Finally, You Have a Seat in the C-Suite: Now What?

New physician executives are generally exhilarated by the opportunity of becoming an organizational leader. Still, complex interpersonal dynamics can be daunting.

New physician leaders are generally exhilarated by the opportunity of becoming a leader within their health care organizations. Still, complex interpersonal dynamics within the typical C-suite can be daunting. Newcomers should approach their role thoughtfully and systematically to maximize their effectiveness.

James Ketterhagen

My recommendations are based on a solid foundation of opinion and observation and avoidance of any peer-reviewed research. It’s doubtful that a how-to guide for new physician executives based on the scientific method exists anyway, but I still think that after 25 years of work as a senior executive in four health systems, two insurance companies and three consulting firms, you will find my thoughts useful.

First, understand your new role. Unless by some miracle your first job as a physician executive is to be CEO of your organization, you are no longer “captain of the ship.” You are now a member of the crew, as are the rest of your C-suite colleagues. Each has a role corresponding to whatever function follows the “chief” in their title (CFO, COO, CNO, etc.).

You are the chief medical officer, or something similar. Your role is unique and just as critical as the others. You are the clinical expert. You are no longer, however, the expert on everything. (You never were, but I know many physicians who haven’t discovered that yet). If you don’t understand this, someone will point it out to you and your administrative career may be brief.

I don’t intend to minimize the importance of your role. After all, we are in the health care industry, and clearly the patients and their medical conditions, about which you are the subject matter expert, are the focus of the industry. Insist on maintaining the focus on the patient as primary customer and never allow other considerations (finance, marketing) to override the patient’s needs. Your role is important; it’s just not the only important role.

Some suggestions:

• Take your lead from your CEO. He or she sets the tone and direction for the organization. The CEO has a vision (or should) of where the team should be heading and how to get there, and you should work in concert with that vision.

• Develop healthy relationships with your colleagues. You will learn a lot, and you will need their support. Set introductory meetings in their offices. Learn expectations for you and issues that are important to them. Ask for suggestions, and let them know that you can help them and that you can be trusted.

• Lose the white coat. You are no longer a clinician and shouldn’t need a uniform to demonstrate that you are a medical expert. Wearing scrubs and a stethoscope into executive meetings will tag you as just another physician, and at worst you’ll be seen as not being a team player. Part of your role is to represent your physician colleagues, but as an administrator, not a clinician.

• Learn to run good meetings. Start and end on time. You no longer have people willing to wait for you to show up. Unlike your clinical office, if you’re not there, they’ll start without you.

• Master the art of communication. Participate in discussions, but don’t dominate them. Listen. Be flexible and learn to influence without authority. People are no longer waiting on your every word, and you no longer “write orders.”

Finally, a roadmap: Start out slow. For the first 30 days, listen and observe. In the second and third month, formulate personal and departmental goals and begin thinking about how your team is organized and whether you have the right people. Identify potential barriers. After the third month, develop initiatives and implement programs with the support of your colleagues. Provide ongoing reports to your CEO and the team.

Being a physician leader is every bit as challenging as clinical medicine was, and can be just as rewarding. Enjoy the learning, and take pleasure in knowing that your work is benefiting the patients that you and your organization serve.

Remember (despite what some of your medical colleagues say), you haven’t abandoned the ideals that brought you to medicine in the first place. You’re just accomplishing the same thing in a different way.

James Ketterhagen, MD, MMM, CPE, FACS, FAAPL, FACHE, is president and CEO of JK Partners LLC in Louisville, Kentucky.