As health systems push deeper into the ambulatory setting, many are assembling medical groups at a scale and speed that tempts leaders to run everything from headquarters.
Sean Tedjarati, MD, sees it differently. As executive vice president, chief physician ambulatory officer and CMO of the medical groups at Valhalla, N.Y.-based Westchester Medical Center Health Network, he oversees roughly 1,100 to 1,200 academic and community practitioners across the system’s hospitals. In his view, physicians who believe their work is being directed from a distant center don’t buy in.
The network does need a single identity, Dr. Tedjarati told Becker’s. A shared identity, mission and a patient experience that feels consistent across sites of care is what solidifies alignment, rather than centralized operations.
That “oneness” can’t come at the expense of local authority, he said.
“If [physicians] feel that it is being centrally driven by the, for lack of better terms, ‘mothership’, then there is no buy-in,” Dr. Tedjarati said. “But irrespective of where the patient comes in, she or he, or the patient’s family, are always in the right bus. They’re always at the right station.”
Below that shared mission, local circumstances must drive the details. Some of the communities WMCHealth serves are rural and face access challenges that call for different recruitment strategies and models of care than the system’s academic hub.
“So, the leaders that you have locally have to be able to make decisions that are pertinent locally,” he said. “Their compensation may be different. Their milieu of the offices will be different. The way they care for the patients will be different. You have to give a level of agility to the local leaders to be able to make decisions without feeling that everything they do has to be cleared by central.”
That is a significant shift for an organization built around centralization. WMCHealth receives about 15,000 transfers a year, which Dr. Tedjarati said is among the highest volumes in the country, and has historically operated with an inpatient-centric mix close to 80/20. The medical group is now working toward something closer to 50/50 or 60/40 ambulatory, while also moving from Cerner to Epic and optimizing its templates and call center.
“It’s a huge shift in mindset of the organization and also the type of people that you’re recruiting,” he said.
Recruitment illustrates why a single central playbook falls short. Physician markets now vary sharply by specialty, Dr. Tedjarati said. Radiology has been reshaped by remote work and new technology, a change he said the COVID-19 pandemic accelerated, and cardiology is going through its own transformation. National benchmarks don’t always keep pace with where those markets actually are, and leaders have to be agile enough to know exactly who they are speaking to. Generational expectations around lifestyle and time at home mean candidates no longer respond to the same pitch.
“You could have talked to an academic oncologist 10 years ago or 15 years ago, almost with the same script,” Dr. Tedjarati said. “But [now] people are looking for different things, and I think there is a generational shift as well, where people are coming into medicine with different expectations.”
The same logic applies to compensation, which the medical group is rebuilding now. National benchmarks from sources such as MGMA set a starting point, he said, but they aren’t one-size-fits-all. Packages should combine a level of security with some “skin in the game” on productivity, backed by the organization’s commitment to give physicians the environment to be productive, from OR access to outpatient efficiency, along with real quality and patient satisfaction measures. Transparency holds the model together — physicians should be able to see their own data and benchmarks on a day-to-day basis.
“I think people do well when they know where they’re starting and where they’re going, and that if they happen to be more productive and more efficient, maintaining the quality that is required, then they should be appropriately rewarded and compensated,” Dr. Tedjarati said.
The balance, he added, is making sure physicians never come to feel like a cog in a wheel, and that the organization still values what they bring beyond productivity, including research, teaching and leadership roles within residency programs.
Handing real authority to local leaders requires a culture change that can’t be rushed.
“So there is a decentralization. There is an empowerment of the leadership at the local level, and it really requires a cultural change and transformation that, quite frankly, just comes in with time,” Dr. Tedjarati said.
Time alone isn’t enough, though. System leaders have to be visible and communicate constantly, he said, while staying out of the way of local decisions.
“It comes in with overtly communicating, overtly being present and making sure that you’re not clogging up decision making locally based on what your perceived central view of them is, because the local folks that are closer to the problem will always know it better,” he said.
Dr. Tedjarati’s own path shapes that view. A gynecologic oncologist who trained at Houston-based University of Texas MD Anderson Cancer Center, he joined WMCHealth around 2009 to build its gynecologic oncology program from the ground up, later serving as chair of obstetrics and gynecology. He still operates and treats patients, which he said gives him credibility with department chairs who need a partner that understands their day-to-day work. But he is candid that no single vantage point covers the entire medical group.
“I can speak the lingo of my own department and specialty very easily,” he said. “But when you’re dealing with departments across, now you have to deal with ENT. Now you have to deal with ortho. Now you have to deal with internal medicine, hospitalists.”
That gap is why Dr. Tedjarati sees leadership development as the long-term answer to alignment. A strong clinical reputation, years of experience or a long publication record don’t automatically make someone a leader, he said. Physicians need to understand systems operations and see themselves as part of how the organization runs, rather than on one side of an adversarial divide.
“I think that chasm and that divide between clinicians and administrators has to be bridged, and that really requires physician leaders to do this type of work,” he said.
That, he said, is the reason he took on the role.
“Otherwise, the easiest place for me is in the operating room and taking care of patients,” Dr. Tedjarati said. “But in many ways, what I do day to day, from an administrative perspective and bridging those gaps, in many ways is now extending the reach of my care above and beyond the people that I see on a day-to-day basis.”
