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Chief “Yes” Officer – The Erosion of Physician Leadership

J. Michael Connors MD asks if physician leaders are just saying "yes" as part of the C-Suite as opposed to representing the needs of the medical staff.

May 27, 2024

I am often intrigued by younger physicians who believe that doctors are victims of being employed, contracted, or under the services of large employers, private equity, etc.

The fact is that this wasn’t always the case.

The corporate practice of medicine is a popular topic when discussing investors and private equity, but it also applies to the growing mega-insurers, health systems, hospital systems, non-profits or for-profits, and even large roll-ups of private practices.

It’s not always the case, but it has become widespread enough that I feel I can generalize to prove a point. Different companies and people have different perspectives, but from my experience—even recently where I was bullied by the CMO for speaking up about lack of clinical outcomes—I find this more the rule than the exception.

Ironically, I received great concern from physicians about a “Chief Outcomes Officer“.. and yet shouldn’t we question our current hierarchy?

In the past, the role of the Chief of Staff was a critical one within hospitals, representing the voice and interests of the medical staff. Over time, this role has evolved into what is now commonly known as the Chief Medical Officer (CMO), appointed by the hospital’s (employer’s) corporate leadership. This shift marks a significant change in the dynamics of medical leadership, with profound implications for physicians’ autonomy and the overall governance of medical practice.

 

Key Differences

Narrative: The Lies of the Chief “Yes” Officer

 

Back in the day, physicians held the reins of medical leadership through the position of Chief of Staff. Elected by their peers, these chiefs were the guardians of medical care standards and physician conduct, separate from hospital administration. Their role was to represent the medical staff’s interests, lead committees, and ensure a fair process when addressing concerns about patient care or physician behavior.

Today, however, hospitals have embraced a corporate hierarchy. The C-Suite now appoints the Chief Medical Officer (CMO), fundamentally altering the balance of power. Unlike the elected Chiefs of Staff, CMOs are often seen as extensions of the administration, more aligned with corporate objectives than the independent ethos of their predecessors.

 

Consider these differences:

  • Selection and Compensation: Chiefs of Staff were chosen democratically and served without extra pay, driven by a sense of duty and peer respect. CMOs, on the other hand, are appointed by hospital executives and receive substantial compensation, often more than what they earned in clinical practice.
  • Handling Concerns: When disputes arose, Chiefs of Staff relied on independent review committees, ensuring that both sides were fairly heard. In contrast, CMOs manage these issues alongside HR, treating physicians like any other employees, with the final decisions often reflecting the will of the C-Suite.
  • Relationship with Administration: Chiefs of Staff had the autonomy to question administrative actions and represent the medical staff’s views. CMOs, however, are generally expected to endorse and promote new policies, acting as cheerleaders for the administration that employs them.
  • Term and Representation: The tenure of a Chief of Staff was typically short, ensuring a rotation of perspectives and specialties, fostering a broader view of medical practice. CMOs, however, often serve indefinitely, their tenure depending on their ability to maintain favor with the executives.

 

The Consequences

As hospitals and other businesses shift towards this corporate model, many physicians feel the strain.

Burnout, feelings of being bullied, and a loss of autonomy are increasingly common.

Physicians report feeling over-regulated and unappreciated, their professional destinies controlled by others.

These sentiments reflect a broader disillusionment with the CMO role, perceived by some as merely a “Chief Yes Officer,” more attuned to the desires of hospital executives than to the needs and voices of the medical staff.

 

Unlike the elected Chiefs of Staff, CMOs are often seen as extensions of the administration, more aligned with corporate objectives than the independent ethos of their predecessors.

