for your first CMO job if the organization isn’t ready for you.
ARE YOU READY TO LEAVE CLINICAL MEDICINE?
This is probably the toughest question aspiring CMOs encounter and really is the crux of this article. We’ve spent years in college, medical school, residency, and in many cases a fellowship. Our clinical career is literally decades in the making, and being a physician becomes part of who we are; it is part of our identity to care for patients. Taking a history, developing a diagnosis, creating a care plan, or performing a surgical intervention that will affect the life of another human being is tangible and gives immediate professional reward.
Not only is the professional satisfaction of being a physician immediate, but also recognition is directed at us individually rather than at a team, department, or hospital. The gratitude and appreciation we feel from a patient or family is a wonderful and amazing part of medicine. More than stature, reputation, and compensation, it is the professional reward that drives most physicians. Careers in clinical leadership such as CMO roles offer rewards and recognition that span years before they are actualized, and they may never be directed at us individually.
So, when is it time to leave your clinical career and pursue a leadership role in medicine? The answer is different for each of us who has seen their careers pivot toward the administrative side of healthcare. My advice is to have some intentionality to this decision. Many CMOs, including me, have found ourselves accepting a leadership role that reduced our time devoted to clinical medicine before spending adequate, dedicated time on the discernment.
It is easy to slide into administrative roles without making a conscious decision to do so. A trusted chief executive asks you to fill a leadership gap, and the organizational need is so compelling that you don’t take the time to consider whether it is the right time to step away from your clinical responsibilities. Is the time right for you to leave clinical practice?
For some prospective CMOs, the opportunity to change the system and improve the model of care for perhaps generations of patients is the reason to forego the immediate rewards of patient care.
For others, it is the chance to leave a legacy of improvement or stability in a health system that is rife with dysfunction and inefficiencies. To improve work conditions and resources for your peers can be a potent motivation. There is tremendous satisfaction in working as part of a team, especially a team that you have selected, nurtured, and inspired. It is the difference between conducting an orchestra and being a soloist. It is not for everyone, but if seeing that success in your team gives you a sense of accomplishment, it is probably a significant indication you will find satisfaction in a CMO position.
There are two reasons one should not leave clinical medicine to pursue the administrative functions of a CMO position. The first is to escape the demands of patient care. If you never loved patient care, if healing and compassion were never aspects of your career and part of your professional persona, then you may not be well-suited to influence and lead physicians. We need chief medical officers who love the practice of medicine and want to see it improve.
The second reason not to leave clinical practice is because you think you will now be in charge and can tell others how to practice medicine. The CMO role is one of influence, but certainly not one of absolute authority. As a CMO, you can set an agenda and inspire others to excellence and professionalism, but you seldom have the command-and-control latitude to create a future all of your own choosing.
There are many descriptions of a CMO performing tasks on a daily basis. Sometimes it’s a salesman; other times a research assistant, a translator, often a cheerleader, and at times a kindergarten teacher (let’s all play fair in the sandbox). It’s a job of influence, guidance, and role modeling without the power of autonomy and authority.
So, at the end of the day, can you set aside the rewards of clinical medicine and channel those energies into system improvement that has a longer timeline and is less personal in its rewards? Some CMOs try to maintain a part-time clinical practice or participate in weekend or evening call rotations, but it is difficult to coordinate with CEO duties.
Staying sharp clinically requires practice, especially in the procedural specialties. Over time, clinical acumen or manual dexterity will decline as they become the bridge into administrative medicine. Retaining a clinical practice until you are confident that leadership is the best use of your time and talent may be a wise decision.
But don’t hold on to the clinical practice too long. As a CMO, you are promoting peer review and professionalism. If you’ve lost your clinical skills and continue to practice, you are not “walking the talk.”
I remember well this transition for me. As a hospitalist, I found it easy to keep one foot in the clinical arena while I progressively assumed more administrative responsibilities. In many urban centers, a hospitalist job focuses on the cognitive and diagnostic side of medicine. Even common inpatient procedures — central line placement, paracentesis or thoracentesis, joint aspirations, etc. — can be performed by interventional radiologists, intensivists, or anesthesia providers, so a hospitalist’s job can focus on the diagnostic work-up, management, and discharge coordination.
Losing procedural volume was not as important as it might be for a surgeon. It was easy for me to devote one of my seven-day clinical stretches to non-clinical administrative activities. From there it was not difficult to move to providing only occasional weekend or night coverage to accommodate more time for leadership responsibilities.
Finally, on busy days, moving to helping with an admission or a discharge allowed me to record enough clinical activity to remain privileged, even though it was clear my primary job was now administrative rather than clinical.
I recall one afternoon after my administrative tasks had been mostly completed, I paged the triage hospitalist and asked if there was an admission or two that I could help the team with. When the response was a pause, a ruffling of papers, and then a tentative suggestion that he thought I could manage a 92-year-old dementia patient who had a UTI and probably needed nursing home placement, it became clear to me that perhaps my time was better spent improving the system of care rather than on the modest help I could provide caring for one ailing patient.
During the next credentialing cycle, I dropped my admitting privileges. It had been an eight-year journey of gradually reducing my clinical time, and I was ready to devote myself fully to administrative leadership.
