As CEO of a large integrated health care organization, Nicholas Wolter, M.D., has not seen patients in a clinical setting for a dozen years. Yet, he still thinks of himself as both a physician and an executive: "Your physician identity never goes away," says Wolter, chief executive officer of the Billings (Mont.) Clinic, a community-governed and physician-led health care organization. "But I also know that I have been able to have an ongoing and very significant impact on our patient community in my role as an executive by leading the Billings Clinic in terms of improving patient safety and quality of care."

Wolter's experience illustrates the challenges and opportunities in physician leadership. While the persistence of the physician identity makes it hard for many physicians to ever see themselves as leaders — or be seen as leaders by anyone else — Wolter shows that physicians can become strong leaders if they envision themselves in both roles.

For many physicians, the mental breakthrough that allows them to expand their sense of self comes from recognizing that they can have an even bigger impact on patient care as health care leaders than as clinical practitioners.

Addressing the Changing Landscape

Clinicians are facing strong pressures to keep up with major changes in the health care industry, including new payment strategies, evidence-based treatment protocols, fully integrated delivery systems, accountable care organizations and patient-centered medical homes.

These changes will require physicians to transform the way they practice medicine. Because they have experience in clinical practice, physician leaders frequently have credibility with clinicians, which makes them uniquely effective in convincing physicians to respond to the demands of the new health care models.

The challenge for the health care industry will be finding enough talented physicians who are ready, willing and able to step into leadership roles. Fortunately, there are steps health care organizations can take to help physicians make a smooth transformation from clinician to leader.

Preparing for Leadership Roles

Physicians often have been promoted into leadership roles based on their recognized clinical expertise. But an excellent physician is not necessarily a capable leader.

Health care organizations typically have attempted to prepare physicians for leadership roles by offering development programs with an emphasis on functional management skills — finance, governance, strategic planning and so forth. More recently, some organizations have enhanced their leadership development programs to teach physicians leadership competencies such as collaboration, teamwork and critical thinking.

These are all valuable skills for a physician leader to have, but they are not sufficient to transform a clinician into an effective physician leader. To make that leap, the physician must transform his or her self-image or self-identity. If physicians do not see themselves as leaders, no one else will see them as leaders either.

Succeeding with Initial Opportunities

If a physician's first leadership experience, often a departmental chairmanship, is negative, he or she may lose interest in any future leadership roles. Accordingly, health care systems have a vested interest in making a physician's first leadership experience as rewarding as possible to encourage physicians to continue on the leadership path.

In the past, hospitals often expected physician leaders to find their own way. They hoped that physicians could learn to be effective leaders through trial and error. Some may, indeed, overcome any initial stumbles and emerge from this crucible as leaders. But without proper support and training, too many physicians who could have been valuable physician leaders will become disillusioned and pull back permanently into clinical practice.

By better facilitating the transformation from physician to physician leader, health care organizations can strengthen their leadership pipeline. At the Billings Clinic, for instance, groups of physicians and nonphysicians meet on a quarterly basis for facilitated sessions on leadership behaviors.

"We also support continuing education for some of our physicians who want to obtain master's degrees," says CEO Wolter. "And more recently, we have been assessing high-potential leadership candidates and then providing customized development plans that include a mentoring component."

"Our experience has been that these types of development efforts are incredibly successful in terms of enabling our organization to develop a cadre of physician leaders who have the knowledge and skills to be effective leaders," concludes Wolter.

Finding the Right Physicians

Physicians do not just leap from being clinicians to being leaders; that transformation process starts with self-awareness. This means that health care organizations must determine what motivates candidates when evaluating clinicians for leadership opportunities: What energizes them? What attracts them to certain types of activities and situations? What draws them to the role of physician leader?

Asking these questions likely will reveal that some physicians are not attracted or energized by leadership roles or interested in holding others accountable for performance outcomes. This may be a disappointing fact for organizations that had pegged these physicians as leadership material, but it is better to make such a discovery early than figure it out later after a reluctant physician leader has turned in years of uninspired performance.

On the other hand, by giving promising young physicians opportunities to lead projects or cross-functional teams, health care organizations can identify potential physician leaders early in their careers. The earlier an organization can identify the physicians with the desire and skills to be a leader, the sooner the organization can give those physicians the behavioral and technical training they need to assume leadership roles.

Starting the Leadership Journey

There is no magical transformation that allows physicians to walk into a training session on Friday and emerge as physician leaders on Sunday. Evolving from physician to physician leader is a journey that takes time and requires periodic reinforcement at formal development sessions.

Health care organizations can enable the first phase of this transformation and demonstrate their commitment to physician development by offering emerging physician leaders training that shows them how to:

  • develop insights into their own values, strengths, areas for improvement and behavioral drivers;
  • identify their previous clinical success factors and the behavioral changes they will need to make to find success in their new leadership roles;
  • manage themselves and their relationship with others;
  • build their understanding of the role that self-image plays and reframe their self-image to lead more effectively.

Once they have become better at understanding and managing themselves as leaders, physicians can continue their transformation from clinicians to leaders by learning how to promote collaboration across their organization.

The formal transformation from clinician to physician leader should culminate in a "capstone project." Such a project gives developing physician leaders a chance to put their hard-won leadership knowledge to the test by tackling a business challenge or opportunity relevant to their health care organization.

Tapping Peer Power

Physician leader development programs are most effective when physician leaders experience the program together with other physicians as part of a group or cohort. The peer-coaching element of this group dynamic can play an important role in transforming physicians into leaders. In fact, physician leaders who went through training programs 10 years ago often say that they still keep in touch with other physician leaders from their training cohort and continue to benefit from their insights and perspectives.

By helping physicians master the emotional components of leadership, health care organizations can encourage the development of the capable physician leaders needed to guide the industry through the challenges ahead.

C.J. Bolster is national director of U.S. industries for Hay Group. Rod Fralicx is a vice president in Hay Group's health care practice.