Creating good governance structures and providing leadership training can increase physicians' engagement in medical groups, according to Marc Mertz, vice president of GE Healthcare Camden Group, a healthcare consultancy with offices around the country.
Mertz teamed up with Peter Valenzuela, chief medical officer of the multispecialty Sutter Medical Group of the Redwoods, a multispecialty group of 125 providers in Santa Rosa, Calif., at this year's Medical Group Management Association (MGMA) annual conference, held at the Moscone Center in San Francisco, Calif. Together the two explained how physicians can take more important roles in running medical groups.
More and more physicians are employees rather than owners of their practices, said Mertz, and this is causing them to feel less invested in the practices' success. Mertz cited a 2006 survey by Jackson Healthcare in which 36 percent of internists and 51 percent of surgical specialists were "actively disengaged" from leadership.
"This is just a recipe of disaster," said Mertz. "We'll never be able to respond to the opportunities and the challenges of the market if you have this level not only of non-engagement but active disengagement."
Addressing the problem requires involving physicians in the vision, strategy, operation, and oversight of the practice so they develop a sense of ownership, even if they don’t have legal or financial control, Mertz said.
Where physicians legally own a practice, they may have a role in the governance through a board of directors. But as employees physicians either have no formal place in medical practice governance or may only serve on advisory boards with no real power.
Instead, physicians should take leadership positions near the top of the organization. "You can call it what you want," Mertz said. "It could be a joint operating committee of a physician leadership council. The key is the physicians are at the table with the administrators dealing with high-level issues."
The physician leadership council or committee can then delegate to subcommittees nitty-gritty decisions, such as finance and technology. These subcommittees can offer an opportunity for young physicians to get involved in some issue they feel passionate about, and this experience will help develop their leadership skills, Mertz said.
Physicians should also help make decisions throughout the medical group, Mertz said. He recommended dyad structures in which a physician is paired with an administrator.
But creating a structure for physicians to participate won't help the organization unless physicians have leadership skills, said Valenzuela.
Sutter Medical Group of the Redwoods drew up a list of leadership skills from the book "FYI: For Your Improvement — Competencies Development Guide" by Heather Barnfield and Michael M. Lombardo. The top leadership asked physicians and their administrator partners to choose the leadership skills they wanted to improve.
The administrators and physician leaders identified 10 skills to work on, and chose coursework from the Harvard ManageMentor online curriculum that focused on those skills. For example, one module coached the leaders on how to run better meetings.
It can be challenging to justify the time physicians take away from clinical care and the money spent on such training, Valenzuela said. But the group has seen a 25 percent increase in work relative value units (WRVUs), a 41 percent increase in total patient encounters, and 28 percent increase in internal referrals from 2013 to 2015, suggesting that this work has paid off.