Episode 111: Just What the Doctor Ordered

Speaker 1: You are listening to Your Practice Made Perfect. Support, protection, and advice for practicing medical professionals brought to you by SVMIC.

J. Baugh: Hello everyone, and welcome to this episode of Your Practice Made Perfect. My name is J. Baugh and I'll be your host for today's episode. Today we're going to be talking about physician leadership in the practice, and joining us today to talk about this topic is Steve Dickens. Steve, welcome.

Steve: Thank you, J. Glad to be here.

J. Baugh: Well, it's good to have you here to talk about this important topic. Before we get started talking about today's topic, can you give us a little bit of background information on yourself, Steve?

Steve: Sure. I'm currently the Vice President of Medical Practice Services at SVMIC, and Medical Practice Services, or MPS, is the group that helps physicians with the business side of medicine. So, we spend a lot of time in practices working with different issues from assessments, governance, strategic planning type issues. We do a lot of education. Aside from that professionally, by education, I have a law degree and have spent many years working in different leadership roles. Before coming to SVMIC in 2008, I had spent 15 years in physician-owned hospital executive positions and also served as Chair of the National Medical Group Management Association.

J. Baugh: Well, it sounds like you certainly have a lot on your plate, and so we're thankful and glad that you're able to share a few moments today to talk about this topic. So let's begin talking a little bit about physician leadership today, and the business side of medicine. If a physician is interested in pursuing some physician leadership opportunities within their practice, where should they start?

Steve: There are a lot of different opportunities for a physician who wants to exert his or her leadership skills within a practice. And certainly, there are many informal opportunities, simply in working with employees and being a mentor to them, directing the operations of the practice. Physicians definitely have an opportunity to use their leadership skills as they're trying to convince patients of the things that they need to do. But in a formal sense, depending on the size of the practice, there are very likely, task force or committees that they can work with. Just looking at a project within the practice. Do we want to build a new building? Do we want to look at a new electronic medical record system? Even looking at flow through a practice.

The recent COVID situation has been a great example. Physicians and practice administrators have had to rethink the way patient flow works in an organization. And taking charge of that process and keeping it on track without going askew really requires some leadership skills, particularly in a crisis like this when everyone around you is losing their heads. As you look outside of the practice and the governing structure there, the local hospitals are almost always looking for physician volunteers. And even within the community, we view physicians as leaders. So, I think there are opportunities within civic and community organizations too.

J. Baugh: So, what are some leadership avenues that a physician could pursue within a practice?

Steve: Well, the leadership avenue within a practice is really going to depend on the size and sophistication of the organization. And that's going to be driven by the number of physicians. If it is a small practice, then very likely the governance is going to be somewhat casual. It may be the physicians getting together once a week, once a month, just to talk through budgeting items, financing, maybe some personnel type issues, making those decisions as more of a team. We tend to see that with a small group of partners. As the group gets larger, in a medium-sized practice, we oftentimes will see eight to 10 to 15 physicians who are participating equally in monthly or quarterly board meetings, making decisions. In those types of situations, usually, the physician leader is working with the administrator on determining the agenda. What are the things that need to be brought to the group?

When we get into very large organizations where it is just unrealistic for large numbers of physicians to meet together with any amount of regularity, what we usually see there is a committee structure and usually a board of directors. And that board of directors is a subset of the larger group. And they generally will have powers that are spelled out specific to them, and there may be campaigning that goes on. It may be an organization that defines everyone rotates onto the board. But the best place to look to find those opportunities is really what is the work of the practice? Who is making these decisions? And if it's not you currently making those decisions, sit down with the people who are and say, "Hey, I want to get involved in this. I want to learn more." That's a great way to get started. Ask what are we doing? Why are we doing it? And how did we reach where we are?

J. Baugh: So, what makes an effective leadership structure?

Steve: That is a big question. The most effective leadership structures occur in those organizations where the group is able to make decisions. That's really what we want to get to. There is something that's been outlined in the literature called Governance Disorder Syndrome, and groups that have Governance Disorder Syndrome, or GDS, are those groups that can't make decisions or at least make timely decisions. And an effective leadership structure really has three elements. We're able to make timely, effective decisions. We agree to abide by the decisions. And when we have meetings that are productive, they aren't chaotic and disruptive.

These are the groups that even if I disagree with what the decision was, if we as a group have followed our rules, we followed our guidelines and we've made an informed decision, when we walk out of the meeting, we're all on the same page. If the vote was seven to six, when we walk out the six people who voted against it are just as much in support and seeking the success of the decision as the seven who voted in favor of it. Those are the groups that really have an effective leadership structure because they recognize we don't all get our own way all the time, and the group has to move along. So it's important that we reach that consensus and that we move through with the plan.

