As a pediatrician, I have always known the value of my presence. At least, that is how I remember feeling during long nights in the hospital taking care of sick children, in the clinic or in any situation that required pediatric expertise. “How can I help?” I would always ask as I entered an exam room. Answering questions from wide-eyed parents about their foreign and frightening new bundle of joy, connecting with a teenager who just “couldn’t talk to my mom about it,” resuscitating a blue neonate reluctant to take that first breath, reassuring reluctant parents about the merits of childhood immunizations … I could easily identify and see the value I was providing and the meaning in a day’s work.
Five years ago, I offered to provide temporary assistance in the C-suite because our physician-owned multi-specialty medical organization was searching for its first full-time medical director but needed some physician leadership while we looked. The work seemed interesting, and I felt I could be of service. I never expected that this gesture would mark the end of one career and the beginning of an entirely new one.
My role as a medical director, and eventually as a chief medical officer, felt familiar in some respects and very foreign in others. I often felt like the entire medical staff was now my pediatric practice; that the doctors were my new patient panel and my job was to be of service — to improve their work health, to ease their experience and to answer their questions. My desire to understand physician burnout — to assess its impact on our own doctors and to identify and eliminate its contributors — was part of this mindset. Burnout was the epidemic ravaging my new “patient” population. By making doctors’ lives better, I knew I could positively influence the experience of each of their patients, thereby expanding exponentially my opportunity to be of service.
But the pace of work as an executive was entirely different from anything I had experienced as a practicing physician. As an executive, daily work consisted of building parts of programs and projects that would take months, even years to complete. I often found myself too busy to eat lunch, yet reflecting at day’s end wondering, “What did I get done today?” The issues we would tackle seemed absurdly abstract and long-term compared to the concrete patient complaints I could tackle in an exam room. On occasional nights and weekends, I would gladly escape to the after-hours clinic, donning my white coat and stethoscope, certain that I could handle anything that walked through the door. The experience of confidence, competence and completion was a far cry from the steep learning curve I was scaling as an executive. The familiar exam room was a welcome relief from the alien environment of administrative offices.
Like most physicians, I insist on being very good at what I do. I want to be an expert at whatever I am responsible for. I understood that organizational dysfunction and a lack of effective leadership contributes to the epidemic of physician burnout. And so, I pursued an education in medical management and leadership development, taking on the courses and curriculum with the same fervor I felt in medical school. The insights I gained were brought back to my organization with enthusiasm as we tackled nothing shy of cultural transformation. The physicians created a new vision for the organization, we built a clinician compact that outlined the commitments required from all in order to achieve that vision, and we started tackling the daily “pain points” for physicians and their patients that had always seemed too endemic to eradicate. While I understood conceptually the importance of physicians leading change, it was only over time and in retrospect that I began to see the concrete value of physician administrative leadership.
Six months ago, I began serving as the CEO of our organization. We decided to become a physician-led group rather than just physician-owned. My old role of chief medical officer is now filled by four part time medical directors. I get to support, develop and mentor other physicians as they explore their leadership capabilities and expand their management competencies. But I am no longer just overseeing the medical staff. The well-being of an entire healthcare organization, the 750 employees and the 100,000 or so patients that rely on us are now my responsibility. And contrary to the need of every fiber of my being, I can no longer be an expert at what I am now responsible for. I have taken my accounting and finance courses, but will never have the expertise of our tenacious and meticulous CFO. I have studied operations and management control systems but will never have the perspective, patience or methodical approach that our phenomenal COO exhibits every day.
It seemed that the work of a chief medical officer was abstract and diffuse, but the daily work of a CEO is even more ethereal. My job now is to honor our core values, to identify and articulate a strategic direction, to hire the right people to help us get there, and then to provide resources and remove barriers to keep everyone moving in that direction. “So what do you do all day?” my teenage son asked me. I used to be able to answer him with an interesting case presentation about a child his age, someone I saw in clinic that day. His eyes now glaze over if I try to tell him about what I do. There are days when I miss direct patient care and the clarity of personal value it provided. But this new role represents yet another steep learning curve and an even greater opportunity to find answers to my favorite question, “How can I help?”
Karen Weiner is CEO, Oregon Medical Group, Eugene, OR.
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