The authors of this article led a Town Hall meeting, The Chief Medical Officer (CMO) Position: Surgeons as Leaders, at the American College of Surgeons (ACS) Clinical Congress 2017 in San Diego, CA. A profusion of interesting topics was discussed during the meeting, and the members of the panel wanted to share the ideas that emerged with the community of surgeons at large. In this article, we address key questions that arose during the Town Hall about what it takes to serve as a CMO or in other surgeon leadership positions.
The Town Hall
We were happily surprised at the crowd draw for the session and realized that this topic was worth sharing. The purpose of the Town Hall was to get attendees’ minds flowing with questions, comments, and suggestions about the surgeon leaders who serve as CMOs at their institutions. Many surgeons were pleasantly surprised to see a presentation on the topic and felt compelled to know more. Others shared their frustrations with the “revolving door” of leaders, and the inconsistency and instability of those occupying the C-suites at their institutions. In some instances, surgeons noted that their hospital administration had little understanding of the surgical field.
Surgeons spend many years in training to provide high-quality, safe, reliable care to their patients, which makes them ideally suited to serve as leaders within their institutions. Moreover, such leadership is especially critical in this day and age in which a spectrum of political decisions related to quality and cost control affect health care.
Evolving surgeon leadership positions
Although the Town Hall discussion initially revolved around the topic of the disappearing role of the CMO, many new forms of physician leadership in the hospital setting were discussed as well, including physician advisors who act as liaisons to insurance companies and pharmaceutical companies. Physician advisors offer skilled opinions regarding market research and development. These fairly recently defined positions are open to all surgeons with an interest in business and management.
As clinicians with intimate knowledge of all aspects of patient care, surgeons can create their own jobs and titles in the future. We need to understand that the tasks and occupations that will engage us 10 years from now may not exist today. For those health care professionals working in the 20th century, who would have expected the alphabet soup of executive titles in health care that we have today, including chief quality officer, chief medical information officer, and chief patient experience officer—a list that keeps growing as the technology and hospitality industries become more integrated with patient care.
One such title that is being introduced and that exemplifies a surgeon’s duties within the department of surgery is the surgical quality officer (SQO), whose responsibilities are described in some detail in the ACS manual, Optimal Resources for Surgical Quality and Safety.1 What makes the SQO position different from the traditional CMO or surgery department chair is the need to focus efforts on quality improvement, safety, cost-effectiveness, and reliable care across all divisions and surgical subspecialties, including urology, gynecology, obstetrics, orthopaedic surgery, neurosurgery, cardiothoracic surgery, otolaryngology, and so on. More experienced surgeons are best qualified to serve as SQOs, as they have the institutional knowledge and authority needed to foster change, especially cultural change, within a department. An SQO works closely with many teams, including the division heads within surgery, the operating room (OR) team, anesthesia team, and administrators in the department of quality and risk management.1
One question posed during the Town Hall was regarding the necessity of an advanced business degree, such as a master of business administration (MBA). There are myriad ways to answer this question. Some universities, including the Brandeis University Heller School for Social Policy and Management, Waltham, MA, offer an Executive MBA for Physicians.
Although matriculation through these programs may land an open-minded surgeon that next great job, it is important to weigh the benefits against the fact that acquiring these degrees can require extensive time, money, effort, and family support. For many individuals, either an advanced degree or on-the-job experience can provide the exposure to the knowledge base and vocabulary of business and finance administration they need to serve in leadership positions.
However, with the evolving nature of the job market, positions, including that of CMO and other leadership roles, are continuously being revamped or eliminated, and in today’s society of advancing technology and complexity, this fluid environment can hinder connectivity and clear communication between leadership and physicians. Quite often, job transfers occur, and longevity, stability, and cultural traditions are lost or compromised. An advanced degree may help you get an invitation to the boardroom, but the real challenge may be in determining whether an additional degree will better equip you to accomplish your career goals than will learning by reading and going to conferences.
Some physician executives are opting to engage in intensive seminars on the business and health policy aspects of medicine rather than pursuing an MBA. Participation in such a course of study may improve one’s understanding of managerial behavioral sciences, accounting, economics, finance, and business operations. Notably, the education obtained in these programs may serve as an adjunct to on-the-job training and, more importantly, may empower a physician to contribute comfortably and confidently to efforts that address the growing complexities of health care. Some of these programs are part-time and designed for full-time working physicians, where they participate in-person for a weekend or two at a time or where they may be able to complete the entire course online in one to two years.
Are you better armed with an education that enhances your financial and management skills? Absolutely. Is it worth it? That depends on your values, goals, and mission of your career. The decision to pursue further education in the business of health care depends on what your professional and personal growth looks like to you, today and in the future. This decision depends on how involved you want to be behind the scenes in policymaking, public health initiatives, or on the front lines making decisions as a chief executive officer, CMO, SQO, or starting your own entrepreneurial company or intrapreneurial service line.
Other ways to make progress in health system administration
Perhaps more important than pursuing formal education opportunities, surgeons need to build trust, integrity, and accountability in relationships with administrators to earn the respect they deserve and the voice they need to be leaders within their respective institutions. Other institutional leaders need to know you as a person, as opposed to the degrees or the letters after your name. A commitment to building rapport and developing genuine relationships with your colleagues and supervisors are the foundation of a successful career as a surgeon leader.
