Moving Away from the Bedside

After completing a fellowship in adolescent medicine, Mark Werner, MD, CPE, FAAPL, spent 25 years in leadership roles related to patient care: vice president of medical affairs, chief medical officer, president and CEO of an integrated medical group, senior vice president for a health system.

Eight years ago, he surprised himself by moving to a health plan organization, where he served as chief physician executive. Two years later, he was recruited to another position that he had never envisioned for himself: national director for clinical consulting at a consulting firm. Along the way, he has become convinced that physicians need to think beyond the confines of clinical leadership for two reasons: What it means to be a physician is changing and physicians' skills and expertise are needed in many other capacities.

“I think other healthcare providers — nurse practitioners, for example — will do more and more of the actual bedside care delivery, so getting unhinged from the traditional doctor–patient encounter role is very important for physicians to do,” says Werner, a former AAPL board chair. “And those of us who want to be leaders, who have an impact on the health and wellbeing of our society, need to think more broadly about what our career options actually are.”

Those options range from the obvious sectors — pharmaceutical, health insurance, and public health, for example — to tech companies that are rooted in healthcare, such as Cerner and Epic, and those that are newer to the healthcare space.

“Microsoft, Apple, Alphabet, Amazon — they have all been hiring physicians,” says Mike Guthrie, MD, CPE, MBA, who coaches physician leaders making career transitions. “And there are hundreds of start-ups in which physicians help with the design or testing of new products and services.”

In his current role at The Chartis Group, Werner finds the same satisfaction that he found in healthcare administrative roles: working to improve healthcare at the system level instead of patient health at the individual level. He and his team work with many of the nation’s largest academic medical centers, integrated health systems, and medical groups. Projects range from developing an enterprise-wide strategic plan to targeted care-delivery initiatives, such as designing a new primary care delivery model, integrating digital health into in-person care, and evaluating the performance of a medical group.

“This gives me a chance to have even more impact by working in many organizations all at once,” he says. “Instead of helping lead one health system, I tend to work in four or five at a time.”

That bigger-picture view also lured Kyle Hoedebecke, MD, CPE, MBA, MTE, MPA, MS, FAAFP, away from practicing family medicine. After completing his military service in the U.S. Army, where he served as a physician leader for more than a decade, he joined Oscar Health as a medical director, reviewing requests for tests, procedures, and medications as well as credentialing physicians.

“That’s what I do half of the day; the other half, I work with startups as an adviser and/or angel investor,” he says. “I’m able to leverage my medical understanding and background as a family physician to help startups.”

Hoedebecke serves as an adviser or mentor to several early-stage organizations that need a clinician’s perspective to guide their development plans. One of the companies he advises, for example, is developing a technology which uses ultraviolet light to kill airborne pathogens without exposing humans to unsafe radiation. At Hoedebecke’s suggestion, the company adapted the technology for surgical suites with the goal of reducing the risk of surgery-related infections.

“Having experience as a physician allows me to give some insights that other folks, who have decades of experience in the business world, wouldn’t necessarily think of,” he says.

Albert Tzeel, MD, MHSA, CPE, FAAPL, was a pediatrician for a health maintenance organization in Arizona when he found his true calling. He accepted the HMO’s invitation to help with utilization management reviews during lunch hours and found the work to be important and intellectually stimulating.

“The more you learn, the more you realize there is a real need for folks who understand the clinical side,” says Tzeel, an AAPL board member. “There’s a lot of opportunity to really make an impact for a larger population of patients.”

In the past two decades, he has enjoyed several roles of increasing responsibility at Humana, where he currently serves as regional vice president-health services for senior products in north Florida. He leads a large team responsible for everything from individual case management and strengthening physician relationships to tackling social determinants of health at the community level.

Guthrie, meanwhile, was a consultation psychiatrist and vice president for medical affairs at a two-hospital system in Colorado before his career pivoted to the business of healthcare. He helped coordinate a three-hospital merger, oversaw the turnaround for a bankrupt health system, and worked in several positions for a large healthcare group purchasing organization. For the past 15 years, he’s been self-employed as an executive coach for senior physician leaders, faculty member for AAPL and many other organizations, and adviser for several start-ups.

In many of his leadership positions, Guthrie’s business training and skills have perhaps been more essential than the MD degree, but the combination has proved attractive to employers and provided added value.

“For example, when I was chief operating officer, I didn’t need to be an MD to do that,” he says. “But because of my medical background, I brought a unique perspective to the work and I had a sensitivity to physician issues and some other things that were helpful.”

Thriving Outside the Clinic

The physician leaders interviewed for this article agreed that a wide range of employers are looking for physicians’ medical knowledge, particularly if it is coupled with business acumen, but the success factors for a physician in medical practice may be quite different from those in other professional settings.

All physicians are smart and can quickly learn the technical aspects of other careers, Guthrie says; however physicians, including those who are very successful in their medical careers, may not have needed to develop the high degree of emotional intelligence, humility, and other leadership attributes that are essential for success outside the medical clinic.

“One of the challenges is the ability to transition from being the expert in the room because of specific clinical knowledge to being someone who works to get things done with, and through, other people as a team leader or a team member,” he says.

When Tzeel interviews job-seeking physicians, he is looking for individuals who understand teamwork. “First and foremost, it really boils down to interpersonal relations,” he says. “How well do you get along with others? Can you express yourself well? That being said, are you able to kind of keep your emotions in check? Because many times that’s a requirement.”

