The Senior Resident Leadership Initiative: A Blueprint for Aspiring Physician Executives

Researcher, chief resident and sub-internship coordinator, or resident committee liaison are all programs with introductory-level leadership opportunities for residents. Formal physician leadership curricula with learning objectives dedicated to patient safety, quality improvement (QI), operations, and other topics are generally the next step for those who are interested in departmental leadership. These classes tend to be primarily department-focused and usually are work-study programs with advanced degrees (e.g., Master of Business Administration or Master of Science) in the form of administrative fellowships.

Although executive-level healthcare administrators typically come from a variety of clinical specialties, they often have informal nonclinical expertise in institutional efforts such as medical directorship, quality assurance and process improvement, clinical documentation improvement, risk or utilization management, claims appeals, or revenue cycle analysis. This is in addition to any prior formal business management education or designation from leadership societies such as the American Association for Physician Leadership and the Certified Physician Executive (CPE) via the Certifying Commision in Medical Management that may distinguish them from other clinicians.

Healthcare organizations benefit from physician leaders who devote their careers to addressing system-level change.(1,2) Although the majority of hospitals in the United States are now run by nonclinicians, physicians occupy the highest executive position at most of the top-ranked healthcare systems. Physician-led hospitals also boast significantly higher quality outcomes than those led by non-physicians.(3–7) As healthcare executives, physicians become uniquely positioned as critical patient advocates, managing the effective treatment of disease and negotiating organizational imperatives with physicians and clinical care teams that maintain institutional solvency.

Residency is a logical point to begin preparing for leadership roles; there often is time for independent study and elective periods, in addition to a culture of learning unique to academic institutions that host these programs. Resident physicians often pursue skill-based advanced clinical education (i.e., ultrasound, emergency medical services, toxicology), research, or medical education to supplement their formal learning; however, leadership training is often overlooked as a focus at this career stage.

To fill this education gap, a resident-led curriculum was developed to provide physician trainees interested in a career in leadership a core set of competencies that will prepare them early on to lead in the healthcare setting. This educational model provides both structured learning and the flexibility for resident-specific administrative interests; it can serve as a blueprint for those interested in a post-residency career in executive healthcare leadership.

The Leadership Initiative

The NewYork-Presbyterian Emergency Medicine (EM) Residency Program is a four-year dual-campus program that offers physician trainees the opportunity to experience clinical practice at two major quaternary care centers in New York City: Weill Cornell Medical Center and Columbia University Irving Medical Center.

Residents are exposed to all facets of emergency medicine as required by the Accreditation Council for Graduate Medical Education (ACGME), in addition to the many innovative programs our departments offer (i.e., simulation, global health, ultrasound, pediatric EM, geriatrics, telemedicine, etc.). They are expected to longitudinally participate in a defined Academic Practice Track with dedicated conference time (six sessions/year) plus external meetings.

When residents become “senior” residents in their third and fourth years, they are provided three 4-week elective blocks to further commit to this scholarly endeavor and/or pursue individual healthcare-related interests within the institution or elsewhere. More than a dozen established Academic Practice Tracks are available for residents to explore in emergency medicine (including themes listed above), from critical care and prehospital care/tactical medicine to sports or austere (disaster/wilderness/space) medicine.

This Healthcare Leadership Initiative was created as a longitudinal supplement to required residency learning and as a pilot Academic Practice Track. It is meant for residents who plan to pursue leadership positions within the healthcare industry post-residency to develop business, management, and leadership skills.

Curriculum and Leadership Track Competencies

Resident selection and participation in the Healthcare Leadership Initiative is overseen by the residency program director, the department chairs, and their respective operational and administrative faculty. The primary goal of the curriculum is to develop four core healthcare leadership competencies: knowledge of healthcare systems delivery, professional networking and mentorship, communications and leadership training, and program development and quality improvement (see Figure 1).

Figure 1. The four healthcare leadership track competencies

Participating residents complete educational modules, enroll in seminars, begin mentorships with healthcare executives, and create individualized projects to accomplish their learning objectives and to meet core competencies. At the end of their residency training, residents are expected to attend a national conference, submit their projects to an academic conference, and present their work to residency colleagues and administrators as a final capstone project.

