Interview with Dr. Norm Chapin

My name is Dr. Norm Chapin. I am the Medical Director for Columbia Memorial Hospital in Hudson, New York. 

How big is the hospital?  They are currently staffed for 120 beds. 

Can you describe for me some of the steps you’ve made in rising through the leadership ranks?  I graduated from my residency in 1985 and for the first 5 years from 1985-1990 I practiced clinical emergency medicine.  In 1989, I was assigned responsibilities related to EMS education and ED quality management.   In 1990, I took a directorship position of a very small Emergency  Department near Detroit, Michigan and I worked there for about a year. I realized that I had taken that position maybe a little bit sooner then I was ready. I felt like I did not have adequate administrative experience.   My wife and I were looking to move out of Detroit at the time so we moved out of Detroit in 1991.  I went back to just practicing clinical medicine and emergency medicine again. 

Then a couple of years later I was given the opportunity to assume responsibility for the Quality Management Program in the Emergency Department.   I started doing some administrative work again and in 1996 when I accepted a position as Assistant Director of an Emergency Department near where I had been working. 

At that time, how much time was split between clinical practice and administrative practice? At that time, our normal clinical commitment was 144 hours per month, 12 - 12 hour shifts and I was doing 120 hours of clinical and 24 hours a month administrative time. 

As time went on did you do anything in particular to improve your leadership abilities or management abilities?  At that time, other than having a mentor I really didn’t take any formal courses in administration and leadership. Most of my CME classes were straight clinical courses.  I was doing more teaching all the time and I was learning more about how to present data to people but it was pretty much seat of the pants learning.  I really didn’t get into any kind of formal education at that time. 

When did you get into any kind of formal education?  In 1999, I was promoted to the Chief of the Department and I joined the American College of Physician Executives and I began taking some of their courses. I took my first course from them in 2000.  I also joined the ACPE list serve and began receiving their publications.  I was initially going to get my CPE Certification through ACPE and I took approximately 50 credit hours or so toward that but never completed it. 

You are enrolled in a more formal program now.  How did you decide to do that?Well, between 1999 and now I had assumed additional administrative roles.  Within the hospital I was elected as Secretary and Treasurer of the Medical Staff. The Emergency Management Group that has the contract at our hospital had branched out and I had taken a leadership role in getting two new contracts for the group. I was involved in negotiations with 3rd party payers, involved in negotiating with hospital administrators about contracts, I was doing a lot of recruiting, a lot of human resources types of things and I just realized that I needed to have a better background on the business side of medicine and healthcare in general. I’ve been interested for the past 4 or 5 years and going for my masters degree I had been challenged to really find the time to do that.  I had looked at several programs that were completely self study.  There was a little bit of a deadline to them but most of them were studying on your own, taking full on-line courses with no residency periods and that just didn’t work for me because it was too easy for me to push off the deadlines and I didn’t stick with any of those and didn’t think they would be a good fit for me just knowing my own personality.

A couple of years ago I met Mike Stahl who is the Director of the Physician Executive MBA Program at the University of Tennessee.  I talked with him. I was very interested in the program. It had a good track record.  We got a new ED contract shortly after my initial contact with Mike and I became totally immersed in the start up. Last year, 2007, I met Mike again at a national emergency medicine conference and applied to the program. I t was just very good timing for me. I applied and was accepted at the MBA program. I’m not quite half way through yet but it’s going very well. 

In your current position what percent clinical are you and what percent administrative?  Right now, I am only doing about 24-30 hours a month in the Emergency Department and the rest of the time I am Administrative. 

Do you see your clinical time further decreasing or staying about that level?  Emergency Medicine is a pretty demanding specialty and I still feel comfortable clinically right now but I when I became the Director, I went to half time clinically. That was back in 1999 and there was probably only one or two months in there that I actually only worked half time.  I was always picking up shifts for people because of scheduling problems and things like that so I always felt like I maintained a pretty good comfort level with clinical medicine. In the last year my clinical time has gone down to 2 or 3 shifts a month it is getting harder for me to maintain my comfort with practicing there.  I think over the next year as my administrative role continues to evolve, I’ll probably stop clinical medicine completely.

