For centuries, the medical profession has held a place of significant authority and trust in society, and the sacrosanct patient-physician relationship remains the dominant driving influence in today’s complex, ever-changing global healthcare industry. This elevated role of the physician, however, is shifting and even deteriorating on some levels, posing a risk to the future of effective healthcare delivery.
To reframe the role of physicians to one that remains worthy of the historical trust, confidence, and respect acknowledged by patients, families, and colleagues in other healthcare disciplines, we must transform physician education and training to include more focus on leadership skills as well as practical business and practice management principles such as marketing, communication, and finance.
Medical education today, unfortunately, focuses primarily on the science of medicine and clinical decision-making skills, neglecting the development of much-needed leadership and management skills. A 2022 study found that 79% of medical students perceive leadership as a core competency, and 55% believe that leadership skills are not taught adequately.(1)
Physicians today face ongoing challenges to their recognized authority and trust — challenges from patients armed with internet-based information, from employees who must be managed, from interdisciplinary teams that must have collaboration and from dense administrative bureaucracies that must be tolerated and even embraced.
Other significant trends influencing healthcare, such as workforce fluctuations, private equity encroachment, state and federal health policies, nontraditional national retailers, value-based care models, and the attention required for social determinants of health in the population, are also escalating pressures upon the physician workforce. Healthcare leaders face a plethora of challenges across all sectors of the industry.
Many, not all, physicians discern what this potentially means for their careers. Burnout rates are high, according to the American Medical Association (AMA), with 48.2% of physicians in 2023 experiencing at least one symptom of burnout.(2) So, perhaps not surprisingly, moves to non-clinical roles are increasing.
In a 2019 survey by the Physicians Foundation, 27% of physicians reported they were not primarily engaged in patient care,(3) matching a 2018 AMA survey in which 25% of physicians were in non-clinical positions.(4) The United States is also on track to potentially experience a shortfall of as many as 86,000 physicians by 2036. This includes a shortage of between 20,200 and 40,400 primary care physicians and between 10,100 and 19,900 surgeons, according to the Association of American Medical Colleges.(5)
Additionally, a large portion of the physician workforce is nearing the traditional retirement age of 65. Physicians 65 or older were 17% of the active workforce in 2021, and those between age 55 and 64 made up another 25% of the active workforce. Therefore, it is very likely that more than a third of currently active physicians will retire within the next decade.(5) The physician workforce needs and the pipeline are currently not being met or filled adequately.
LEADERSHIP TRAINING FOR IMPROVED OUTCOMES
On the positive side, however, leadership training for physicians leads to improved clinical outcomes and organization performance. The benefits of physician-led healthcare systems include the provision of superior patient experiences, better efficiencies, and delivery of higher quality care when compared to non-physician-led systems.
In a 2022 Centers for Medicare and Medicaid Services (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) report, only 6% of hospitals overall received the highest rating in providing superior patient experience; in contrast, 41% of physician-led hospitals received the highest rating in that category.(6)
In 2022, 59% of the nation’s physician-led hospitals had lower Medicare costs per beneficiary than the national median. According to the Congressional Budget Office, accountable care organizations (ACOs) led by independent physician groups produced substantially larger savings than those led by hospitals, and ACOs with a larger proportion of primary care physicians were also more likely to produce greater savings. Hospitals with greater physician leadership involvement also score higher in performance metrics and lean management processes.(7)
In the annual U.S. News and World Report survey of top-performing American healthcare systems, a strong majority of those in the “Honor Roll” each year are led by physician CEOs. Similarly, an overwhelming number of top-ranked hospitals reported in the Newsweek annual international survey on “Best Hospitals” are run by physician CEOs, supporting the strong connection between high performance ratings and physician leadership. In the United States, only 6% of the hospitals have physicians as CEOs.(8)
EMBRACING PHYSICIAN LEADERSHIP DEVELOPMENT
Clearly, if properly trained and experienced in leadership, physicians can enhance patient-centered care while simultaneously improving patient and institutional outcomes. The shift toward value-based care models will undoubtedly continue, and physicians are the natural stewards for the healthcare industry to better itself.
