Empowering physicians to lead: the benefits of physician leadership [PODCAST]

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In this episode, we are joined by Peter Angood, MD, CEO and president, American Association for Physician Leadership (AAPL). We explore the increasing value of physician leadership in health care and dive into the findings of a recent white paper produced by the AAPL. Discover why physician leadership has become essential for health care’s continued improvement in quality, safety, efficiency, and the transition to value-based medicine. Learn about the growing demand for physician leadership in the health care industry and the marked increase in hospitals and health systems seeking physician candidates for CEO positions. Hear why having medical colleagues in leadership positions helps to ensure a focus on patient care and why physician leaders are more trusted and effective change-agents in health care. Join us for a fascinating discussion on the importance of physician leadership in health care.

Peter Angood is CEO and president, American Association for Physician Leadership.

He shares his story and discusses his KevinMD article, “Why physician-led health care leads to quality patient care.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today we welcome back on the show Peter Angood. He is CEO and president of the American Association for Physician Leadership. He’s the author of the book All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Health Care. We’re going to talk about a new white paper from the AAPL on the evolution of physician leadership. Peter, welcome back to the show.

Peter Angood: Thank you so much. It’s great to be back with you as well.

Kevin Pho: So we’ll talk about this new white paper and your book in a little bit, but first off, for those who didn’t listen to our first episode together, just briefly share your story and journey to where you are today.

Peter Angood: Sure, sure. Well, as you say, I’m the president and CEO for the American Association for Physician Leadership. It’s an organization that’s almost 50 years old, but I’ve been in this role a little over 10 years now.

I got here through a clinical path. I trained up in the whole realm of trauma surgery and surgical critical care, and like many of us, I got into that mid-career phase of life and was sort of saying, “Well, do I really want to keep doing that?” I had started to think more about systems and larger-scale change, and I was very fortunate. I got to shift over out of clinical care and was the first chief patient safety officer at the Joint Commission. We did a lot of national and international work, most notably with the World Health Organization.

After that, I shifted over to the National Quality Forum and got interested in the measurement side of life. I had a very brief stint with GE Healthcare and ran their patient safety organization, but I found myself thinking more and more about leadership, and I really wanted to get into that gap zone. With the Joint Commission, NQF, etc., I recognized it’s all fine to be doing policy development and implementation, but there’s a gap to what’s going on in the front line.

This organization, AAPL, really functions in that arena. We’ve got good connections to organized health care and the policy world and all that type of thing, but we are clearly impacting the front line of health care as well. We’ve trained physicians to be better leaders and managers. It helps them with their own personal lives, it helps them with their institutions, and ultimately it really helps with improving patient care and the delivery of better-quality patient care. So it’s been a privileged journey so far.

Kevin Pho: So when you say that you train physicians to be better leaders, from your experience in this field, what prevents physicians, or what do they need to learn in order to be better leaders?

Peter Angood: Well, you know, it’s fascinating, isn’t it? You go to your dentist, you go to your veterinarian for your pet care and all that stuff, and it’s obvious those people have had some exposure to management and leadership and how to run a practice and all that. And then reflect back on your own medical training or residency. You got none of that, right? No management, no insights into business, nothing on leadership. And yet, through the nature of our business, we’re viewed as leaders. Even if you’re running a sole rural practice, the people in your environment are looking to you to be a leader.

And so I take on the philosophy that at some level, since our society views the medical profession as a lead profession that’s well trusted, all physicians are leaders at some level. It doesn’t matter if you’re in a formal titled role or not. We don’t get any of that through our training. Some of us, by default, just because of the personalities we are, will gravitate into strong leadership roles and pursue careers in that path. Then there are others who may have the aspirations, but they need a little bit of extra training, extra exposure, and extra experience before they can get more comfortable and more confident in their own capabilities.

And then there’s that whole group of docs who are perfectly fine; they just want to look after patients. But even in just looking after patients, they are still viewed as a leader in that environment. So how do you assume that role more comfortably and help others in the team function better as you look after patient care? We’re all involved. We just have never been exposed to how to do it better.

