The demand for physician leaders who can guide their organizations through health reform far outpaces supply, and it is not likely to change any time soon. Given the scarcity, health care organizations are in fierce competition with each other to attract and retain physician executives, especially the select few who combine stellar resumés with strong managerial and relational skills.

For hospitals and health systems that want to win the recruiting war for physician leaders, it's not enough to offer a top salary (many smaller organizations don't even have this luxury). They must find other ways to endear themselves to qualified candidates.

Support for the Position

Organizations need to demonstrate that they have an environment that is conducive for physician leaders to succeed. This isn't always the case. Physician executive positions — even chief medical officer, for example — are still somewhat new, and many organizations do not fully understand the best way to integrate them into their leadership structure.

One best practice is to establish clearly defined roles, authority and deliverables for physician executive positions, especially those newly created. If a health system is recruiting a CMO, chief clinical integration officer or chief physician executive, its managers must already have laid the groundwork by communicating to all stakeholders why the position is important to the organization, soliciting input from those stakeholders about the position's roles and responsibilities, and establishing where the new leader fits within the governance structure. Even before a candidate search begins, the organization should establish metrics by which the physician executive's success will be assessed and determine his or her compensation.

Strong candidates will be looking for these signs of preparedness. They also will want to know how, once on board, they'll be supported in the critical first few months on the job. Will mentoring or coaching be offered, for instance? This can be tricky for organizations in which there are few, if any, physician leaders already in place. It may be necessary to be creative and help new leaders connect with peers elsewhere. A case in point: One large metropolitan system recently hired a CMO for each of five different facilities. Once the CMOs were in place, they met regularly to share best practices and mentor each other.

Training can be a nice-to-have or even a must-have for many potential physician leaders, and progressive hospitals and health systems are developing their own in-house leadership programs to help identify and develop physician executives. Curricula vary in length and complexity, but the idea is to let talented physicians know that the organization is serious about career development and cultivating the best leaders for its current and future needs.

A Tale of Two Hospitals

Those health care organizations that have put in place an environment for success will win the hearts and minds — and, ultimately, the commitments — of qualified physician leaders. It is helpful to consider the tales of two health care organizations — Hospital B, as in "behind," and Hospital A, as in "ahead" — that conducted CMO searches recently, taking quite different approaches and receiving dramatically different results.

Hospital B had little experience in conducting widespread searches for key executives. Its idea of looking for a physician leader was limited — little more than placing an advertisement in the Sunday newspaper and interviewing the modest pool of candidates who applied. Clearly, a hospital looking for a dynamic new physician leader needs to think more broadly and market the position aggressively, both regionally and nationally.

The hospital had other challenges as it began its search. This was not the first time that Hospital B had hired a CMO. It had had several in the past, but none of them came in with significant management or leadership skills. They were all home-grown and had not been given meaningful opportunities to lead. Once in the position, they had little in the way of training or leadership development. As a result, they had no real understanding of the role, nor the authority, scope or duties usually befitting a physician executive. Thus, there was not a template for success for the position.

Part of the problem was the CEO, who had served for more than 20 years and did not appreciate the need for a broad leadership team that included physician executives. Certainly not every old-school CEO refuses to change, but in this instance it was true. He couldn't envision delegating significant responsibility to a physician or even other C-suite colleagues, and certainly couldn't envision looking outside his hospital for fresh ideas.

Fortunately or unfortunately for Hospital B, reality is now setting in. The changes sweeping the industry are pressuring the board and CEO to rethink their roles and bring in a visionary physician leader. The problem is that many candidates have shown lukewarm interest in the position. A few believe it's "not a good fit" for them. Translation: The job and organization are not viewed as attractive.

Hospital A never had a physician leader. Responsibilities that typically might have been assigned to a CMO were handled by an elected physician leader, namely the president of the medical staff. Over time, the demands of the position — conducting peer review, overseeing clinical program development, dealing with physician behavior issues, leading Joint Commission accreditation efforts and more — became unmanageable. The need for a full-fledged CMO was clear.

The CEO at Hospital A had never worked with a CMO before, but was a progressive thinker and good communicator. Recognizing her limitations, she began consulting with medical staff and hospital leaders about how a CMO might help and what they felt his or her main responsibilities would be. She worked closely with physicians — especially the skeptics who questioned whether the position was needed or worried that their roles as "informal leaders" within the organization would be undermined and diminished. By communicating openly and by putting many of the senior physicians on the search committee, the CEO got influential physicians to buy in.

The CEO also spelled out goals and responsibilities for the position, again with input from key medical staff. Looking to see what other similar hospitals had done, they established criteria and expectations by which the new CMO would be measured. They budgeted not just for the position's salary but also for training and mentorship opportunities.

As Hospital A went out into the market looking for its first CMO, it was ready. It knew what it wanted and let it be known that highly skilled physician executives were central to its plans for growth and development. A pool of viable candidates, internal and external, began to emerge. A few of these leading candidates confided that they were won over by Hospital A's enthusiasm and vision.

More Than a Salary

The tales of Hospital A and B are based on real organizations and situations. Some organizations just seem to get it when looking for physician leaders — they know that the market is tight and that good candidates expect much more than a handsome salary. Other organizations struggle to create the right environment for physician executives. Though they may win a few recruiting battles, they won't win in the war for talent.

Linda J. Komnick, M.H.A., is a health care consultant for the executive search firm Witt/Kieffer. She is based in the firm's Oak Brook, Ill., office.