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Are You Ready to Become a Physician Executive?

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After learning biochemical pathways, memorizing notes as tall as yourself (my second year notes were measured to be one and a quarter times as tall as me), learning to become ambidextrous in the operating room, and taking the time to develop the social skills to have a calming bedside manner – you became a physician. Now you are considering becoming a physician executive in medical management. Being a physician executive means you will learn to become a coach and progress to being a mentor, read financial reports, quality surveys, discipline disruptive providers, and organize strategic long term organizational plans. With advanced training, you will strive to have staff members problem solve independently with assistance from your insight.

Some issues to consider:

Are you a self-starter and lifelong learner?
Are you accomplished at networking and using social media?
Are you willing to relocate, possibly often?
Are you good at wearing different hats? And adding new hats?
Are you ready to give up clinical medicine and wearing your white coat?
Are you ready to not be looked at the same by your peers?

How does a physician transition into becoming a physician executive? Some start by sitting on committees and boards within their facilities. Others perform part-time reviews of authorization requests and appeals. Typically, the career physician executive will initiate advance formal training in medical management from a resource such as the American College of Physician Executives (ACPE), Certifying Commission in Medical Management, or the American College of Healthcare Executives (ACHE). This training can be online or in person at meetings or concentrated tutorials. The ACPE, for example, has legendary courses such as Physicians in Management, Financial Decision Making, and the Three Faces of Quality. Newer coursework is available such as High Reliability 2.0 and the Integrated Health Systems Series. Additional helpful resources are the ACHE, Medical Group Management Association, and the American Academy of Family Physicians to name a few.

Additionally, you will again need to learn a new language – this time it is the language of health care, managed care, reimbursement, claims payments, etc. Did I mention the new acronyms you will see like alphabet soup in your sleep? ROI, LOS, COC, ADK, MLR, NCQA, COB, DOI, IBNR – this list is continuing to expand rapidly now with the addition of health care exchanges.

Physician leaders that have the talent and courage to become the liaison between providers and administration while staying abreast with advances in medicine are a rare breed. The best in the field network constantly, read voraciously (think New York Times, Wall Street Journal, USA Today, Bloomberg Business, Forbes), effectively communicate orally and in writing, possess computer skills including Excel and PowerPoint, attend state and federal forums on health care, read company financial reports, patient census, contracts, organize quality improvement projects, credential/recredential providers, motivate staff members, facilitate short-term and long-term strategic planning within local and corporate structure, and update policy regularly while managing to motivate stakeholders.

Becoming a part of an organizational family (whether hospital, insurance, private, government, academia, pharmaceutical industry, or consulting) can be an enriching position for a physician executive. These providers function by a defined set of expectations, responsibilities, objectives, and short- and long-term goals. Some manage from a distant location. Others literally manage by walking around interacting with staff members. These leaders are able to see the big picture for the organization and be judicious stewards for the state and federal trust funds.

Most enter medical management as an Associate Medical Director. These physicians have chaired some committees, volunteered in their community, managed a practice, lead a task force at the hospital or private group. Eventually, some became (or entered medical management) as a Medical Director. Be careful, as this is a very loosely held term and could mean many different things such as: you practice 95 percent medicine and manage the call and vacation schedules as your management duties or you manage 225,000 lives for one state for a national Fortune 100 company with no clinical involvement. In short, before you give up clinical practice, remember these two important caveats:

1) It is very difficult to go back; and
2) You will never be looked at the same again (colleagues will want to assume you don’t understand their plight as you are no longer a practicing clinician)

As you grow your knowledge base as a Medical Director, you may advance to a Senior Medical Director position and begin to be involved with the Senior Management team of the organization. At this level the ability to create and manage successful change within the organization is paramount.

With these accolades comes an opportunity to expand your knowledge base and comfort zone to the entire C-suite (Chief Medical Officer (CMO), Chief Quality Officer, Chief Medical Information Officer or Chief Clinical Integration Officer.) Sometimes these positions are with new organizations in different locations. If you have a spouse and/or children, deep consideration will occur whether or not this transition is the best choice for your family as a whole. As a CMO, you often will be tasked with managing the entire medical operations of your organization and be accountable for production, quality, grievances, cost savings, and growth. Some systems are corporate enterprises and have multiple CMO’s that feed into one centralized corporate CMO. If you are in this position you might lobby at the level of Washington, DC or for a national organization or branch of the military either promoted or elected. Many times you may cross into the political arena as you navigate your physician executive landscape. For some, they are able to side with a political party – others may choose to be bi-partisan.

Opportunities to be at the forefront of health care delivery and utilization are expanding as our health care climate is continually changing. You may want to consider or reconsider becoming a physician executive as you start your career or as a mid career change. Good physician executives are becoming increasingly sought after domestically and worldwide. For some, these roles can lead to an exciting and challenging transition for the next segment of your medical career.


Melissa V. Avery, MD, MMM, FAAFP, CPE has been an entrepreneurial physician executive for 14 years with roles for government programs and private insurers, including health care systems. She is a recertified family physician with a master’s of Medical Management from Tulane University, fellow from the American Academy of Family Physicians, diplomate from the American College of Physicians Executives and is a certified physician executive. Dr. Avery may be contacted at Bluegrass Family Health, 651 Perimeter Drive, Suite 300, Lexington, KY 40517, (615) 818-1967.