The physician leader: Part politician, part soldier

By Elizabeth Gallup, MD, JD, MBA

Given the opportunity to influence health care delivery, will you or other physicians in your organization speak out regarding what’s best for patients and the practice of medicine?

If you, as a physician, choose to shape health care, you must come out of the shadows and participate in the local politics of medicine — involving yourself in local turf wars and continual meetings with fellow physicians to prioritize the agenda and strategize negotiations with payers and hospitals. Personal sacrifice of precious time and energy is required for long-term gain.

But the gains are substantial. As an empowered leader, you’ll create consensus and cohesion in your group, influencing health care decisions from negotiating contracts to defining clinical pathways. This empowering movement is happening even as some hospitals and payers pressure physicians to accept less than true partnerships with their institutions.

‘Nerves of steel’ essential

In this article, I have some suggestions for determining the ideal physician candidate for taking charge of change, as well as some ideas to help you assess whether your organization is influential.

Finding a physician leader doesn’t necessarily mean looking outside your practice. Ask yourself these questions to identify potential leaders within your practice:

• Who among you is already leading the charge, helping physicians iron out their differences and moving forward to influence health care delivery?

• Who is standing up in meetings with administration to ask the tough questions and following up when the answers seem murky and evasive?

• Who is figuring out what is needed to partner with a physician service organization to manage practices and capitated contracts?

• Who is building bridges between primary care physicians and specialists so physicians can stand together to contract with payers for professional and global risk contracts?

• Who is standing firm as a patient advocate?

Chances are, the leaders of physician organizations will come from the ranks of baby boomers. Why? According to Tom Gorey, president of Policy Planning Associates, these physicians realize they have at least 20 years of practice ahead of them and are willing to take risks that will enable them to control their future. In his studies of various physician organizations, Gorey has noted that "at every site, the president or chair was a physician in his or her early 40s."

Whether your group has influence or not largely depends on the nerves and knowledge of your physician leaders. Physician leaders are:

• informed about the state of the health care industry, including management of physician services, and willing to keep up with patterns and emerging trends;

• knowledgeable about how people react under the stress of changes, and experienced in the ability to diffuse anxiety so change can be adopted;

• able to communicate with all constituencies who have a vested interest in the changes at hand;

• most of all, possessed of nerves of steel and a willingness to take risks.

The first three attributes can be learned. "Nerves of steel," however, has more to do with an innate ability to withstand stress, including standing up against intense opposition forces that will try with all their might to prevent change.

People-pleasers and wafflers need not apply for physician leadership positions, because weak knees disqualify these applicants. Friendly fire and even coup d’etats from within physician ranks can test physician leaders as much as artillery from hospitals and payers.

Taking firm positions also requires taking chances. No one knows for sure how the clay of health care delivery systems will look after it has baked in the kiln of local politicking. So the right stuff for physician leadership is as much about accepting uncertainty as it is about taking an occasional dip or slide in popularity. Physicians cannot wait for a sure thing, or they will be left at the train station.