Is health care about to watch a rerun of its mistakes in the 1990s, when unprepared doctors were thrust into leadership positions, only to burn out wearing two different hats?

That was an idea surfaced by Frank Byrne, M.D., president of St. Mary's Hospital in Madison, Wis., during a conference I attended earlier this month. Byrne, himself a physician turned exec, seemed skeptical about docs in leadership when he spoke out from the audience during a session. So, I wanted to call and pick his brain for a story I'm working on for the magazine about physician CEOs.

Byrne told me that, while the rapid change going on in the industry is similar to what took place back in the 1990s, this time feels different. Physicians are actually getting the training and support they need to become leaders as hospitals are seeing that clinical integration is inevitable and it can't be done without docs at the top. But he says hospitals should be cautious in picking their leaders, and doctors need to know their limits when they take on larger roles.

"Pick the situation carefully and make sure there are clear boundaries and what you're trying to take on is realistic," he says. "As physicians, we sometimes don't know how to say 'No,' and we just take on more and more."

Fifteen years ago, the common thought was that doctors needed to be practicing medicine to be a successful and respected administrator. Byrne thinks that mindset is changing as doctors become more aware of work-life balance.

Still, it can be hard to put on a suit and say goodbye to patients you've built relationships with over the years. When Byrne made the switch from pulmonary and critical care doc to administrator, he had to ease away slowly and spent some time volunteering at a free clinic to get his fix.

"I loved patient care," he says. "There's nothing as immediately gratifying on a daily basis in administration as the physician-patient relationship. Every day, you knew exactly what you would accomplish, you knew who you could help, who you weren't able to help, and maybe you found other ways to support them and their family through a critical illness. In administration, there's nothing that really gives you that tangible, daily, immediate feedback and gratification like you get serving patients directly."

Doctors who really want to lead while still practicing may have some options. Emergency medicine could be a good fit, as it has a set shift that can be aligned to not interfere with administrative duties. Primary care, on the flipside, may not be as ideal, with regular patients showing up during the day expecting to see their usual PCP, who's off somewhere in a board meeting.

Byrne's advice for executives looking to promote physicians: Don't set them up for automatic failure. "Put people in positions where they have a chance to be successful, where they have an opportunity to really influence care and make it better, safer and more efficient, give them the training and support they need, and build the team in a way that they can be successful."

What has your experience been like with physician execs? Have you had trouble recruiting them? How have you molded young docs into future leaders? Has your hospital seen considerable improvement in its clinical outcomes since a physician CEO took over, or the opposite? Share your thoughts with me at mstempniak@healthforum.com, or 312-422-2605.