Learning the language of finance, value equations, and return on investment (ROI) is not something typically achieved in medical school or during our early career stages. Those who pursue other channels of advanced learning or come to medicine from other industries may have a modicum of knowledge in these areas, but this is not the norm; it takes time and purposeful intent to learn this language.
I often refer to one of my early experiences as a junior trauma/surgical critical care (now acute care surgery) attending speaking with the chief financial officer at a prestigious institution about the urgent need to upgrade the ICU environments.
We all know ICU teams closely monitor the outputs for a variety of patients’ physiologic functions, and so when after my impassioned plea to the CFO he asked me about the ROI, I was dumbstruck. All I could naively think was, “Why is he asking me about our renal output indicators?” I also thought, “Why doesn’t he know we call it hourly urine output?” I can only imagine what he was thinking of my knowledge base as we continued the conversation. (We did get the ICU upgrades eventually, and I learned a great deal about finance.)
Simplistically, the value equation is often displayed as: Value = Quality / Cost. Obviously, a wide variety of perspectives and/or variables can be applied to this equation, but the core principle remains: Value, from whatever vantage, is directly related to the quality available or generated and is dependent on the costs required to generate this quality.
THE COMPLEXITY OF PHYSICIAN LEADERSHIP DEVELOPMENT
Although it was present before the pandemic, there is an increased interest and ongoing investment in physician leadership development. It is not surprising that a clear relationship between physician leadership and organizational outcomes is complicated; the complexities of the healthcare delivery system do not easily allow for simple or direct causal analyses.
Similarly, as much as physicians know about or appreciate the value of physician leadership, there is a dearth of research related to the tangible benefits of physician leadership on organizational performance and patient outcomes.
For example, hospitals and health systems and the populations they serve are situated in various regions and settings; their patient populations are diverse with disparate access to care and resources, often making outcomes measures and research complex and subjective. There may also be a variety of other external factors, such as organizational culture, models of medical staff, and the degree of institutional board support for evaluating physician leadership and development.
Currently, the onus to learn the tangible and intangible attributes of leadership is primarily on individual physician leaders at every career stage. A strong mantra of mine, and of AAPL itself, is that at some level, all physicians are leaders, regardless of their clinical activity or level of administrative responsibility. A physician leader is developed either informally through trial-and-error in various positions, participation in mentorships, or a variety of physician leadership development programs (PLDPs).
AAPL has a 50-year history of providing PLDPs with a full spectrum of programs, products, and services to support physician leadership and is the internationally recognized global leader in this regard. But given the increased awareness and focus on physician leadership in the industry, competition has inevitably developed for AAPL. AAPL must retain its value!
Numerous other programs with diverse formats in various settings offer physicians access to leadership development:
Combined MD-MBA programs — There are 82 combined MD-MBA medical school programs.
University masters’ programs — There are 320 MBA programs in healthcare administration.
University programs — 395 universities offer a leadership degree.
Institutional programs — 50% of hospitals have leadership development programs (80% are developed locally in-house).
Generic leadership courses — There are 2,045 leadership development programs (variety of vendors).
Consulting and search services — Hundreds of consulting firms have focused on leadership development programs.
Professional associations — Numerous medical societies offer PLDPs.
ACGME/ABMS — HALM fellowships and certification are now available.
Private equity and non-traditional companies — These include Welsh, Carson, Anderson & Stowe and the Health Management Academy.
Additionally, a variety of indirect leadership development competition is present:
Healthcare media — e.g., HealthLeaders, Modern Healthcare, NEJM Catalyst.
Open online communities — e.g., Coursera, EdEx, Coursebox.ai.
General public websites, social media, books, conferences, etc.
DRIVERS OF SUCCESS
Healthcare is a high-stakes industry (arguably the highest), and leadership is essential, regardless of any one individual’s level or title. Moreover, the shift toward value-based care necessitates physician-led collaborative team-based care to provide the highest level of quality, safety, and efficiency at all stages of patient care, thereby ensuring optimal patient outcomes.
Physician leadership success now depends on several factors, including content and delivery channels of leadership training and education, board-level physician participation, mentorship, potential executive coaching, recognized opportunities to advance within an organization, efforts to improve engagement and combat burnout, and continuous investment in physician leadership development throughout all types of healthcare delivery systems.
The main drivers of success are a committed organizational culture for leadership development, strong quality improvement programs, and a recognized leadership pipeline.
Beyond the clinical delivery aspects of the industry, several related sectors of the industry are also paying attention to physician leadership. Numerous companies in the search sector, the payor sector, the technology sector, and the pharma sector have initiatives to recruit and develop physicians as knowledge agents as well as leaders.
As the delivery of healthcare is changing, so are roles/responsibilities. An ongoing challenge for AAPL is to continue tending to our core constituency (physicians) while also searching for ways to be on the leading-edge of this inevitable evolution, with various providers becoming further involved in the patient care and leadership spaces alongside physicians. Extending the value of AAPL’s offerings further into the industry beyond physicians alone constitutes a set of initiatives well underway with full support from the AAPL Board of Directors.
Jimmy Chung, MD, an AAPL board member, recently commented, “We need to look at what modern society and its citizens need and remodel our health system to meet their needs... [A]s health information and medical knowledge become more accessible and digestible to the general public and medicine becomes more demystified, perhaps the role of the doctor needs to be redefined. If what we really want is a healthier community and better educated populace, doctors need to rethink how to stay relevant in a new world with technologies that allow people greater access to information and self-care....[O]verhauling the medical education system would be a good place to start. Then perhaps today’s medical students will have a clearer picture of what they can expect, and the profession will attract the right people with appropriately aligned goals and aspirations.”
EVALUATING VALUES AND BENEFITS
And so, while the core parameters of the traditional value equation (Value = Quality / Cost) will remain the same, the value of physician leadership continues to require better definition in terms of its quality of contribution to the healthcare industry. To do so while also recognizing the costs of providing physician leadership development is essential if an improved perceived value in the healthcare system is to be realized in terms of patient care outcomes. The patient-physician relationship will, and must, continue to be a dominant driver in value for the foreseeable future, even with the multitude of changes occurring in the industry.
AAPL has, therefore, developed an evolving thought leadership and research enterprise to facilitate the comprehension of the value and benefits for physician leadership. Several retrospective evaluations on the impact of the association’s Certified Physician Executive (CPE) program on individuals and organizations have recently been completed and are in the publication phase of dissemination. Similarly, proactive research initiatives are underway, and funding opportunities are being assertively sought. There will be more to report on the outcomes of these in the coming months. Further delineating the ROI of physician leadership is a high priority for AAPL.
Remember, leading and creating significant positive change is our overall intent as physicians. AAPL focuses on maximizing the potential of physician-led, inter-professional 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 complexities of our industry, and we can choose to embrace the opportunities where our individual and collective energies create the beneficial value needed desperately for our industry — a transformation toward value-based care highly predicated on the ROI that has been inherent in the patient-physician relationship for centuries. Let us all keep maximizing the opportunities offered in our profession.
Through this AAPL community, we all can continue to seek deeper levels of professional and personal development, and to recognize ways we can each generate constructive influence at all levels. As physician leaders, let us become more engaged, stay engaged, and help others to become engaged. Exploring and creating the opportunities for broader levels of positive transformation in healthcare is within our reach — individually and collectively.