This happens because physician leadership brings unique clinical perspectives and expertise, leading to stronger interprofessional collaboration, better handling of complex challenges, enhanced decision-making skills, increased efficiency, and improved patient outcomes.
Effective physician leaders have self-management sensitivity, team-building acumen, complex problem-solving skills, and the ability to motivate others. Successful physician leaders are often characterized by increased self-awareness and regulation, integrity and humility, self-motivation, social awareness and regulation, all coupled with strong long-term strategic perspectives. Collectively, these traits contribute to their effectiveness in managing relationships and building successful networks.
Organizations that have embraced physician leadership development programs (PLDPs) have recognized significant improvements in their healthcare organizations, including cost savings, operational gains, and better patient care. For PLDPs to remain successful, however, we must emphasize the importance of adequate funding, a supportive infrastructure, positive cultural factors in the institution, and the availability of mentorship or coaching programs for enabling successful leadership trajectories and institutional outcomes.
Being a physician is an opportunity to grow and emulate the traits of a leader in all communities, not just in the healthcare industry. One does not need formal roles and a load of administrative responsibility to be recognized as a leader.
Physicians’ natural traits of altruism, commitment to others, and a desire to help create positive change on many levels are attributes of leadership that are readily recognized by others. And at some level, all physicians are leaders.
The healthcare industry needs physicians as leaders. The traditional model of physicians in healthcare must change, and we must prepare trainees accordingly if they are to be set up for success. The future of patient care and the industry’s betterment depends on this transformation.
TOWARD POSITIVE TRANSFORMATION
Remember, leading and helping create significant positive change is our overall intent as physician leaders. AAPL focuses on maximizing the potential of physician-led, interprofessional leadership to create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally.
Therefore, as physician leaders, we must embrace the opportunities where our individual and collective energies create the beneficial changes our industry desperately needs. We must continue to be innovative and adaptive in our efforts. Let’s continually maximize the opportunities in our profession.
Through this AAPL community, we all can continue seeking deeper levels of professional and personal development and recognize ways we can each generate constructive influence at all levels.
As physician leaders, let’s become more engaged, stay engaged, and help others become engaged. Exploring and creating opportunities for broader levels of positive transformation in healthcare is within our reach — individually and collectively.
References
Chavan AK, Bendriss R. Leadership Curriculum in Medical Education: Exploring Student and Faculty Perceptions in a US Medical School in Qatar. J Healthc Leadersh. 2022;14:163–173. https://doi.org/10.2147/JHL.S370645 .
Berg S. Physician Burnout Rate Drops Below 50% for the First Time in 4 Years. AMA News Wire. July 2, 2024. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-rate-drops-below-50-first-time-4-years .
The Physicians Foundation. 2019 Survey of America’s Patients: An Examination of How Patients Experience the American Health Care System. 2019. https://physiciansfoundation.org/wp-content/uploads/2019/10/The-Physicians-Foundation-2019-Survey-of-Americas-Patients.pdf .
American Medical Association. AMA Analysis Shows Most Physicians Work Outside of Private Practice. AMA Press Release. May 5, 2021. https://www.ama-assn.org/press-center/press-releases/ama-analysis-shows-most-physicians-work-outside-private-practice .
Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. AAMC. March 2024. https://www.aamc.org/media/75236/download .
Centers for Medicare and Medicaid Services. Survey of Patients’ Experiences (HCAHPS). Data.cms.gov. https://data.cms.gov/provider-data/topics/hospitals/hcahps#hcahps-star-ratings .
NDP Analytics. The Economic and Social Benefits of Physician-Led Hospitals. NDP Analytics. September 2022. https://ndpanalytics.com/wp-content/uploads/PHA-Economic-Impact-Report-092022-Final-R1.pdf .
See H, Shreve L, Hartzell S, Daniel S, Slonim, AD. Comparison of Quality Measures from US Hospitals with Physician vs Nonphysician Chief Executive Officers. JAMA Netw Open. 2022; 5(10):e2236621. https://doi.org/10.1001/jamanetworkopen.2022.36621 .