Kevin Pho: All right, so let’s talk about the new white paper from the American Association for Physician Leadership. It talks about the evolution of the physician leader. So give us the high points of the white paper.

Peter Angood: Yeah, you know, building off of my last comment, the industry still relies heavily on physicians as the dominant driver of the delivery of health care, and that patient-physician relationship is still kind of sacrosanct in the industry, right? Yes, we’ve got nurses, pharmacists, PAs, and NPs, and they’re all very important, but that dominant driver is the patient-physician relationship.

And so prior to managed care, it was always kind of assumed that physicians were the most influential in terms of setting the trends and the directions for the industry. As the payer community of all types, government included, became more involved, as the models of managed care evolved, and as we’re now struggling to try to shift to value-based care, it continues to be evident that physicians are more and more looked to for direction and insights on how we provide better care: higher quality, safer, more efficient, and value-based these days.

And I use the example, you know, we’re well past the 20-year mark now of the To Err Is Human report that talked about safety, and yet there were some recent stats that just came out that showed we really haven’t made significant change in safety and quality. And I posit that a lot of that is because we’re still caught up in how to shift our systems and our processes, and we haven’t looked critically at the clinician side of it in terms of how we deliver all of that stuff better.

So the evolution, to answer your question, is that I think physicians need to be in stronger leadership roles. They need to be given the credibility for being leaders. And I think institutions, whether it’s a practice, a hospital, a health delivery system, or post-acute care, all need to recognize that physicians have this capability to not only improve the quality and delivery of care, but to also lead the teams and the administrative stuff in order to make that all occur better. So that’s the evolution of it.

We are a horribly complex industry, arguably the most complex industry out there, and the added benefit of a well-trained clinician who’s got that added training and experience in leadership and management, that coupling together is unprecedented in other elements of our industry. So let’s leverage it. Let’s leverage that value of physician leadership to change the industry.

Kevin Pho: So next steps: How do we do that? Should physicians themselves rise up and proactively take those roles, or is it up to the medical institutions, with the onus on them to hire more physicians in those roles?

Peter Angood: You know, I think it’s both, Kevin. I think it’s both. Depending on which numbers you look at, roughly half, plus or minus, of physicians are employed at some level now, right? And so they’re in environments where there’s an expectation that they comply with organizational mandates and comply with organizational direction. And yet many, many of those organizations are looking for how to better engage the physicians and how to integrate them better into the systems and processes, and therefore there’s a natural evolution: Well, how do we then help the physicians become more involved as leaders? There’s an increasing percentage of delivery systems that want their institution to have a physician as the CEO, and so institutionally there’s an obligation to really facilitate physician leadership.

Now, physicians, as we said a moment ago, don’t get any of this exposure inside of our training. If we’re lucky, we’ve gotten some mentors who have helped us kind of develop some of this, but more often than not, physicians need to recognize they need to proactively seek out the experiences. Sometimes they need added education or added credentials to really acquire that set of skills and fit really nicely as successful leaders. So it’s both the institutions and the physicians themselves.

Now, the other half of the docs, who aren’t employed, are still trying to run practices that work better, right? The finances are tough, the staffing is tough, and patient demands are critical, all of those things. So again, it’s not enough just to have your clinical acumen in terms of disease management. How do you help physicians run a better practice, work with their interprofessional teams, and provide better service delivery to their patients? And then they’ve got to deal with the bureaucracy of billing and administration, and with which other external entities they have to work with in their practice, whether it’s the radiology services or the lab services, etc.

So there’s a pressure at all levels: individual, institutional, and, you know, the last one is the patients. The patients still want docs to be in charge of their care. They want to be able to trust their physicians and their physician practice, and to know that that practice or that physician is helping to lead them through the care delivery that’s required. So it’s multifaceted, Kevin. It’s multifaceted.

Kevin Pho: One of the things that you mentioned earlier is that sometimes physicians would need those added educational credentials in order to seek these leadership roles. So I assume we’re talking about things like an MBA. How essential is that MBA for physicians to be physician leaders? Is it necessary? Is it required?

