Pathway to Chief Medical Officer – Insights from Rex Hoffman, MD, author of I Want to Be a Chief Medical Officer: Now What?

If you have ever thought about becoming a Chief Medical Officer (CMO), today's episode is for you. From preparing for the position to surveying hiring executives, my guest has analyzed each and every aspect of becoming a CMO. Here is your roadmap to becoming a Chief Medical Officer next on SoundPractice.

This transcript of their discussion has been edited for clarity and length.

Michael Sacopulos: My guest today is Rex Hoffman, MD, MBA, FACHE, CPE. Hoffman is a physician and the author of the book I Want to Be a Chief Medical Officer, Now What? The book is published by the American Association for Physician Leadership. Rex Hoffman, welcome to SoundPractice.

Rex Hoffman, MD, MBA, FACHE, CPE: Thank you, Mike. Great to be here.

Sacopulos: Oh, it is our absolute pleasure to have you today. Before we dive into the book, which is great, I am interested to know a little bit about your career path. Can you tell us how you came to today?

Hoffman: Yes, thank you for the question. My father was an interventional radiologist, and I was always very fascinated with what he did day-to-day in his job, and my uncle was a medical oncologist, and I liked parts of both specialties and ultimately became a radiation oncologist melding the two together. I practiced that for about 18 years. During the second half of my career in that role, I started taking on more and more administrative roles, was involved in overseeing all of radiation oncology for Providence Health System. Ultimately became the co-chair of the Cancer Institute for Providence Health System. And during that journey, I was involved in negotiations for some expensive equipment. During those negotiations, I realized my Achilles heel was a lack of business knowledge when it came to medicine and decided to get an MBA at Kelly School of Business in Indianapolis, Indiana, which I was proud and happy to take part in.

While there, one of my classmates was a Chief Medical Officer, and at the time, I'll be honest with you, I didn't know much about what they did, but each time I went back to Indianapolis for 21 months, I was glued to my conversations with him, really fascinated with how he spent his day-to-day job, learning about strategic planning for the hospital, learning about managing length of stay or disruptive physician behavior, and ultimately decided I wanted to become Chief Medical Officer. The question was what do I do at that point? I did not really have any guidance, and so part of the reason for putting this book together was really to help other aspiring doctors who want to be CMOs with a guidebook on how to get there and what to do.

Sacopulos: Well, that certainly makes you a physician leader to do such a thing. Is this your first book?

Hoffman: This is my first book, yes. I did contribute to another book with Mark Olszyk and Aaron Dupree, Chief Medical Officers on the Chief Medical Officer's Essential Guidebook last year when I was a co-author on that one, but this is the first book that I've actually been the main author on.

Sacopulos: Well, that is certainly also a great book, but yours seems to me to need to come first. We must get people into that position before we guide them on what to do with it and people just tune in. Again, the name of the book is I Want to Be a Chief Medical Officer, Now What? Why don't we talk a little bit about the format of the book? How did you lay it out?

Hoffman: I created five parts over 180 pages. Part one is do I really want to be a CMO, for people that really do not understand what the job is about. The introduction is about my personal journey on becoming a CMO. The first chapter is, what is a Chief Medical Officer? What are some of the roles and responsibilities when you are one, such as case management, credentialing, managing disruptive behavior in terms of physician performance evaluation, physician compensation, managing medical directorships or professional service agreements, physician well-being and quality assurance, some of the things that they deal with day-to-day activities. And then the next chapter really goes into whether it is time to transition or be a CMO? It is a big decision to leave your clinical practice, and do I have the necessary experience? Is the organization ready for a CMO? Am I ready to leave clinical medicine? Is my family ready to leave clinical medicine, and am I ready to lead? Some of the things that you really need to take to heart when you are trying to make that important decision.

Part two of this book is feedback from some chief executives and others involved in the hiring process of CMOs. What we did was we sent out a 10-question survey to 10 chief executives, three health system chief medical officers, and two regional chief medical officers looking at different aspects of what they look for, such as what is the importance of experience? Is it important that I am a medical staff chief of staff? Is it important that I served on the medical executive committee? Is it important that I served on the utilization management committee or the quality management committee or credentials committee? Is it important that I was a medical director?

We then asked them questions about degrees and different credentials. What about being an MBA? Does that carry value? An MHA? An MPH? An MMM? Or the AAPL CPE certified physician executive, what is their value in that? Or a JD or PhD? And then we also queried them. What were some characteristics they looked for in potential applicants for a CMO job? What was important? And some of those that rose to the top were being articulate, compassionate, honest, influential, and having integrity. It also mentioned several that we want to avoid displaying when we are a CMO candidate, and I will leave the book to you to learn what those are.

Part three went into applying for the job itself, where to find a CMO job, identifying the geography, launching a search, partnering with an executive search firm. Then we went into questions on how to assess a specific CMO job, dissecting the job description and necessary qualifications, researching the hospital or health system in detail or considering compensation or work-life balance. Then we talked about how to prepare your resume for a CMO job, the format and design, the branding statement, and what is an executive summary, and then how do you interview for a job, how to prepare, what to wear, some of the pitfalls that you want to avoid.

Part four went into some advice from people that held different types of CMO jobs, hospital. You look at hospital operations, quality metrics, case management. As a CMO of a medical group, you are really managing personnel or quality safety metrics or business management, or the CMO of a health plan where you deal with strategic thinking, policy development or provider engagement. Or the CMO of a health system where you are looking to innovate at scale and leading by example.

And then the last part of the book, part five, is now you have gotten into that role as CMO. What are the things you really need to tackle from the get-go? And one is the first 90 days as a CMO, how do you get to know your key stakeholders? You should walk the halls, learn organizational details, and make a plan for being successful during your first 90 days. And then the last chapter in the book talks about the importance of mentorship. What is a mentor? What is mentoring, and what are some of the benefits of having a mentor? So that is really a layout of the book, chapter by chapter really some of the key things that we felt were important for anyone that was aspiring to become a CMO.