What advice would you give to young physicians who are considering being involved in leadership activities?   I would discourage young physicians from making a decision regarding full time administrative too early in their career.  I think my first mistake was taking on an administrative role before I really matured enough as a clinician to sustain that.  I don’t think I had enough maturity to deal with physicians who have been practicing for 20 or 30 years.  I don’t think I had earned my stripes so to speak.  I also think I tried to go from a position where I had very minimal administrative responsibilities when I was a director of a department too quickly.  So I think the best advice is to go slowly, make sure that you enjoy doing the administrative things, make sure that you gain enough experiences clinically so you can really be assured that your skills and your understanding of how healthcare works either in your specific specialty or throughout a multi specialty physicians organization or a managed care organization or a hospital organization which ever your practice has placed you.  M ake sure that you really do understand the organization well before you decide to take a real significant role there.  Committee participation, involvement in medical staff affairs, participating in performance improvement projects in the organization are each excellent opportunities to gain leadership experience.

What special skills or unique insight do you think physicians bring to the leadership table than non-physicians would not?  Well, I think we really understand other physicians better than non-physicians do.  I think we also understand patients in a way than non-physicians don’t, because we have really been with them through a lot of medical crisis.  We really understand their fears and their concerns.

I think we understand what physicians and what patients expect of physicians in a way that non physicians might not understand.  I think that gives us an advantage when discussing strategic initiatives within a healthcare organization or discussing  the vision or mission of a healthcare organization.  We have a different perspective of the complexity and how difficult it is sometimes to meet patient’s expectations and needs.  There are also aspects of healthcare as a business that we don’t understand or have a very different perspective of.  I think a team where both of those perspectives are represented at the Senior Executive level ,   gives  organizations a huge advantage in   responding  to some of the pressures that they face. 

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Interview with Dr. Kit McCalla

My name is Kit McCalla, I am a Osteopathic Physician and my job title is Orthopedic Surgeon. I also sit on several policy boards including the Arizona Osteopathic Medical Association Board of Trustees.

Do you have a current leadership position in your organization?  Board Member on the Board of Trustees for AOMA.

How big of an organization are you a part of?  It’s a service membership organization in the State of Arizona and it’s membership is about 900 members. 

What have been some of the steps or the positions you have had over the course of time leading you where you are today?  Mostly it is just getting involved.  The biggest thing early on seemed to be you raised your hand at a few committee meetings and the next thing you know you’re sitting on committees. If it’s your passion about what you do then it kind of goes easy from there. You just get involved in the development process for topics you have interest, the purposes and the mission of the organization you represent. 

What do physicians bring to the table as unique skills or attributes as leaders as opposed to some one who isn’t a physician?  Well, it’s definitely a perspective and what is unique about being a physician in a lot of leadership roles, whether it’s public policy or just sitting on a school board.  You really get the perspective of being on the side of the patient. You have a wonderful opportunity of years of education in studying people, the behaviors of people and how that plays into either different roles in government or society. 

What percent of your time do you spend with leadership versus seeing patients?  I am in private practice so I spend a ton of time in private practice and I try to do leadership nights and weekends and short episodes outside of practice. Essentially I am about 60-70% private practice work on my business and then the rest of the time is leadership.               

What type of training experiences have you had to prepare yourself as a leader?  Well, actually by getting involved.   I was noticed by other leadership people in the healthcare industry.  I actually volunteered once (or twice) and the next thing I know I was nominated to participate in a national health care leadership program called the HPF Health Policy Fellowship in 2005-2006.   The Fellowship program is a year-long graduate educational program is designed for individuals who are preparing for leadership roles in the osteopathic profession and positions of influence in health policy.  The program is through New York Institute of Technology and Ohio University and is modeled after an abbreviated version similar to the Robert Wood Johnson Health Policy Fellowship.

You are currently enrolled in the Physician Executive MBA program at the University of Tennessee.  What need is the program fulfilling in your training?   Well, from a practice standpoint or a professional standpoint there is an extreme frustration with the lack of knowledge from business in terms on how to create structure and run a business successfully.  It’s easy to run a business in terms of providing health care services to people/patients, but I have found it’s hard to keep the doors open and the light bills paid.   I am hoping by becoming involved in the MBA program I will be able to develop a viable medical practice which can continue to deliver the highest quality of care at value prices to the consumer.  Beyond that, from a leadership standpoint, I feel compelled to try and help more people in a more meaningful way, as a leader in health care policy or in terms of health care reform than as just a “provider” one patient at a time in medical practice. 

That seems to be a common statement I hear from physician leaders, rather than a patient at a time they are improving the health and wellbeing of groups of patients. 

What advice would you give to clinicians who are considering being involved in leadership positions?  First of all, I think the physicians are going to either consider getting involved or not. In my opinion, you are either going to be angry, frustrated, and bitter (and complain a lot) or you are going to be frustrated and motivated to get involved.  Those will get engaged and try to make a difference. 

In my observation, Mike Stahl, PhD, Director of the University of Tennessee Physician Executive MBA Program, engaged this “frustration” interacting with prospective physician MBA leaders at a physician convention last year, and he quickly identified how some physicians like us were in the latter division. 