Do I miss the clinical work? Almost every day. And that is probably why I make a halfway decent administrative leader for my organization: I participate in regular multidisciplinary rounds with my clinicians, stay current with my license and board certification, and do a fair amount of shadowing clinicians while they do their work. It is not a substitute for clinical practice, but it partially scratches that itch and my need to stay relevant clinically.
Be prepared to make this decision, and the transition away from clinical practice to be a journey for you. There will be days when, as you flip through listings for clinical positions in your area, you wonder whether you made the right choice. There also will be days when you see consensus develop on improved workflows, a physician career saved by succeeding in a performance improvement plan, or when your hospital becomes CMS 5-star-rated that you will be reassured it has all been worth it. It takes time to see the trade-off value, but being a CMO is an incredibly rewarding career.
IS YOUR FAMILY READY FOR THE TRANSITION?
Let’s not forget the most important people in this discernment over the timing of becoming a CMO. Your spouse, your children, and perhaps aging parents need to be front and center in this consideration. Although the time demands of a CMO position are less than those in a clinical practice, I can assure you that at times they will feel like more.
In moving to a CMO job, you may replace the every-fourth-night calls and monthly weekend hospital calls that defined your clinical career with a Monday to Friday job, but be aware that those Monday to Friday weekdays that start with the anesthesia department meeting at 6:30 a.m. may not conclude until the end of a medical executive committee meeting at 9 p.m.
Your hospital may expect you to attend dinner meetings and do out-of-town travel for system, state, or national organizations, and even though you are not “on call,” you are expected to respond to patient care in the hospital on a regular basis. There are times when disruptive physician behavior, clinical errors, or unannounced visits by regulatory agencies send you to the hospital spontaneously.
You can be a great parent and a great CMO. You can coach T-ball or soccer and be a CMO. You can be an incredible son or daughter and provide care supervision to aging parents. But having a spouse, friend, or sibling who understands your role and is willing to cover some of the home front when you are pressed into hospital or medical group responsibilities is something to think through and plan for.
The other side of the equation is setting boundaries with your clinical leadership team and ensuring there is effective coverage when you take time off. Share your calendars, be aware of each other’s home obligations, and create an environment of mutual support in the C-suite. It will serve you and your team well.
The guidance here is that you understand your CMO time commitments and have an honest discussion with those on the home front. Support from these individuals will be the difference between feeling torn by competing obligations and being able to focus and succeed in your leadership role.
ARE YOU READY TO LEAD?
If whether to leave clinical practice is the toughest question, the most important question is: Are you ready to lead? Healthcare today does not need reluctant or passive leaders who lack a vision and passion for the profession. We have too many serious problems to allow placeholders finishing the last few years of their career in an administrative role to hold the CMO jobs.
We need chief medical officers who have a “fire in the belly” to transform healthcare and the patience to plan, build support, and change a process that can take years. We need CMOs dedicated to developing the next generation of physician leaders. We need CMOs who are ardent supporters of professionalism. We need CMOs who play an active role in clinician wellness and mitigate the epidemic of burnout in our ranks. We need CMOs who are passionate advocates for our patients and are relentless in their pursuit of quality and safety for those under our care.
If you have a nagging sense that providing great care at the bedside will be insufficient to the patients you care for, if you find yourself bothered by inefficiencies and ineffective clinical strategies, if you see substandard care and it leaves you stirred to action, leadership may be calling your name.
Stepping into a CMO role can be hugely rewarding, but you must want it. You have to want to make care better by leading your colleagues and transforming the care model. That is the essence of the successful CMO: You must want to lead.
IS THE TIMING EVER RIGHT?
We have covered quite a bit of ground, and I have given you much to consider before you judge yourself ready for your first CMO job. You might be thinking that if you are waiting to have all these topics and concerns answered in the affirmative, the time will never be right to transition to a CMO job. Many successful CMOs, including me, will tell you that we weren’t fully ready when we stepped into our first CMO job, and yet we did just fine.
The reality is that having each criterion fully secured and each box checked may be overly cautious and prevent you from taking the plunge into the world of physician leadership, so please consider this article with a balance of both wanting to not make a rushed or poorly considered decision and the knowledge that if you have answered most of these questions in the affirmative and have a strong sense of purpose and dedication to the role, you will in all likelihood be successful as a CMO.
But also recognize that for some of you, waiting is the better course of action. It is common to worry that if you decline the position, the opportunity may never again present itself; however, the reality is that CMO positions open relatively often. The average tenure in a hospital CMO job is measured in years, not decades. Physician leaders choose to move to system roles, return to clinical practice, or transition to another hospital or health system. Unfortunately, sometimes these roles get reorganized and eliminated, only to reappear two years down the road.
The constant is that it is hard to effectively run a hospital, medical group, or health plan without effective senior physician leadership that most often comes in the form of a well-prepared CMO. Patience is sometimes in your best interest. Prepare yourself; wait for the right position, then jump in and have a satisfying career as a chief medical officer.
Excerpted from I Want to Be a Chief Medical Officer: Now What? by Rex Hoffman, MD, MBA, FACHE, CPE.