Viewpoint: The trouble with C-suite 'DINOS'

At the top of a recent LinkedIn article is a cartoon: An ominous T-rex in a white coat looms over two physicians. "We're from the C-suite," the title reads, "and we're here to help." 

Executive DINOs — shorthand for "doctors in name only" — tend to garner resentment from front-line staff, according to the article's authors, Graham Walker, MD, assistant physician in chief at the Permanente Medical Group in Oakland, Calif., and Matthew Sakumoto, MD, a primary care physician and chief medical information officer at Sacramento, Calif.-based Sutter Health's West Bay Region. 

The MD and DO executives that impose new policies on clinicians may be well-intentioned, but despite their medical degrees, they are too far removed from patient care to understand the implications of their decisions, the authors argue. Oftentimes, C-suite leaders are too bogged down with administrative work to continue seeing patients, and those who do might take easier cases; as a result, they rarely have to carry out their own ideas. 

"No email brings greater fear to a department chief than one suggesting a new workflow," the authors wrote. "'We met [without you] and have some ideas on how you can help us with [performance goal, quality metric, patient satisfier, other-under-staffed department]. We need to tell your nurses/doctors /MAs/pharmacists/housekeepers to [put this magical phrase in your note/give this medicine/write this order/do or do not use this diagnosis].'"

There is no better way for clinician executives to gain their colleagues' trust than to step out of the ivory tower and back into the patient care room, the authors say, posing the question: "What would renting be like if your landlord had to live in the same house as you?" 

They also suggest a few guidelines surrounding good, fair physician leadership, including term limits or reassessments; role turnover expectations; allowing departments to have a say in who their leaders are; interdisciplinary collaboration; and clinical minimums. 

"Like everything in clinical medicine, physician administrative leadership is also a Goldilocks problem," the authors wrote. "We need physician leadership and voices in healthcare. But we also need physicians doing the work. While caps on terms or administrative time may slow the speed of change, it may actually enhance the change since your leaders are respected and trusted and aren't being resisted, questioned, and challenged with every suggestion."

Read the full piece here

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