It was an interesting observation of human (physician) behavior, just the topic of healthcare and the problems in healthcare really stimulate a lot of emotion from physicians across the board.   There are some that seem to just be bitter, angry and in various stages of shutting down, whether it be their practice or their engagement with health care in general.  Others seem to be stimulated by the dialogue, the debate, and how they may try to participate in making a positive difference to populations of patients. 

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Interview with Mike Stahl of PEMBA

This interview with Michael Stahl, PhD, program director of the University of Tennessee ’s Physician Executive MBA (PEMBA) program is the first in a series of interviews dealing with physician leadership.  Physicians who are contemplating leadership roles will benefit from the experience of  physician leaders and mentors of physician leaders.  Medicine’s many challenges can be conquered with the participation of clinicians who have a firm understanding of patient care and have been schooled in modern business practices.  This series of interviews is for our developing physician leaders, we need you.

 

 

Good morning my name is Mike Stahl, Program Director of the Physician Executive MBA at the University of Tennessee.  I’m also a Chaired Professor of Business.  I teach strategy and business planning in both the Physician Executive MBA and the full time MBA at the UT and I attempt to lead the faculty and lead the Physician Executive MBA Program.

  

What qualities do you see coming through in clinicians in their leadership roles that are unique and different from other MBA students?  Pete this is a real easy question for me because you are really asking what was the driving force and the driving theme behind this Physician Executive MBA and its 11 year history.  When we designed this program in 96 and 97 (we taught the first class in 98 ) our guiding mantra was always the issue of physician leadership.  Our guiding mantra was always to empower physicians who wanted to lead.  Because we on the faculty had an underlining theme that physicians, because of Hippocratic Oath, because of Physician’s Oath, because of their understanding of the patient and patient outcomes first and foremost, because of the guiding light of do no harm,  physicians are in a far better place to lead healthcare organizations than non professional employees.  When we train full time MBA students who are not physicians, who are not clinicians, when we train them in a full time MBA program whether at the University of Tennessee or any other accredited MBA in the United States, you can train a 30 something person with all of the tools and techniques of business and they can analyze any healthcare operation, they can come up with lean ways of doing business, they can improve the efficiency but since they are not physicians, they not imbued with that notion of do no harm.  How does this change operation or how does this new outpatient whatever or how does expanding the capacity of the hospital or how does adding another hospital or building another facility, they don’t think first and foremost what does it do for the patient.  They think almost as any other business enterprise; what does it do for the enterprise. The issue of the patient first and foremost is the biggest difference that we see between physicians leaders and non physician leaders in healthcare.

  

Are there particular skills that physicians/leaders have to concentrate on developing more than the average MBA student?  Yes, in the sense  most physicians that we see do not have degrees in finance, do not have degrees in economics; do not have degrees in Accounting in the undergraduate level.  In fact, I should substitute the word almost all for the term most because they have not had that undergraduate background when we designed the curriculum for this Physician Executive MBA.  We’ll start those core areas in business (finance, accounting, and economics).   We’ll start at a level that I’m going to call basics and then try to bring everyone along to the same level.  By the time they graduate they’ll be capable of designing pro-form financial statements for a business plan for a new healthcare enterprise but at the beginning most do not have skills in finance, economics and accounting unlike many other full-time MBA programs where half the class might have degrees in business and the other half might have multiple courses in undergraduate business so you see the different starting point.

  

What advice would you give to Clinicians that are just beginning to get into leadership roles and beginning to think about what they should do to be providing themselves with additional expertise and training?  I guess I would give two pieces of advice.  My first would be know thyself.  Know where he or she wants to go in a leadership role.  If he or she is interesting in influencing the course of health care delivery in a larger context than just his or her own immediate patients, if you know that to be your future then I say develop those leadership skills.  If alternatively you see primarily almost exclusively in a clinical role than ones future in a leadership role is obviously limited.  Now, if the answer to the first question is yes, that the physician wants a broader leadership role my first piece of advice is to go to non degree short courses, whoever offers them.  Some short courses in leadership and healthcare, some short courses on dealing with issues where physicians need to become involved in changing those organization policies concerning the problem.  If those courses feel good, if you take a course in strategy or take a course in leading other professional employees or you take a short course in finance or short course in other issues concerning broader context of healthcare beyond your own immediate patients, if those short courses feel good then you might think longer term in terms of a degree not unlike a Physician Executive MBA (PEMBA).  If those short courses don’t feel good then again maybe your role in the future is not so much in a physician leadership role but maybe more in a classical clinical role.

 

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