Providers are looking to physicians to take on greater leadership roles, to move beyond their traditional patient care responsibilities. Those physicians with the inclination and ability to rise to the challenge are becoming hot commodities in the health care marketplace. "There's no question that competition for physician leaders is intensifying across the country," says Cliff Deveny, senior vice president of physician practice management at Catholic Health Initiatives. "As a result, recruiters are dangling bigger incentives in an effort to lure strong physician leaders away from their current employers."

For reasons discussed in our two previous articles, "The New Power Players" and "Is There a Leader in the House?," physician leaders will play a critical role in helping health care organizations navigate the transition toward accountable care models. Health care organizations, recognizing the need for strong physician leaders, are investing great amounts of time and resources in training, mentoring and recruiting a talented corps of physician leaders. Now they must determine how to not only retain them, but keep them engaged.

More than Money

Health care systems feeling pinched by cost-cutting pressures should be relieved to learn that salaries and bonuses are rarely the deciding factor in retention scenarios. "The biggest driver of retention in any industry is not usually money; it is the fit between the person and the role," explains Ziad Haydar, vice president for clinical excellence and physician integration at Ascension Health. "If hospitals are successful at integrating physician leaders into true leadership roles, they will have a greater chance at retaining those leaders."

What is a true leadership role? As Deveny sees it, physician leaders want the same thing that any other leader wants; they want to have input. They want to contribute to the organization's vision and its mission. "Physician leaders want to be treated like all the other senior executives, not just in terms of compensation, but also in terms of having a voice equal to the CEO, COO and CFO," says Deveny. "They want to have a meaningful relationship with these executives, not just serve as a figurehead."

Haydar agrees that giving physician leaders real influence is crucial to any retention effort. "Health care organizations will be able to retain physician leaders only if they use physicians as true leaders," he says. "In a healthy organization, that means clinical leaders should have a strategic role that is on equal footing with the CFO, the chief human resources officer or the general counsel. But this idea of giving physician leaders significant strategic authority is a new concept for most health care organizations."

Beyond a Conduit

The physician leader job, which began as an honorific post 20 years ago, evolved into an advisory position in which physician leaders were expected to monitor the pulse of a hospital's physicians and be their liaison to the CEO. "In recent years, however, the physician leader role has continued to evolve to the point where it is no longer just about leading physicians, but now relates to the entire health care enterprise," says Haydar. "In the future, a physician leader will have to be more than a chief quality officer. He or she will have to play a role in defining the ideal patient experience, the clinical goals of the enterprise, supply usage policies, vendor relations and which strategic programs the health care system should explore."

Omitting physician leaders from these strategic discussions has its risks, especially if competing organizations are giving physician leaders a seat at the table. "Physician leaders who are stuck in less strategic roles will be more likely to leave if another organization offers a position with true leadership potential," warns Haydar.

Beyond the flight risk issue, health care systems have good reason to give physician leaders greater authority and responsibility — their insights will be crucial if systems hope to succeed in the new health care environment. For example, as health care systems seek ways to cut costs and improve quality, they are moving toward developing evidence-based standards of care that can be applied across the organization. "There are some parallels to the development of clinical pathways in the 1990s," says Deveny. "But the difference here is that we are moving from saying we would like physicians to use the pathways toward requiring physicians to use them."

While physicians can make exceptions to these standards, their actions will be audited and explanations will be required for why they diverted from standards. "Someone, most likely a physician leader, will need to be able to communicate the rationality of this system and create a vision for embedding the protocols in the organization's culture," points out Deveny.

Using a "Magnet"

As health care systems search for a way to retain physicians, Deveny suggests that it might be wise to follow the lead of the nursing side of the medical profession, particularly in relation to the highly regarded Magnet Recognition Program certified by the American Nurses Credentialing Center.

"The Magnet system has existed for many years on the nursing side to encourage shared governance, leadership development and empowerment," says Deveny. "Maybe it would make sense to take these same principles and apply them to physicians? Most hospitals have hardwired ladder programs to take nurses from the bedside to leadership positions, but the same type of progression usually does not exist for physicians."

Responsibility, Accountability and Empowerment

It's a case of symbiosis: Physician leaders want an equal seat at the table with C-suite executives, and health systems need them to be there. Making physicians accountable without empowering them to lead change, however, is a recipe for turnover.

Imagine a situation where a physician leader is given responsibility for improving quality outcomes at a hospital. The physician leader identifies ways to reach those goals by changing some of the hospital's traditional relationships with high-volume specialists. "If the CEO then blocks those changes from a reluctance to upset those specialists, the physician leader is understandably likely to feel frustrated and look for other employment opportunities where he or she will feel less restrained in reaching quality improvement goals," says Haydar.

Retaining these leaders may not be easy, but it will be a key to success as the health care industry transitions to a model where hospitals will be paid less and expected to deliver a higher quality product with greater transparency. "It takes a certain kind of person to lead that change — a physician leader with street credibility and the background to analyze data and develop protocols for standards of care that can be implemented across an entire hospital or health care system," says Deveny.

Giving physician leaders pathways for growth and development, making them feel valued, giving them an equal seat at the table with other executives, soliciting their input on important strategic choices, providing them with attainable goals and empowering them to reach those goals — these are important retention tools for health care systems that depend on physician leaders to blaze a trail into an uncertain future.

Stephanie Sloan, Ph.D., is a senior consultant at Hay Group in Atlanta. Rod Fralicx, Ph.D., is a vice president at Hay Group in Chicago.