There are numerous other ways to get involved in hospital leadership and to arm yourself with the right tools for success if pursuing another degree is not of interest or feasible to you. For surgeons who are fresh out of residency and fellowship, it is imperative to get involved with your hospital committees. Committee experience allows surgeons to become more comfortable with the vocabulary of health policy and administration, gain confidence in public speaking, attain knowledge and experience in certain fields, and understand the economic and business decisions of an organization. It also provides opportunities to improve emotional intelligence with learning and practice.
There are many different topics to choose from in the medical and surgical arenas: utilization management, care coordination activities, patient pathways of care, financial reimbursements, information technology system improvements, and public health, health policy, advocacy, and reform.2 We can all agree that physician engagement is imperative to achieve cost savings, develop quality metrics, and create value as the patient advocate. Surgeon champions can provide the critical buy-in and alignment between administrators and other physician peers.
Traditionally, many clinicians viewed the pursuit of business training and executive positions as a betrayal of their commitment to medicine. A physician executive with a business degree may have been accused of “drinking the ‘Kool-Aid’…another one lost to admin.” Fortunately, this bias is becoming a relic of the past. Understanding and rewriting policies, procedures, rules, regulations, and guidelines are essential tasks for hospital administrators, and they benefit from the input of clinically seasoned surgeons. More importantly, experienced surgeons understand and can explain to their hospital administrators how factors such as geographic region, the regional hospital system, payor mix, and other intangible factors affect clinical decision making and patient care.
Furthermore, even though surgeons welcome changes that improve patient outcomes, some are troubled by the increasing regulatory and administrative burdens that lead to further loss of autonomy.3 Surgeons have the ability to be more adept at the negotiating table. To become more skilled leaders, we must switch from viewing ourselves as “captain of the ship” to a multimodality team approach, whether we work with other professionals in academics, pharmaceuticals, insurance, or community-based surgery practices. There is a clear need to train physicians to act systematically and not as “heroic lone healers.”4
Many people who choose surgery as their life’s work may have a natural capacity to lead; however, surgeon leaders still must acquire an essential skill set, including the ability to communicate effectively and build group consensus, which must be learned, matured, and honed over time with courses, coaching, and simulated exercises.5 Many studies and articles have proven that training physicians in social awareness, social skills, and the relationship aspects of leadership is vital to the success of a particular department and institution.5 Many institutions and organizations offer courses in relationship building, team building, conflict resolution, situational leadership, emotional intelligence, art of communication, mediation, and other strategic organizational skills.
Can a surgeon successfully complete his or her administrative and clinical tasks and be a full-time CMO or otherwise serve in a hospital leadership position? It’s tough to answer this question with a definitive “yes” or “no.” Most likely, one or the other—clinical practice or executive leadership—would have to be curtailed. There are a few caveats to consider when taking on additional responsibilities, such as not spreading yourself too thin and remembering to spend two hours at night reading and educating yourself. Surgeons spend most of their time at the workplace, and with that in mind, it is imperative to remain sane and balanced, making time for family, hobbies, and other interests outside of the OR. Many degrees and opportunities are available to surgeons, and none is more important than their medical degree and surgical training.
Ultimately, the physician is the first and last person to interact with the patient. Patients look to their physicians to guide them in very difficult and unforeseen circumstances. There is obvious relevance regarding a surgeon’s role in leading by example, especially in the wake of multiple areas of environmental and human-induced traumas. We need to keep learning and evolving through courses provided by the American Association for Physician Leadership, Lean Six Sigma Training, the World Health Organization, U.S. Cochrane Center, Institute for Healthcare Improvement, STEEEP (safety, timeliness, efficacy, efficiency, equity, and patient-centeredness) training, and the ACS Leadership and Advocacy Summit and Surgeons as Leaders program, just to name a few.
Surgeons seek to help guide their patients and trainees through the system. We must listen, acknowledge, process, collaborate, train, transition, and then act as a team in the best interests of our patients. We must continue to educate and train ourselves using the many resources available and keep up with evidence-based protocols and health care reform. We can cultivate a spirit of learning for ourselves and must go out of our way to care about the greater good of our patients.
- Ashley SW, Ellison EC, Moffatt-Bruce SD. Surgical Quality Officer. In: Hoyt DB, Ko CY, eds. Optimal Resources for Surgical Quality and Safety. Chicago, IL: American College of Surgeons; 2017:37-48.
- Sangji NF, McNicoll CF, Sood D, Ehlers AP. Reframing surgical leadership in 2017: Surgeon-scientist or surgeon-advocate? Bull Am Coll Surg. 2017;102(8):49-57.
- Stoller JK, Goodall A, Baker A. Why the best hospitals are managed by doctors. Harvard Business Review. December 27, 2016. Available at: https://hbr.org/2016/12/why-the-best-hospitals-are-managed-by-doctors. Accessed February 10, 2018.
- Grant RT. The evolving role of the physician advisor. Collaborative Case Management. 2016;61:4-6.
- Perry J, Mobley F, Brubaker M. Most doctors have little or no management training, and that’s a problem. Harvard Business Review. December 15, 2017. Available at: https://hbr.org/2017/12/most-doctors-have-little-or-no-management-training-and-thats-a-problem?autocomplete=true. Accessed February 10, 2018.