1. Knowledge of Healthcare Systems Delivery

Residents participating in the Leadership Initiative must first develop an understanding of our broader system of healthcare by learning about healthcare systems delivery — the insurance companies, employer groups, care providers, and government agencies that work together to provide healthcare to our population.

Various organizations provide comprehensive online educational tools; for example, AAPL has elective courses in health law, finance, quality and risk, and operations and policy. Residents are asked to acquire 10–20 CME credits through online training in the systems delivery subtopic of their choosing. Residents also have the opportunity to attend at least one executive leadership conference during a senior elective month to be exposed to new and relevant ideas from industry leaders.

Where available, participation in departmental or hospital-wide committees, for example the Housestaff Quality Council, is strongly encouraged. These groups provide additional opportunities for idea development in the context of organizational priorities. Residents use this knowledge and exposure to create and develop a project of their own based on their individual interest in the subject, in one of the domains of hospital operations, QI and patient safety, or hospital revenue and reimbursement.

2. Professional Networking and Mentorship

Mentorship is considered essential for professional development; therefore, residents seek an executive mentor within their healthcare organization. Program leaders help by educating residents about the roles and responsibilities of senior management executives and their teams. A senior leadership organizational chart explains the hospital’s various chief officer and executive director positions, including their corresponding operational objectives.

Introductions are made through appropriate administrative channels, and when a mentor is confirmed, a connection is made. The resident assumes responsibility for the mentor/mentee relationship and learns to “manage up” by establishing professional objectives and determining what level of participation the mentor is willing and able to provide.

The primary responsibilities of the executive mentor include providing professional guidance regarding career trajectory, networking on behalf of the resident within the hospital, maintaining interval communication with the resident to provide strategic guidance, and furthering the progress of a longitudinal project.

The executive mentor is expected to bring the resident to upper-level leadership and town hall meetings and provide the context of discussions. He or she also is expected to help the resident develop an understanding of the relationship dynamics between various healthcare executives. These executive-level meetings provide valuable insight into strategic and business planning to promote understanding of overall practice operations and reveal how coordination of healthcare finance, compliance, information technology, human resources, and operations come together to improve patient experience and outcomes.

As the mentor/mentee relationship develops, the resident should begin to establish a list of potential project team members who will contribute to the longitudinal project, for example, representatives from information technology, case management, operations, and hospital counsel. Project ideas and suggestions for participating members may come from conversations between mentor and mentee or be independently promoted by the resident.

Residents also are invited to join the AAPL as student members and participate meaningfully in the member mentorship program. This offers residents an opportunity to network beyond the confines of the host institution and learn more about various organizational challenges faced by physician leaders and their corresponding management strategies.

Additional opportunities, such as becoming a Community Ambassador within the AAPL forum, offer a chance to both expand contacts and obtain leadership knowledge from executives across the country.

3. Communication and Leadership Training

Residents should complete at least one emotional intelligence assessment, such as the Dominance, Influence, Steadiness, Conscientiousness (DiSC) assessment, the Myers-Briggs, the Birkman Personality Assessment, or the California Psychological Inventory. Findings should be reviewed with the executive mentor, and thoughtful discussion should take place regarding implications about which management techniques, job descriptions and settings, and career goals may be more or less attractive to the resident based on the insight of the mentor. Residents also complete the AAPL foundational course in communications, finance, negotiations, quality, and influence before forming their project committee.

Upon completion of these educational tools and under the guidance of the executive mentor, the resident should begin to feel comfortable assuming the position of independent project lead and begin to develop committee roles and objectives that will be laid out in official project proposal format and communicated effectively to all team members.

4. Program Development and Quality Improvement Training

Leadership Initiative participants are expected to complete the Institute for Healthcare Improvement (IHI) online modules in improvement capability to learn the framework for initiating a QI project. Residents will use this training to structure their longitudinal administrative project.