J. Baugh: So if I am a physician leader within a practice, what would be some of the typical responsibilities that I would have?

Steve: Again, those responsibilities are going to depend on the size and sophistication of the group, but at a very minimum, if you are the physician leader in the organization, you are going to be working very closely with the practice executive. Whether that's a CEO and administrator or an office manager, you two need to be on the same page. You all need to be working the same plan, although you're going to be coming at it from different perspectives. You're really going to be a counsel to that practice administrator or executive. They are going to be bringing different levels of decisions to you. You want to make sure that you've defined the terms of engagement there. How do you want to communicate? How do you all want to make decisions? How frequently do you want to do that? Do you want to set up a regular time, or is this going to occur on an as-needed basis?

As the lead physician in the organization, you're going to have staff who want to come to you. They're going to want to maybe try to get around the things that the manager said to them. One of the key things you can do there is that when staff come to you with decisions that have been made, and that have been communicated by the manager, you want to send those staff back to the manager. That really shows a cohesive leadership team. Beyond that, as a physician leader, there may be budgeting, check signing, you may actually be chairing the meetings of other physicians, those types of things.

But definitely, one of the issues that's going to fall within your realm of responsibility, is dealing with physician behavior issues. It is the responsibility of physician leaders to deal with those behavioral issues, those performance issues, whether you've got a physician who isn't keeping his or her schedule, they're not getting their notes done as they should. Or perhaps the stress of practicing medicine is becoming evident in the way that they're interacting with their patients or the staff members. It's your responsibility to talk with that individual and help them work through whatever that plan is to correct it.

J. Baugh: So, as you've been talking about some of the responsibilities of being a physician leader, it sounds like it could certainly be a challenging endeavor. So what are some of the specific challenges that a physician leader might face?

Steve: There are definitely some challenges to being a physician leader. First of all, we as a society view physicians as leaders. We just, by default, when they walk into a room, say, "Oh, hey, wait, the person who's in charge is here." Even outside of the healthcare setting, in organizations with our children or colleagues or whatever - community civic groups - we expect the physicians to be natural-born leaders. And the reality is that their education really isn't focused on leadership. It's a very clinically-focused education. They are trained to spot out problems and to figure out what to do with them in that sense.

So in terms of managing people and developing communication skills, that's not something that the system is set up to provide them. And it's also very easy for physicians to demonize the system. We put so much on our physicians these days in terms of what we expect from the rules and regulations, there seems to be a new one coming out every day, that it's easy to fall into this pattern of complaining about our staff, or the payers, or even our patients. So too often times we find that we can become part of the problem without having realized that we've done that.

J. Baugh: So in terms of someone wanting to become a physician leader within their organization, what would be some of the most important elements in being a good leader?

Steve: Well, there are a lot of aspects to being a good leader, and we could spend a lot of time talking about those, but I really boil it down to four primary categories. Not in any particular order, I think the most significant elements to a successful leader are relationships, competency, communication, and character. And when I talk about those, people who are good leaders are able to develop positive relationships. They're able to develop working relationships with people that they perhaps don't see eye-to-eye with. They deal with things in a very proactive stance. They don't let problems fester. They genuinely like people, and they recognize that everyone comes from a different background, and they can be empathetic to someone without necessarily liking them. Certainly, we know physicians value competency, and their training builds that into them. And one of the best ways to demonstrate competency is through your ongoing education.

Good leaders are lifelong learners. They're always looking for ways to improve their skills. In terms of communication, many people think they are effective communicators because they know what they're talking about. The difference for a good leader is that he or she understands their communication is only as good as the person who is listening to them understands it. So whether you're talking to a patient, or to a patient's family member, or to a member of your staff, you have to take that person where they are and communicate to them in a way that means something to them.

Physicians are very smart people. They're very well-educated. They use words and terminology that is second nature to them, but it's foreign to most of the rest of us. So remember to talk to me in a way that I can understand you, that's really part of what makes you so smart. And then finally, the issue of character. Character is about ethics and integrity. It's about deciding who it is that you want to be. And the best leaders are confident people who make conscious decisions about how they want others to see them. The character really comes down to who you are when you don't think anyone is watching you, because I can assure you, someone is always watching you. So again, to sum up those four elements, it's about character, communication, competency, and relationships.

J. Baugh: So what are some things that physicians can do to succeed as a leader?

Steve: Well, I believe it begins with hiring the right team for your office. Train them, tell them what you want them to do, tell them how you want them to do it, and why it's important that they do it that way. And then empower them to do it. Don't be afraid to ask questions. You should be questioning financial reports, you should be asking questions at meetings. How did we get to this decision? How much research have we done? Engage in the conversation. Find people who are experts in areas you are not partnered with. Whether that is another physician mentor, someone who is a leader, whether that's your billing expert, or your coding expert, or your practice executive, they know things you don't. Your nurse, the people working the front desk, they see things from a different perspective. Look for ways to partner with your patients and their families.

