The role and scope of the CMO has transitioned and matured considerably over the past 30 years. Very few hospitals had a position of a senior medical leader, and the concept of “Let the doctors practice medicine and the administrators run the hospital” prevailed. But hospitals and evolving healthcare systems rapidly recognized the need for physician leadership at the senior administrative level. Physician executive positions came to be seen as not only valuable but also indispensable to the future of the organization.
The CMO became an integral member of the senior management team, with a unique opportunity to bring the needed medical expertise to the decision-making table. The trend of increasing responsibilities will continue. The successful CMO will have to personally evolve to keep pace.
The following are four challenges that a CMO will likely encounter through the course of a very rewarding career.
1. Master interpersonal and business skills not taught in medical school or encountered in the practice of medicine. In addition to the clinical arena in which the physician is typically very comfortable, the CMO must now thrive and grow in the business environment, with different rules and expectations. Many practicing physicians who choose administrative positions had no inclination they would do so when they were medical students or residents—or even in clinical practice. In the C-suite and boardroom, they are now surrounded by a team that has typically had much more knowledge and experience in the business aspects of the organization. To be a successful leader, the physician must learn business skills that were likely never taught during that physician’s original training.
The CMO is part of a team and must participate in shared decision-making and negotiations, a new challenge
for many physician executives. Fortunately, in recent years, the practice of medicine has also recognized the value of shared decision-making among the clinical care team, but this was not typically the case.
Because of the different skill sets required, the best clinician does not necessarily make the best CMO. The outcomes of administrative decisions may not be as straightforward as making a diagnosis based on a patient examination. A successful hospital safety program designed primarily by the CMO, for example, may achieve a substantial clinical result, but the success of the initiative cannot be drilled down to a specific intervention, as with an individual patient. The feedback is usually delayed. Administrative initiatives are on a 30,000-foot level, as opposed to ground-level outcomes with a particular patient. The differences between the clinical arena and business world in many ways are analogous to micro and macroeconomics—very different skill sets.
Thus, the new physician executive often has a learning curve in finance, marketing, decision-making and other fundamental business skills. Many seasoned CMOs believe it takes at least five years on the job to feel comfortable in the new environment.
2. Understand the difficult (and very personal) challenge of giving up clinical practice. As the CMO progresses along the administrative career track, the increasing demands may ultimately require the physician to transition out of direct patient care. Along this journey, the CMO begins a measured process of reducing patient care time. Entry-level medical administrative positions are usually part time, and patient care duties may not be substantially affected, but as the scope of administrative responsibilities increase (and the availability of clinical time correspondingly decreases), conflicts will inevitably arise. Most senior CMO positions today now require 100% administrative time.
The administrative and clinical responsibilities cannot be realistically compartmentalized. It is common for a patient to get sick during administrative time or an administrative crisis to arise during the clinical time. Juggling the two responsibilities often results in the frustration of fellow administrators and patients, as well as the individual CMO.
As the physician’s patient time decreases, there is the legitimate concern that clinical acumen and skills could be adversely affected. This is especially true for interventional specialists who must maintain a requisite volume of procedures to stay at the top of their game. Except for emergency physicians or hospitalists who can vary shifts per month, there is not a great deal of practical flexibility in reducing clinical time.
Typically, the decision point to end clinical practice comes sooner rather than later, and the CMO may likely reach a point where there is no turning back to clinical work. The issue becomes personal, as the love of practicing medicine, which brought that person into the field initially, must now be put aside. Fortunately, the CMO role has more than enough challenges. There is plenty of opportunity to immerse oneself in other productive medical endeavors.
Some believe ongoing clinical practice is necessary to maintain credibility with the medical community, but the successful physician executive will maintain credibility through the results achieved as a physician leader.
Becoming an administrator must be seen as a career transition, a change in specialties. Some responsibilities are added, some must be given up. Such may be the fate of clinical practice for the physician executive.
Despite giving up the practice of medicine, effective CMOs take pride in knowing that their administrative achievements contribute to the overall improved care of patients. CMOs continue to “practice” medicine, but on a different level.
3. Maintain competencies related to business, clinical and new technologies. All executives are challenged to keep up with changes that occur in their field. The CMO must maintain a comfort level in three areas: clinical medicine, business acumen and new, emerging technologies. This is a formidable task.
The business of healthcare is rapidly changing and evolving, and it will only get more complicated and sophisticated. All members of the senior healthcare team must stay abreast of these changes.
On the clinical side, the CMO needs to have a working knowledge of multiple specialties, not just the one in which that CMO initially trained. Most of the time, the clinical issues in the hospital occur in a field where that CMO had little or no formal training, a particular challenge for that CMO.
The CMO is in a critical position to evaluate, prioritize and implement new technologies. As an example, AI has exploded onto the medical scene in the past few years with the opportunity to revolutionize medical care. The CMO must be a major thought leader in the evaluation, selection and implementation of these new and emerging technologies.
Staying current in any one of these areas can be daunting. To be current in all three can require gargantuan efforts on the part of the physician executive, much more than the physician typically had to encounter while in clinical practice.
4. Develop and nurture a healthcare network. Like in all leadership positions, decisions made by the CMO can be difficult, and it is not uncommon to feel lonely or not have support systems. During these times, the CMO may miss the collegiality encountered in medical practice.
Furthermore, administrative decisions that are not popular with the medical staff only feed on the perception that the CMO has truly exchanged the white coat for a suit coat and has abandoned them.
During these times, it is imperative that the physician executive develop and nurture relationships with colleagues. Although every hospital is unique, most challenges that face all healthcare executives are remarkably similar.
Many times, other colleagues have dealt with the same issues. Discussions and collaborations among other executives can lead to mutually beneficial solutions, as well as the ability to candidly discuss a difficult situation.
The ability to groom, maintain and use a healthcare network is one of the most important things that a CMO can do to improve decision-making and even maintain a healthy and resilient attitude.
Yes, the CMO has come a long way, and it is even more exciting to look ahead and see where the position will be in the future. The CMO position can be extremely rewarding and challenging. There is new learning and new challenges every day.
Opportunities for collaboration abound.
Steven M. Berkowitz, MD, is chief physician executive at SMB Health Care Consulting, Scottsdale, Ariz. (steve@smbhealthconsulting.com).