 

Additional Considerations:

  • Balancing Act: While the CMO’s role can be seen as aligning more with administration, it also has the potential to bridge the gap between medical staff and administration. Effective CMOs can advocate for physicians’ needs within the corporate structure, though this requires careful balancing.
  • Varied Experiences: The experiences and effectiveness of CMOs can vary widely between institutions. Some CMOs might effectively champion physicians’ interests and enhance collaboration, while others may indeed function as “Chief Yes Officers.” This variability suggests that the issue may not solely be the role itself but how it is executed.
  • Evolving Healthcare Environment: The changes in leadership roles also reflect broader trends in healthcare, such as increased regulatory requirements, a focus on quality metrics, and financial pressures. These factors necessitate a more integrated approach to management, which the CMO role is designed to address.
  • Potential Benefits: The corporate model can bring benefits, such as streamlined decision-making, consistency in policy enforcement, and potentially better integration of clinical and administrative functions. However, these benefits need to be weighed against the potential drawbacks outlined.

Conclusion

This assessment captures the tension between traditional and modern medical leadership roles and their impact on physician autonomy and morale.

While the move towards a CMO can align with corporate efficiency and regulatory compliance, it is crucial to ensure that this role also remains attuned to the needs and voices of the medical staff.

Balancing administrative goals with the preservation of physician autonomy and engagement is essential for the sustainable and effective governance of healthcare institutions.

As entities grow, these chasms often widen for physicians.

Due process, dialogue, physician leadership, handling of clinical concerns, and singling out physicians who don’t follow the corporate way become even more prevalent.

or younger physicians, the solution isn’t necessarily unions, avoiding employment, or running to solo practice. Instead, we need to reclaim the clinical practice of medicine, ensure fair treatment of colleagues, and bridge the divide between people and profit. It’s not about waiting for regulation or government intervention; it’s about speaking up and acting differently in how we manage our own politics, conflicts, and ensuring due process.

If we leave medicine to others, we see the outcomes.

To take back medicine, it will take partnering with and sometimes complying with profit-minded folks, but always with the ultimate goal of maintaining the integrity and autonomy of the medical profession.

By doing so, we can protect our roles as healers and advocates for our patients, ensuring that the practice of medicine remains true to its core values.

 

To take back medicine, it will take partnering with and sometimes complying with profit-minded folks, but always with the ultimate goal of maintaining the integrity and autonomy of the medical profession. Share on X

 

Note: As a reminder this newsletter is written from my experience and perspective. The article does not imply or relay the opinions of others.  The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.  I am a physician and so can only write from my perspective. If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree and have not intention to suggest or imply that only the physician perspectives matter.  They do matter but as part of a larger dialogue that can foster better health outcomes.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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5 Responses

  1. Yes this change is all part of the transition of medicine from a “cottage industry” to a corporate enterprise. Having served on the board of a 550 bed hospital for a three year term at the turn of the century as the transition was gathering steam it was obvious the administration wanted cheerleaders or as I thought of them, bobble heads. The one very important point, perhaps the most important that you left out was the physicians’ authority to advocate for the medical staff had to be anchored not on self interest, but on the interest of our patients. Today the doctors need support to allow them to provide the best care for our patients. It always has to be in the best interest of the patient.

    1. Patient centered care is long gone. It’s now much more about physicians being employed and “saying yes” to those seeking profit over physicians, patients and relationships.

  2. In my experience, when a physician is employed as a “medical director” by an organization with a controlling leader, he/she has only a little leeway to disagree with the organization’s decisions. Push the limit and you will be quickly replaced by one of the Dr. Arnolds (first name, Benedict), who are willing to sell out medical/patient care principles for personal gain.

  3. The true cause of loss of autonomy is an economic hit by Medicare/Medicaid that was then followed by all private insurers: That it was fraud or breach of contract to charge the patient more than a copay to cover costs. This has led to the downfall of autonomy whereby practices are unable to meet over head costs by charging patients what is necessary. Downstream results? Higher volume patient mills. Equity and corps coming in to apply lean six sigma and factory line mentality that has led to the many woes that we now lament. We should look to how dentists and veterinarians are still able to be successful in private practice because of this simple inflection point.

  4. It is clear on the east coast the CMO is just risking his or her license to validate the financial directives move them in move them out code for the dollars or get out it is commonly known to raise a quality concern is to result in dismissal the medical boards in most states can only punish the providers not the employers .
    I have heard it said this is why we pay malpractice insurance .
    The golden goose is dead .
    I have seen it from its highs to now the very lowest form of health care .
    With out a union medicine is done

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