Lesson from Leaders: Success by Degrees

Peter Pisters, MD, MS, CPE, is already at the top of his game. His status as president of the University of Texas MD Anderson Cancer Center in Houston is only the most recent addition to a curriculum vitae filled with distinguished positions and career accomplishments.

In short, he’s a smart guy who probably could coast on the education and experience that got him where he is today. But he won’t.

“There is tremendous value in continuing education,” he says. “Even after my master’s degree, CPE [Certified Physician Executive] certification and ACHE [American College of Healthcare Executives] fellowship, I still immerse myself in learning opportunities for professional and personal development.”

An advocate of cultivating curiosity and embracing lifelong learning through formal education, Pisters acknowledges stretches of feeling “intellectually stale” that drive him to ramp up his education and chase the challenges that come with advancing his career as a physician leader.

During his years as an assistant professor at MD Anderson, early leadership opportunities revealed to Pisters gaps in his medical school education that he needed to close “if I ever wanted to be a leader at a higher level.” His self-assessment aligns with a 2018 report by Health Care Management Review that says “traditional physician training includes little focus on leadership development, necessitating further training to achieve the potential of collaborative management.”

Responding to such gaps in traditional training — and the demand of medical students seeking business degrees — MD/MBA combined programs in the United States have spiked from six to more than 65 over the past decade. According to a 2010 study by Joshua T. Goldman, MD, MBA, 91 percent of graduates said their dual degrees were worth the extra time and cost — and 89 percent said they enjoyed “significant” return on the investment.

The bump in salary for physicians with advanced degrees is significant, according to the 2016 Physician Leadership Compensation Survey, conducted by Cejka Executive Search and the American Association for Physician Leadership. Physician leaders with an MBA earned 13 percent more than those with none, it shows. And those with CPE credentials earned 4 percent more.

That same survey shows the average salary for physicians is $350,000, including $437,000 for CEOs and $388,000 for CMOs. Reaching such positions, however, generally requires the credentials that come from continuing education.

Pisters grew more aware of his own need for higher credentials when MD Anderson selected him, as a professor, to represent one of its divisions internationally. That opened his eyes to the scope of the organization.

“I saw that those people were just as passionate about the mission as I was, that they were extraordinarily talented and had skills, knowledge and abilities that I didn’t have. I was energized by that,” he says, “and began to realize that I needed to work to close those gaps.”

He accomplished that by pursuing three external pathways: the CPE track through AAPL, a master’s in health care management, and ACHE fellowship certification.

Within a year of getting his master’s degree and CPE credential, he was hired as president and CEO of University Health Network in Toronto, Canada.

Pisters was deliberate in his plan and purpose to pursue continuing education, but the path to executive leadership isn’t as calculated for every physician.

Necessity: Mother of Reinvention

When Gregory Mishkel, MD, was in medical school, the idea of getting an MBA never crossed his mind. Med school was tough enough.

“Just getting into medical school was the epitome of what you could do,” he says. “When I was in medical school, I didn’t know anybody who even thought about getting an MBA. It was hard enough getting the MD, for goodness’ sake.”

Business education wasn’t on his radar, and neither was leadership. That changed, however, after a series of health issues — three back operations, an acutely ruptured disc in his neck, and a partial nephrectomy — forced him to phase out his practice as an interventional cardiologist at Prairie Heart Institute in Springfield, Illinois, for a full-time executive position.

“You come to that point in your career where you realize that going full-out [as a proceduralist] is not a good idea,” he says, “and maybe it’s a good idea to try to reinvent yourself and make a difference a different way.”

Inspiration came during his recovery from the nephrectomy at Johns Hopkins Hospital, where he obtained new perspective as a patient at a top-rated facility. Waking up with drains, catheters, IVs and a Demerol drip, he says, “you come to understand what it’s like to wait for pain meds. I was so grateful for my care and the outcomes that I began to think, ‘How am I going to make a difference moving the needle on empathic care?’ ”

Months later, he answered his own question when he was named executive medical director at Prairie Heart. His objective: “Deliver the kind of care that I’d experienced” at Johns Hopkins.

To make that happen — to become an effective leader — he knew continuing his education was essential. “I was maybe a year in as executive director when I realized that if I wanted to do this better, I really should think about getting an MBA,” he says.

A year after getting his MBA, he was named vice president of cardiovascular services and chief of division of cardiology at Northshore University Health in Chicago. He started in January.

Opportunity, Education Open Doors

Pat Torcson, MD, took what he calls the “traditional” path to physician leadership: He was drafted.

Making the rounds one morning at St. Tammany Parish Hospital in Covington, Louisiana, he received a page saying he’d been nominated to run for the medical executive committee. A true honor, he was told.