Physicians who blow up when things don’t go their way may be tolerated in a medical office, but that won’t fly elsewhere. “If you aren’t doing well from an interpersonal relationship perspective, that reflects on the organization,” Tzeel says. “So how people conduct themselves is very, very important.”

He wants to see passion, as in a physician who truly shares Humana’s mission of improving the health of its members, but the “captain of the ship” role that physician leaders play in a medical office may not translate to other types of organizations.

“We encourage you to use your curiosity and come up with new ideas and potentially new programs,” Tzeel says. “But one has to be amenable to working within the structure of a larger organization to get ideas vetted. Perhaps your idea has been tried before and you’re not aware of it. Or maybe it’s a great idea, but should be piloted because we’re not necessarily sure what the outcome is going to be.”

Making the Leap

Werner encounters many physicians who, having acquired a master’s degree in business or health administration, think they are ready for any position they want. “No, you’re not,” he says. “You’ve got some basic knowledge and you understand how some things work, but you’re not finished yet.”

Rather, physicians who aspire to a new type of career need to consider three areas of preparation, Guthrie advises. First, they need to know how businesses work financially. The way money flows in healthcare is different from other sectors of the economy. Success outside of patient care requires understanding how businesses identify and respond to their customers’ needs and profit from their ability to adapt and innovate in a competitive landscape.

“Then there’s a skills piece — how to be effective managers or leaders of other people — that is not taught in medical school,” Guthrie says. “After a number of years of practice, physicians are often pushed into leadership roles because they are excellent clinicians, but they are not trained to optimize their impact in an organizational setting in a systematic and intentional way.”

Acquiring that knowledge does not necessarily require a formal degree program. “The AAPL has been offering — for many years now — a sort of ‘Whitman’s Sampler’ approach to management and leadership education, which allows physicians to explore where their interests are and identify where they need more skill training,” Guthrie says.

AAPL members who have completed a four-phase curriculum — 150 CME hours — through the association or have a relevant graduate management degree are eligible to pursue the Certified Physician Executive (CPE) certificate, signifying their mastery of leadership and presentation skills. Open only to physicians who have at least one year of management experience and are board-certified in a clinical specialty with three years’ experience, the CPE capstone event is a 3½-day series of interactive exercises and presentations. CPE candidates must pass an evaluation by AAPL fellows, other CPEs, and industry leaders.

The third area is application of that knowledge and skill to gain the judgment and wisdom that comes from experience. This might come from volunteer work, leadership in a professional association, or a part-time job that facilitates the transition. For example, Hoedebecke’s position as an insurance company medical director is a work-from-home position with flexible hours. That job allows him to expand his knowledge of the healthcare business, which is useful in his entrepreneurial activities as a start-up adviser and investor.

“I start my Oscar work early so I can finish early and transition into my adviser roles,” he says.

While a master’s degree in business, health administration, or medical management might be good preparation, getting another degree is neither essential nor a guarantee of success in a new career. “I do think those degrees are valuable, but they do not replace actual job experience and actual job accomplishments,” Werner says.

Tzeel, who holds a master’s degree in health services administration, thinks much of that educational content can be obtained from pursuing the CPE credential or other AAPL programming. That said, the degree itself does confer benefits. “If you want to get involved in executive management, for better or worse, a physician is looked at more legitimately if they do have that master’s degree, so I think it’s helpful,” he says. “Is it an absolute requirement? No.”

Hoedebecke, a member of AAPL’s November 2020 Capstone cohort, views the CPE credential in a similar vein. He already held an MBA when he pursued the certification as part of his strategy to move away from bedside medicine. He values both the leadership skills and the prestige that come with the CPE designation.

“It’s quite exclusive because there have only been about 3,000 physicians ever to have earned it,” he says. “And it shows that a third party — the AAPL, which is well-respected — is vouching for me and my leadership skills. That gives me instant recognition and credibility.”

Other advice from those who have made the leap:

• Leaving a clinic or hospital position to escape burnout is not a good idea.

“A demoralized and burnt-out person who thinks that just changing the pot that they’re planted in is going to make a big difference in their life will be very disappointed,” Guthrie says.

He encourages physicians who are miserable in medical practice to address the source of unhappiness before embarking on a new career path. A new role in their current organization or a move to another organization might be very helpful; fleeing to a new field out of despair is not.

“Making a big change in their career, a real complete change of direction into an unknown territory, requires the ability to acquire new knowledge and new skills,” he says. “When you are not feeling your best is not a good time to do it.”

• The first move away from patient care doesn’t have to be a forever choice.

“There is an increasingly rich cornucopia of options for people with medical training to have a high impact on health, healthcare, public health, disease burden, you name it,” Werner says. “We need to learn how to apply our knowledge of medicine to many other things other than just bedside care delivery.”

He encourages physicians who want to move away from clinical roles to think carefully about their personal and professional goals and the kind of work environment in which they will thrive. Describe them in general terms, so that a job search might lead in unexpected directions. A few incremental moves may be needed, and that’s OK.

“Every time you make a transition, you are making a bet that you’re going to be OK,” he says. “When you take on new or different roles, the worst thing that can happen is you learn a lot and then you move on to the next thing.”