Perils of being a physician leader

You’ve been pulling long hours at your practice for the past five years, and are finally building a sizable patient following. Your hospital is making record profits in part to your labor.  One day you get a call from the administration.  Will you finally get that raise that you’ve desperately needed?  No such luck, but the administration invites you to attend their exclusive meetings.  You say, “yes” without truly understanding what the job entails.

You would be lucky to have these chairs in your hospital conference room

Guess what? You’ve now become a physician leader. Sometimes your hospital or group may spin the title in euphemistic terminology like “executive team”, “management team”, or “lead provider” (shudder).  No matter how this title is spun, the bottom line is that you’ve just volunteered for more work.  Don’t think that you can cut back on your clinical hours just because you have that fancy new title.  That extra $1,000 every quarter on your paycheck will SURELY cover those extra hours of your life spent in meetings.

Did you just sign away your life?

 

Becoming a healthcare administrator can promote your career.

There are merits to becoming a leader.  Most doctors in every stage of our careers still report to someone else.  As a medical student, you reported to residents, attendings, and even nurses!  As an attending physician, we still report to our chairmen, the insurance companies, and other regulators.  There is always someone who is above you at any point of your career. When you become a physician leader, you start gaining that authority to help make our healthcare system better.

 

 

The second you move onto an administrative role, you automatically acquire authority. Authority to make decisions. Authority to change the silly policies that you hated to deal with when you were a peon.  These changes can be as insignificant as replacing the low-grade coffee stirrers in the break room.  How about getting rid of that noontime mandatory team huddle that you always missed because your clinic runs two hours late? Done!

More importantly, you gain the opportunity to grow your career as a healthcare administrator. You get to see the side of the healthcare system outside of direct patient care. You will see how complex, confusing, and inefficient our healthcare system really is.  This is where you can actually shine. What goals can you implement in your hospital to improve healthcare delivery? How does the revenue cycle for an orthopedic clinic work?

You might actually be a whiz at healthcare policy.  That would be a powerful skill to have. Instead of fighting hypertension in the clinic, a strong healthcare policy reform could prevent the same disease in thousands of people without stepping foot into the clinic! There is real opportunity in administration to lift yourself out of direct patient care.

 

Becoming a healthcare administrator can destroy your health.

This picture is more representative of hospital conference room chairs.

Look, being a leader is not all fun and fame. Who knows how many failed administrators never become CEOs, start up their own consulting firms only to fail, or even quit medicine altogether.  Administration is not a sure path to lifelong success.

We all know that being a physician leader involves added work. You have to hustle through your patients and then rush to meetings afterward. The hustle is actually not the hard part. You already know how to hustle.  The problem is that progress with any hustle takes time. You will fail. Many people will hate you for implementing changes.  It may take years before you realize whether you’ve accomplished anything, and that can take a  heavy toll on our psyche. You might burnout.

Related read: How To Identify Physician Burnout — And How To Prevent It

No one is immune to burnout. I get notices almost every month that CEOs or senior staff  members of local hospitals getting replaced. Some take on roles in other organizations. Others vanish. I doubt that every single one of them actually left their prior jobs because they were offered wildly lucrative offers elsewhere. I bet that most of them burned out from their long hours and lack of job satisfaction. Don’t think that you are immune to administrative burnout simply because you are a doctor.

 

Becoming an administration adds tension between your colleagues. 

Once that title of “lead physician” gets appended to your name, your colleagues will view you differently.  That inherent trust that you shared is no longer as apparent.  That is a weird feeling. Whether or not you actually continue to suffer through the pain of clinic, useless meetings, and stupid online compliance training makes no difference. Your colleagues probably think that you actually know something that they don’t. The lack of certainty is a powerful motivator for skepticism.

 

You probably aren’t going to be besties with the administration either.

If you can’t be friends with your fellow doctors, you’ve still got your administrative posse right?

 

Wrong.

 

<insert cynicism> Half of your hospital’s management team aren’t physicians (or providers if you’ve already been brainwashed). Some of them may not have any formal professional degrees other than “B.S.” or some made-up title like “DFO” (Director of Financial Operations). Since this is a financial website, I’ll add that all of these people have salaries higher than your best friend who got a USMLE Step 1 score of 260—this is considered a high score—but decided to go into family medicine.  <end cynicism>

Related read: Is a degree from a prestigious medical school advantageous for doctors? 

This administrative team expects you, the physician leader, to be on board with their recommendations.  Some of these recommendations will be unfavorable. Do you have to be a sycophant and agree with their decisions? Or do you risk your future career as CEO by going against the grain?  Will you always be outvoted since you are the sole physician on the board? What can you actually accomplish if you don’t already agree with the existing administration?

 

Will you be happy as a physician leader?

I’m all about happiness. If you don’t like what you do, you probably aren’t going to be motivated to improve your skills. If you dread the 5 hours a week of additional meetings in addition to your clinical practice, you’re probably not going to be good at your job.  However, if you love spending a few hours every evening planning for your meetings, you might actually be a great administrator.

 

Related read: Why are you a doctor, lawyer, or engineer?

 

“A jack of all trades is a master of none.” There are only 168 hours in a week.  I know a vascular surgeon who works 85 hours a week. Imagine adding on another 8 hours of your weekly life going to meetings.  For most people this is unsustainable.  You will break down.  If you pare down your clinical activities, you might not actually have enough time to maintain your clinical or surgical skills either.

There is a fine line between the clinician and administrator. Plenty of us do both, both are we sacrificing our abilities to perform one for the sake of doing both?

 

Have you considered becoming a physician leader?

(Photo courtesy of Flickr)

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  • JHJ

    Very interesting …and true…I am at a point in my life and career where my children are in or close to college (no more travel team baseball!), so family obligations aren’t what they used to be. This coincides, of course, with getting older which all coincide for more opportunity for physician leadership in the hospital. Instead of rushing through clinic or rearranging patients to make baseball games, I am now doing it to make meetings. I am all for serving and giving back, but your article is a reminder that if we don’t guard our lives and careers striving for balance, any vacuum will be immediately filled …

    • Smart Money MD

      It’s easy to get pulled in many directions, especially if you say ‘yes’ to everything. In some ways, being involved in leadership also gives me pause to what actually happens in the background. I’m not sure if in the long-term doctors will actually have much say in the healthcare system!