How physician leadership has evolved and where it's headed

John A. Brennan, MD, serves as president and CEO of Dallas-based Children's Health & UT Southwestern Joint Pediatric Enterprise.  

For Dr. Brennan, his leadership path — experience that has become more sought-after by those hiring C-suite roles — began during his residency at LAC+USC Medical Center in Los Angeles, when he was asked to be chief resident. 

Dr. Brennan's next major leadership role was with the 22nd Strategic Air Command at March Air Force Base. Dr. Brennan was responsible for the emergency department and the quality program for the on-base regional hospital, he told Becker's. Three years after this experience, he was recruited to be the chair of a New Jersey health system’s three emergency departments. He was then recruited to become the senior vice president of clinical affairs of an 11-hospital health system in New Jersey.

Dr. Brennan ultimately became president and CEO of Newark (N.J.) Beth Israel Medical Center and Children's Hospital of New Jersey. After nearly eight years in this position, he was recruited to be the executive vice president and chief clinical integration officer for a Georgia-based health system. After six and a half years in this position, he was recruited to be the inaugural president and CEO of Children's Health and UT Southwestern Joint Pediatric Enterprise.

"During this career trajectory, I appreciated how much leadership opportunities build on our previous leadership experiences and having mentors to share their life experiences," he said. "I also quickly understood that you needed to have additional tools to be a successful leader."

This led to Dr. Brennan obtaining a degree in public health and healthcare administration at New York City-based Columbia University.

Dr. Brennan said his background was crucial for him to better understand the day-to-day challenges clinicians have in providing clinical excellence. He added that clinicians are constant learners and always "challenging" themselves and their teams to constantly improve.   

Increased interest in physician leaders 

Dr. Brennan is among the many physician leaders serving in C-suite positions at hospitals and health systems. And although physicians in leadership posts is nothing new, the trend continues to develop as healthcare organizations face financial, staffing and operational challenges. 

For insight on how physician leadership is developing, global executive search firm WittKieffer accessed its president-level hospital/health system placement data from 2019 to present and compared it to the 2009-to-2012 time frame. One key takeaway: The firm's percentage of physician president-level placements for all types of delivery organizations has remained 14 percent. That percentage covers community hospitals, academic medical centers, regional health systems, entity presidents within systems and others. The percentage of physician leaders within academic medical centers has historically been higher than in community-based hospitals, the firm said.

Although the percentage of the firm's MD president-level placements for all types of health delivery organizations has not shifted, WittKieffer has seen in recent years more physician leaders being both sought and interviewed by clients than 10 years ago, Paul Bohne, managing partner in the firm's healthcare practice, told Becker's.

In healthcare, WittKieffer performs more than 500 executive searches annually, including about 70 CEO searches and more than 100 physician leadership searches in 2021.  

"Our data suggests that many fiduciary boards, particularly over these last few years of extenuating challenges, are often choosing CEOs with foundational experience focusing on oversight of [profit and loss], broad scale operations and other administrative and leadership responsibilities," Mr. Bohne said. "This noted, we are seeing MD leaders more frequently sought for president roles, more who are further prepared for these roles, and many who are ascending into a variety of senior leadership roles with greater focus on advancing all forms of integration, strategy and partnership formation, and where [profit and loss] responsibilities, through direct or dyad leadership, are an increasing part of role scope. Chief clinical officer roles are [also] being more broadly defined as key leaders within the C-Suite."

The most recent 2022 data provided to Becker's from consulting firm Mercer also sheds light on physician leadership trends. The latest data shows that 33 percent of CEOs of standalone hospitals have an MD, compared to 44 percent for teaching standalone hospitals (teaching hospitals not affiliated with systems). Additionally, 38 percent of CEOs of systems have an MD, compared to 37 percent for teaching systems, according to the data. This is representative of data provided from more than 1,500 U.S. healthcare organizations into Mercer's 2022 IHN Survey's Executive Module. Most of the organizations represented are hospital systems, although some are settings such as physician practices and outpatient clinics.

For comparison, Mercer reported 28 percent of CEOs of systems with an MD in 2022, compared to 30 percent for teaching systems. Twenty-six percent of CEOs of standalone hospitals had an MD in 2021, compared to 20 percent for teaching standalone hospitals. 

Christine Mackey-Ross, BSN, RN, president of AMN Healthcare Executive and Physician Leadership Search, said there appears to be more of an expectation now that physicians will be in the pool for the most senior of C-suite roles at hospitals and health systems.

This is the case "certainly in CEO positions, and roles that traditionally require kind of a clinical background," she said. Other roles she is seeing primarily occupied by physicians are chief quality officer and chief value officer. 

One position she is not seeing filled primarily with physicians: COO.

"It's hard for many [physicians] to take that COO role because it absolutely requires operational experience," Ms. Mackey-Ross said.

Additionally, chief medical officer is a role for which many healthcare organizations have hired physicians.  

In fact, due to the increased demand for physician leadership in the C-Suite, the Association of American Medical Colleges has developed the Chief Medical Officers Leadership Academy, a career development program. It is open to newly appointed CMOs as well as senior physician leaders preparing to assume the CMO role in the coming years.  

Moving into 2023 and beyond

No matter the role a physician is in, the challenges facing hospitals and health systems are well documented. Kaufman Hall's November "National Hospital Flash Report" — based on data from more than 900 hospitals — showed 2022 has been an especially difficult year financially. Hospitals' median operating margin was negative-0.5 percent through October. Hospitals also continue to face workforce shortages and the "tridemic" of flu, COVID-19 and respiratory syncytial virus.

Amid these and other challenges, it is unclear how trends in physician leadership will develop into 2023 and beyond. 

"We are in [a] challenging time now for healthcare and are likely to be for the foreseeable future based on the economy, based on changes in patient purchasing behavior, change in health plans," Ms. Mackey-Ross said. "And I'm curious as to whether [hospital] boards will go for … a person who has a traditional background, whereas [previously] they might have taken a chance on physician leadership."

She also said she believes healthcare's focus in 2023 will be on "some really bread and butter operational tightening and performance improvement," and that, overall, "all bets are off with what has been normative before, because we're just entering a strange new time."

From Dr. Brennan's perspective, hospitals with leaders who — whether they are a physician or not — understand clinical care and where healthcare is headed five years from now are in the best position moving forward. 

He said perhaps a famous line from ice hockey star Wayne Gretzky says it best: "I skate to where the puck is going, not where it has been." 

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