NEJM: Leading Clinicians and Clinicians Leading

Last month, the New England Journal of Medicine published a perspective article on leadership titled, "Leading Clinicians and Clinicians Leading."

Richard M.J. Bohmer, M.B., Ch.B., M.P.H. writes "Better organizational performance improves health outcomes, and clinical leadership affects performance. Calls for leadership are common, but the specifics of which clinicians need to do what remain unclear."

He then goes into saying " Leaders create conditions that enable and encourage others to achieve a shared goal through collective action — a challenge in health care, since most clinicians were schooled as individualists, don't necessarily view the goal as shared, and generally feel more accountable to professional bodies than local hierarchies."

He describes 4 key tasks that front-line clinicians leading local systems must achieve in order to be effective leaders. Read the full article here.

Richard Bohmer, MBChB, MPH, is a New Zealand trained physician on the faculty of Harvard Business School. He graduated from the Auckland University School of Medicine and has practiced hospital and primary medicine in New Zealand and England. In 1989 he was part of a clinical team that established and ran a surgical hospital in Sudan. He attended the Harvard School of Public Health on a Fulbright Scholarship, graduating in 1993 with a Masters of Public Health in Health Care Management, and joined the HBS faculty in 1997.

The Emergence of "Health" as the Business of Health Care

A few months ago, the New England Journal of Medicine published a perspective article titled, "What Business Are We In? The Emergence of Health as the Business of Health Care."

The authors end their editorial with this paragraph:

In the future, successful doctors, hospitals, and health systems will shift their activities from delivering health services within their walls toward a broader range of approaches that deliver health. Although we're seeing the earliest steps in this shift toward accountability for health, we currently lack both good tools for moving forward in any substantial way and more established pathways for redirecting financing toward those outcomes. What do we need to move from a product-oriented industry to a customer-oriented one?

Asch DA, Volpp KG. What business are we in? The emergence of health as the business of health care. N Engl J Med. 2012 Sep 6;367(10):888-9.  

NEJM: Physician Executive Career Options Abound

There's an article in the NEJM Career Center titled, "Physician Executive Career Options Abound."

This article highlights some of the "demand for health care leaders with clinical experience and the desire to facilitate systemic change." The author starts by summarizing comments from Barry Silbaugh, MD, former CEO of the of the American College of Physician Executives (ACPE).

Here's the bottom line:

• Management roles are increasing in the health care industry because of health care reform, health IT integration, need for value-based care, evolving care models like ACOs and PCMH, etc.
• Career paths in medical management can be very diverse. 
• Physicians from almost any specialty can find a role in medical management.
• Having formal education in management is very beneficial (but not necessarily essential, as long as you can demonstrate competency in areas like accounting, finance, organizational development, etc.).
• A career in medical management is not for everyone. So, make sure you know what you're getting yourself into.

Interested in a career in medical management? I'd strongly recommend the American College of Physicians Executives (ACPE) as a professional resource and membership organization: www.acpe.org

Volunteering your way to a non-clinical career

There are a number of volunteering opportunities that can help you transition into a non-clinical career. For instance, you may wish to volunteer internationally through an organization like the Peace Corps. Before you know it, you may find yourself working as a medical officer, making administrative decisions in the world of medical management and networking with executives who have built careers in the non-profit sector. You may also find it easier to transition into public health jobs with the CDC or WHO if you have strong international health experience and exposure.

You can also volunteer your time by serving on councils and committees that may allow you gain the skills and leadership experience to break into a non-clinical career. Right now, a prime example is around the world of health information technology. Your hospital or group practice may have an informatics committee evaluating health IT resources, clinical workflow challenges, etc. By actively participating in your hospital IT committee, you may have the opportunity to establish industry contacts and understand some of the key issues that affect hospitals as they make decisions around electronic health records and computerized physician order entry systems.

So, do you have some time to volunteer? There may be some great opportunities to work in a free clinic and to get involved in your local community. While you're providing medical care to the underserved, you may get inspired to become a social entrepreneur.

Here's a link to a New England Journal of Medicine career article on physician volunteering. At the end of the article, they list a series of physician resources for those who want to spend some time volunteering.

Part-Time (and Flex-Time) Physician Practice on the Rise

There's a great article in the New England Journal of Medicine (NEJM) titled, "Part-Time Physician Practice on the Rise." More physicians are recognizing the importance of balancing work and family life. As a result, there's a growing phenomenon of physicians choosing to work part-time. Given that many full-time physicians are working over 40 hrs/week (more like 60+ hrs), those working part-time are working 35 hrs/week and taking regular call.

I know many physicians who have established a blended career model where they spend very little time in clinical practice and they spend a greater amount of time in some type of non-clinical career.

Are you looking for ways to spend more time with your family? Perhaps you're getting burned out and you don't want to work 60+ hours in the clinical setting. Pursuing a part-time practice could be a great option if you're able to find a hospital or group practice that is open to the idea of employing you as a part-time physician. Then again, maybe it's time to significantly reduce your clinical responsibilities and find non-clinical sources of income generation. There's also the idea of job sharing. This is also seen in the corporate setting where two women who are raising a family may share a single job and divide the roles/responsibilities during the week. If you want to share a clinical job, you'll need to find a "partner" who's willing to share the workload with you.

Click here to read the article in the NEJM.

Physician Employment Contracts

What do you need to know about physician employment contracts? In the world of clinical medicine, you may be used to working with attorneys who will review your employment contracts and even negotiate on your behalf. Does that happen in the corporate world? Yes and No. It depends.

It really depends on the type of position you're pursuing. If you're breaking out of medicine into a brand new industry, you may be applying for the same types of positions that are often filled by PharmDs and PhDs. Just because you have an MD or DO doesn't guarantee that you'll be a stronger candidate or that you'll earn more money. I don't think you should expect to see very complex employment contracts in these types of jobs. On the other hand, if you're pursuing jobs in medical management or in senior management positions, then your roles/responsibilities could involve many different elements and you'll probably want an attorney to review your employment contract.

Speaking of employment contracts, if you're new to medicine, you may want to visit the NEJM Career Center and learn about physician employment contracts.

Blumenthal and HITECH in the NEJM

If you get the New England Journal of Medicine (NEJM), you may have seen David Blumenthal's article about Health IT (or HITECH) in the April 9, 2009 edition. It's a Perspective titled, "Simulating the Adoption of Health Information Technology." If you have any interest in health IT, then you should read this article. It's a short article - just a few pages long.