His answer? “Thank you, but no thank you. I have no interest in administration or going to more meetings,” he says.

“But when I shared that with a senior colleague,” Torcson remembers, “he insisted that I call back and accept the nomination because that is our duty as physicians — to provide leadership roles. And serving on the MEC as part of the hospital medical staff leadership is an honor and an obligation.”

With that friendly push, Torcson’s work with the committee opened doors for him to develop leadership skills with courses through AAPL. Applying those course credits toward a master’s degree in medical management, he remembers a professor telling his class that the program typically results in about one-third to one-half of all physicians making some kind of career change. “My thought,” he recalls, “was, ‘Well, that’ll be the person sitting next to me; it won’t be me, because I’m pretty established and comfortable in my current position.’ ”

However, his coursework — coupled with extensive self-reflection and a burgeoning interest in quality and performance — inspired him to abandon primary care for hospital medicine. His MMM degree led to his promotion to director of hospital medicine at St. Tammany a year later.

The degree “was extremely important and valuable because, although I had a lot of clinical knowledge, my knowledge around management and traditional business management skills was limited,” Torcson says. “Organizational dynamics, HR, finance, accounting strategy and managerial communication are all skillsets that I had to develop to be successful, and, for me, it was important to be steeped in the academics of those different disciplines.”

Advancing to chief medical officer wasn’t an immediate goal, but he turned his focus to developing the proper skills so he’d be ready if the position ever opened. Eventually, it did.

Closing The Deal

A year after completing his master’s degree and CPE education, Pisters was named president and CEO at University Health. Three years later, he returned to MD Anderson as president. Was there a correlation between his advanced education and promotions? At MD Anderson, experience for a top executive position was important, he was told, but so were formal training and leadership skills.

“That I had taken accounting and corporate finance was very important. That I could comfortably go toe-to-toe with the CFO on financial statements and that I understood the legal aspects of intellectual property management?” he says. “These skills were very, very important to the boards that hired me as president and CEO.”

Mishkel, meanwhile, was one of two finalists for a position with a stated preference for candidates with MBAs.

“The other finalist was a very credible and nationally known cardiologist,” he says, “but to the best of my knowledge, he did not have an MBA. I don’t know whether I got the job because I had an MBA, but I suspect it didn’t hurt.”

Degrees of Difference

Continuing education means different things to different physicians.

For Pisters, his master’s degree and CPE credential meant a complete leadership skillset, comfort in navigating difficult situations, an understanding of how academic and corporate organizations operate, “and how to combine the best practices of academia and Fortune 50 companies,” he says.

For Torcson, it meant applying the business skills he’d acquired to launch a startup hospitalist program that included a business plan, a financial pro forma and recruiting and hiring practices that were encouraged, supported and adopted by the administration.

For Mishkel, it meant credibility. “I think you’re viewed differently by administration when you have an MBA,” he says. “I didn’t want to be a physician telling them what I thought they should do; I wanted to be a physician telling them what they should do ... but with a business background.”

Pisters is such a believer in continuing education that when he was vice president at MD Anderson, he’d bring his team of medical directors to AAPL institutes twice a year. “We would all take courses, get together in the evening and share insights about what we learned,” he says. “That was a tremendous shared learning experience as well as a team-building experience. I was really involved in the educational programming of AAPL and using that knowledge to help physician leaders that reported to me.”

Pisters says he’s excited to lead his organization, but he knows he didn’t get to that position without some help.

“I’m so indebted to AAPL for helping me to see the opportunities and to close so many gaps that I know that I had,” he says. “I’m still planning to go back to AAPL because I want to model the way for the leaders in our own organization now.”

Adds Torcson: ”Classes through organizations like AAPL are invaluable because they provide education and information on relevant topics that one doesn’t learn in the day-to-day practice of medicine, but are extremely important from a leadership standpoint. How you govern a medical staff requires special expertise and knowledge.”

Torcson admits to “swinging for the fences” last year when, as director of hospital medicine at St. Tammany, he applied for the organization’s CEO position. The search committee acknowledged being “blown away” with his interviews but selected a candidate with CEO experience. A few months later, the hospital’s chief medical officer abruptly retired after 35 years, and Torcson, on the strength of his CEO interviews, immediately was offered the job.

“One of the things I learned from the whole process is that there is an executive skillset that is required to be a chief executive officer,” Torcson says. “Strategy, planning, organizational governance and delegation were some of the skills I admit I didn’t necessarily have yet.”

He already has plans, however, to close those gaps through continuing education. If there’s ever a need for a physician with clinical and executive-level skills, he wants to be ready.