Peter Angood: It’s a common question, and it’s an important question. You know, the larger systems out there that are higher performing, when they’re looking at physicians who are kind of tracking in a leadership role, very commonly they’re asking for those physicians to have some type of added education and a credential of higher learning, if you will, and most often that’s a master’s degree of some sort.

Now, that obviously takes added time, energy, effort, and finances for physicians to get there. Some institutions will bring physicians in and facilitate them acquiring those advanced degrees, but more often the onus is on the individual to seek out some kind of advanced degree. Now, it doesn’t have to be an MBA. Can it be an MHA? Can it be an MMM? Can it be an MPH? Yeah, it’s kind of any one, because what is being demonstrated there is a commitment to understand the industry better, beyond just an MD.

Obviously, we have a variety of things, so, you know, I need to sort of talk about our stuff. We’ve got a competency-based curriculum that takes people through to achieve our credential, which is the Certified Physician Executive. That doesn’t compete with master’s programs, but it’s very complementary to master’s programs. In fact, oftentimes those folks who have had a master’s degree and then come through and do our CPE credential will say, “Gosh, if I’d known about this one first, I would have done this one instead of a master’s.”

And the point is not to toot our horn, but the master’s types of advanced degrees are often more theoretical. So if you are seeking these kinds of roles, yeah, you need an added credential in those higher-performing places, but the kind of credential we offer is much more hands-on and much more relevant to how to implement and change systems and processes in the industry.

But separate from an advanced degree, Kevin, it’s gaining the experience over time as well: committee work, product line administration, looking after a department or a division, etc. For many institutions, that carries as much weight as the advanced credential. You know, you can have somebody show up with their freshly minted master’s degree, but if they’ve never actually run things, they might be a disaster. They might be a disaster. So it’s a combination of both: increased experience and, to some degree, added education.

Is that a mandate for all places? No, no. You and I both know there are docs out there who haven’t got any extra advanced education or credentials, and they’re performing at very high levels as leaders, and, you know, good for them. Some people can do that.

Kevin Pho: One of the sections in the white paper is what makes a great physician leader. From the various interviews that are there, and from your own experience, what are the characteristics that make a great physician leader?

Peter Angood: Yeah, you know, it’s a real constellation of things, and we’ve got a variety of competencies that we embrace as we try to develop our educational programs and our information resources. But at the end of the day, you’ve got to be a confident and well-experienced clinician who knows how to deliver patient care. But then, separate from that, you’ve got to have developed a sense of self-awareness that you’re not just the boss who mandates things, or who expects to just give the orders and then everybody pays attention to you and has to go do it, right?

So it’s learning how to work with others, and learning how to leverage the benefits of what others have as their professional backgrounds, their professional expertise, and their own talents. So interpersonal skills are essential. A degree of humility is making, I think, a stronger presence in all leadership literature these days. And when you combine those clinical skills with strong interpersonal skills and kind of a team-based approach, that’s what’s making good, strong leaders.

Now, behind that, you’ve got to have some managerial technical knowledge as well. You’ve got to understand finances, you’ve got to understand project management, you’ve got to understand efficiency, even a component of HR practices, you know, depending on what kind of environment you’re in. But the biggest piece is that interpersonal piece and how you really leverage that for yourself, because people are already looking to you because you’ve got that clinical background. So don’t lose the moment of being an intuitively natural leader by being a jerk.

Kevin Pho: We’re talking to Peter Angood. He’s the CEO and president of the American Association for Physician Leadership. He’s the author of the book All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Health Care. Peter, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Peter Angood: Yeah, again, thanks, Kevin, for the opportunity. I think the take-home messages are, one, health care is an exceedingly complex industry. Two, physicians are viewed as natural leaders in our industry; the patient-physician relationship is sacrosanct. And then three, leverage the role that you already have to help create the larger-scale change in health care. Depending on your environment, if you need some additional expertise, experience, or education, look for ways to get that, and then don’t hesitate to try and create the change that’s so very much needed in this industry, because the patients and the families need it, and we all need it. Workforce wellness is a separate topic, we know that, but if we can all embrace our leadership, we’ll get to a better workforce wellness profile as well.

Kevin Pho: Peter, thank you so much for sharing your time and insight. Thanks again for coming back on the show.

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