Take the opportunity to enhance your leadership skills. Whether that's the courses you choose to attend as part of your CME, whether it's participating in committees, whether it's getting involved in the leadership structure within your practice or the hospital. And then finally, determine the culture you want in your practice and make sure that you're living it. It's great for you to say that patient experience is important within your organization. But if your staff doesn't see you demonstrating that, if you're making fun of patients behind their back, if you're rolling your eyes, all of those types of things. And I understand we all need to vent a little bit of frustration here and there, but if what you're doing doesn't match what you're saying, then no one else is going to do it either. So choose the culture you want, and then exhibit it.

J. Baugh: So let's go back for just a moment to the importance of effective communication that you mentioned earlier. What advice do you have to becoming an effective communicator?

Steve: Well again, the most important element is to first of all, consider the audience you're talking to. You're going to talk differently to a group of physicians than you are to your medical assistant then you are to a patient who has an eighth-grade education. So understand who they are. Remember that the non-verbal communication is just as important as the verbal communication. Indeed, how you say something, your tone of voice, and your body language, is far more important than what you say. Because I, as the listener, will determine from the way you deliver the message, how important it is, how sincere you are about it, and that will in turn impact how I receive it and what I do with the information.

I encourage you to exercise your emotional intelligence, and emotional intelligence is one of those big catchphrases these days, everything seems to come back to it. But at the end of the day, emotional intelligence is really about knowing what your triggers are, being able to control them, and being observant enough and other people to see how they're reacting. Can you figure out what their trigger is? How are they taking something? And then adjusting your response to better handle the situation so that you are able to connect and engage. If you want to be an effective communicator, you have to be present in the conversation.

J. Baugh: Well, I don't think it would surprise any of our listeners for me to say that healthcare is an evolving industry, and the fact that the COVID pandemic has added more change to the mix. So do you have any advice about managing change?

Steve: Well, I think perhaps the most important advice around managing change is that it is inevitable and you have to be flexible. But as your planning change - and there are a lot of good reasons to plan change - sometimes we need to let go of things that aren't working. Sometimes it's the opportunity to do things better or to do something great. But, imagine both what can go right and what can go wrong. Though, what can go right is the positive aspect of it, and that's what keeps you going. Thinking about what might go wrong helps you plan for those pitfalls.

Decide whether you're working on a short-term or long-term problem. That's going to differentiate the approach that you take there. It's important that you create a vision. Most likely, whatever change you're managing is going to involve other people. And if you want to get my buy-in into what we're doing, communicate to me, where is it we're going? Why are we going there? Why is this important? You want to engage me in that and help me understand what my role is in this, so that you can empower me to become an ally to you as well too. And then you have to become a cheerleader. You've got to keep the project on-task. You've got to keep the change going, you've got to keep the team moving along.

J. Baugh: So as we bring this episode to a conclusion, what are your recommendations for a physician who may be interested in pursuing some leadership opportunities, and wants some additional education or training?

Steve: For the physician who is interested in pursuing leadership opportunities, he or she needs to recognize that leadership is an ongoing process. Honing one's skills is something that one continues to do. There are a lot of great books and authors out there. There are a lot of great podcasts and those things. Find one of those people, or a couple of those people who have theories that appeal to you and follow them. Read their books, listen to their podcasts. As you are traveling, and you're getting your continuing medical education, pop into a leadership program here and there. Walk up and when you meet that person and you're really impressed by what it is he or she has done, strike up a conversation with them, ask them how they got where they are. Be willing to ask those questions. Leaders are inquisitive people.

They are looking for ways to enhance those skills. Be willing to raise your hand to volunteer. So many people are unwilling to say, "Hey, yes, I'll help." But getting involved in developing those new relationships, will really push you to further your leadership skills. And every experience adds to your background, whether you handle something well, or whether it doesn't go well, you learn a lesson from it. So, don't ever stop learning. Remember that leadership really is about a series of choices. It's about how you choose to approach a situation. It's how you choose to respond to the things that happen. So, raise your hand and volunteer.

J. Baugh: Well, Steve, I want to thank you for taking the time to give us some information about physician leadership in the practice. I know that you've provided some great information for our listeners today, and so thanks again for being with us.

Steve: Well, thank you again for having me, Jay.

Speaker 1: Thank you for listening to this episode of your practice made perfect. Listen to more episodes, subscribe to the podcast, and find show notes at SVMIC.com/podcast.

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