Training physicians to lead hospitals can improve quality

Physicians may make better hospital leaders than managers, according to researchers writing in the Harvard Business Review, and more training programs could create more physicians capable of leading health systems.

James K. Stoller, MD, MS, a pulmonary and critical care physician at the Cleveland Clinic, and his coauthors wrote in the blog about several studies which show a correlation between physician leadership and improved hospital performance. A 2011 study, for example, found quality scores were about 25 percent higher in physician-led hospitals than those run by non-MDs based on the top 100 facilities in cancer, digestive disorders and cardiovascular care as determined by U.S. News and World Report.

A 2014 Stanford University study backed up the correlation, concluding that “the separation of clinical and managerial knowledge inside hospitals was associated with worse management.”

Stoller and his coauthors said there are other reasons for physician leadership’s effectiveness that are harder to measure. His own boss, Cleveland Clinic CEO Toby Cosgrove, MD, said having a physician in charge offers “peer-to-peer credibility,” with Stoller adding that patients, donors and the pharmaceutical industry may also place extra trust in a system run by a MD.

“We might expect a highly talented physician to know what 'good' looks like when hiring other physicians,” Stoller and his coauthors wrote. “Cosgrove suggests that physician-leaders are also more likely to ‘tolerate crazy ideas,’” like new surgical procedures.

But simply having a medical degree and clinical experience doesn’t make one qualified to run a hospital, Stoller wrote. In fact, he argued the training to become doctors “handicaps” potential leadership.

“Physicians have traditionally been trained in ‘command and control’ environments as ‘heroic lone healers’ who are collaboratively challenged,” he wrote. “In the context of this paradox, that medical training on the whole conspires against great leadership, there is a clear need to train physicians more systematically.”

Several training models may meet that need, according to Stoller and his coauthors. Yale Medicine CEO Paul Taheri has used an approach of once-monthly session teaching physicians about healthcare business basics and leadership skills. Those who excel are then encouraged to get an MBA.

Other programs offered by hospitals, medical societies or business schools, could help fill the training gap among potential hospital leaders.

“There seems to be a widening consensus that training physicians for leadership matters. Such training promises to enhance the pipeline of physician-leaders so that the benefits of physician leadership can be more broadly realized,” Stoller and his coauthors concluded.