Once residents have determined their project goal and created a list of their committee members and their respective roles, they use the QI framework to move their project forward. Project oversight may be conducted by a department director of quality improvement and patient safety, if available. As project lead, the resident uses Plan-Do-Study-Act (PDSA) cycles to test and measure institutional change in the administrative area of his or her choosing. The resident should assume responsibility for meeting deadlines while networking appropriately to obtain needed resources and to reach project objectives.

Access to Health Insurance Portability and Accountability Act (HIPAA)-compliant electronic medical records (EMRs), billing/appeals software, stored data, or facilities is facilitated by the executive mentor or residency department administration, as needed. Project advancement, including networking and access updates, and coursework completion are forwarded to residency administration regularly to monitor forward progress.

Submission of project findings to academic or professional journals/societies in the form of poster presentations, abstracts, or manuscripts is required before residency graduation. The capstone project culminates with a one-hour presentation to fellow residents and core faculty at a conference during the last year of residency. During this presentation, the resident is expected to outline the track background, objectives, course curriculum, project milestones, and deliverables.

Initiative Requirements

All Academic Practice Tracks require that learning components be assigned designated credit values. The value of these credits is determined by program leaders and is commensurate with hourly commitments. Credit hours for project creation, implementation, and assessment also count toward an overall credit requirement for track completion.

Minimum credit values for successful completion of an Academic Practice Track are determined by program leaders based on resident time availability and other academic/clinical priorities.

Applying the Blueprint

The Healthcare Leadership Initiative has been a success thus far, with full support from residency program leaders and executive mentors. A pilot for this initiative began with one senior Emergency Medicine resident and has shown to provide significant educational benefit, in addition to fostering a deeper sense of responsibility and commitment to hospital involvement.

Future residents who are interested in healthcare administration and who do not have an initial focus of interest (e.g., healthcare finance, quality improvement, etc.) or a thorough understanding of the many arenas of executive-level leadership will strongly benefit from this initiative as it exposes them to a variety of mentors and healthcare domains. Department heads and program directors who identify early physicians who are interested in healthcare administration may use this blueprint to guide residents toward a leadership pathway.

After completing the foundational courses mentioned above and with strong executive mentorship, residents should have a thorough understanding of what administrative physician roles exist in healthcare. Continued support of this initiative from hospital leadership ensures future residents the opportunity to lead projects and teams — two experiences crucial in leadership development.

Whether residents choose a path toward senior hospital management, healthcare payer and managed care, pharmaceuticals, or consulting, physicians will always be a valuable source of knowledge and experience. Residency training is a pivotal period during which early-career physicians are able to explore myriad career options within academic centers. Initiatives such as this offer preparation for a frequently overlooked yet critically important career path.

Current residency directors and department leaders should encourage early-career physicians to build these four healthcare leadership competencies, and they may do so by using this blueprint. This Blueprint for Aspiring Executives provides structured leadership development to physicians so that in the future, healthcare may be managed by those who best understand its complexity.

References

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2. Sarto F, Veronesi G. Clinical Leadership and Hospital Performance: Assessing the Evidence Base. BMC Health Serv Res. 2016;16 Suppl 2(Suppl 2):169. Published 2016 May 24. doi:10.1186/s12913-016-1395-5

3. Bai G, Krishnan R. Do Hospitals Without Physicians on the Board Deliver Lower Quality of Care? Am J Med Qual. 2015;30(1):58-65. doi:10.1177/1062860613516668

4. Kuntz L, Pulm J, Wittland M. Hospital Ownership, Decisions on Supervisory Board Characteristics, and Financial Performance. Health Care Manage Rev. 2016;41(2):165-176. doi:10.1097/HMR.0000000000000066

5. Molinari C, Alexander J, Morlock L, Lyles CA. Does the Hospital Board Need a Doctor? The Influence of Physician Board Participation on Hospital Financial Performance. Med Care. 1995;33(2):170-185.

6. Gupta, A. Physician versus Non-physician CEOs: The Effect of a Leader’s Professional Background on the Quality of Hospital Management and Health Care. J Hosp Admin. 2019;8(5): 47-51.

7. Gunderman R, Kanter S. Perspective: Educating Physicians to Lead Hospitals. Acad Med. 2009 Oct;84(10):1348–51. doi: 10.1097/ACM.0b013e3181b6eb42