Sacopulos: I am glad you went through it in detail because I think the audience can tell just how thoughtful you were in putting together this book. Let us just circle back to I think it was point number five with mentor. Do you mentor others, and do you find that fulfilling?

Hoffman: First, I have had a few mentors in my life which I really felt have been key to my success and my growth professionally, and I have mentored others. Currently, I am mentoring five physicians at the hospital I work at. Also, recently at the AAPL Conference in Nashville, I was mentoring a few docs. They would come up to my table, and I'd give them some advice, look over their resume, give them some advice on how to grow both personally and professionally, and feel that this is so essential for anyone that wants to be successful, whether becoming a CMO, a CEO, whatever they may want to aspire to.

Sacopulos: You did something smart in putting together this book in that you created a survey to generate some really, I think, interesting data. Can you talk a little bit more about your thoughts and why you went down the survey route?

Hoffman: Thanks, Mike, for that question. This is a big part of the book and really wanted to get into the minds and thoughts of those hiring CMOs. After all, these are the people we need to appeal to when we are looking for such a job. And by serving them, the reader really gets an inside scoop as to what they feel is important. There are many myths out there, but this really gives you the reality of what the important things they are looking for. And I felt this would be valuable information for these doctors aspiring to become a CMO to know ahead of time and to improve their chances of landing a job.

Sacopulos: So, in the survey, were there any results that were surprising to you?

Hoffman: There definitely were, and there are myths out there. One big myth out there is that you really need to be a chief of staff if you want to become a Chief Medical Officer. Well, our surveys show that this is not as essential as many may think. Also, many people think it is nice to be part of the medical executive committee. However, this too was not felt to be as important to CEs and Chief Medical Officers during the hiring. Instead, what they found were serving on specific committees within the hospital, and the book really spells out which specific committees one should look at joining to get that benefit.

Sacopulos: Does it vary based on the type of institution that you want to be CMO of? For example, would the hiring process or things valued in selecting a CMO for say a health plan vary from a health system or a hospital?

Hoffman: The first piece of advice I would give anyone wanting to become a CMO of a health plan or a CMO of a medical group or a CMO of a health system as compared to a hospital’s is to get to know a CMO in one of those roles. They can give you guidance. They can really lead you down the road on your journey to become one of those types of CMOs. So, for example, for a health plan, you want to learn about policy development and strategic thinking, things that you would not necessarily be as involved with necessarily if you were at a hospital. For a hospital instead you want to learn about case management and be on committees about that. For a health system, it is usually larger scale. You want to look at being exposed to managing multiple CMOs or multiple physicians across a large landscape. So really it depends on the type of CMO you want to be, and that's why we created separate chapters for each one of those, from people that have successfully made that transition to one of those CMO jobs, whether a hospital health system, health plan, or medical group.

Sacopulos: If you had had this book available to you before you were a CMO, would you have proceeded differently? Sometimes people say that they clear the minefield by using the map, and sometimes they clear the minefield by just walking through it. What would this book have done to alter your path?

Hoffman: I think that I would have definitely jumped and served on several committees earlier and really broadened my knowledge as a radiation oncologist who's dealing more with a very closed network in the hospital and didn't have a lot of exposure to length of stay, readmissions, quality metrics, which are so important if you want to be a hospital CMO. By learning which committees to join and getting some exposure to that information and mastering those subjects, you make yourself much more primed to be taken on as a CMO seriously.

So, I would have served on several committees earlier in my career. I think also as I mentioned a second ago, I really should have been more proactive in reaching out to my CMO to learn more about what he did on a daily basis so I could really get a better understanding of what it was like to be an administrator. And that goes back to if you want to be CMO of a health plan or a CMO of a medical group, really taking that proactive step and really reaching out to them, showing interest. They most surely will take you up on it and will be excited to really share their knowledge with someone that is aspiring to be in their role eventually.

Sacopulos: When you moved into the role of CMO, were there parts of the job that surprised you?

Hoffman: I was fortunate. There was not much that surprised me. I had done exactly what I just mentioned, I was very proactive in meeting several CMOs beforehand, learned about the job and what was involved, and had a CEO that hired me as a CMO that had been the prior CMO to me or two prior CMOs to me. And so, he was a mentor and really guided me early on in terms of what to expect from the get-go. So that really helped a lot as well. So that is another important thing where you are looking to be a CMO. Will you take a close look at who your boss is going to be? Are they really setting you up for success, and are they going to help roll out the red carpet for you, which I have been fortunate to have been a recipient of?

Sacopulos: Our time's about up, and the book is fabulous, but if there is anyone who is still on the fence, one, they shouldn't be. But I am going to let you tell people if they are trying to decide whether to purchase this book, why they should do so.

Hoffman: Thanks, Mike. And if anyone wants to be a CMO of a hospital, medical group, health plan, or health system, this book is really for you. Being as competitive as it is out there to land one of these roles, why not give yourself a leg up on the competition by learning what is important to CEs and CMOs hiring these particular CMOs in terms of experience, credentials, and personal characteristics?

Sacopulos: Solid advice. My guest has been Rex Hoffman. Dr. Hoffman, thank you so much for being on SoundPractice.

Hoffman: Thank you, Mike. I really appreciate being here.

Sacopulos: My thanks to Rex Hoffman for his time and insights. His book, I Want to Be a Chief Medical Officer, Now What? is a must read for any aspiring CMO. My thanks also to the American Association for Physician Leadership for making this podcast possible. Please join me next time on SoundPractice. We release a new episode every other Wednesday.

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