Perspective: physician leaders and their bases of power: common and disparate elements

Physicians hold numerous types of leadership positions in academic, executive, and/or clinical environments. To be successful, physician leaders must exert power, or social influence, as power is conceptualized in social psychology. The power of leaders accrues through their positions, expertise, or other factors, such as communication abilities or their ability to influence others to identify with the vision they espouse. This article discusses the types of leadership roles that physicians play and the power types they must apply in these roles. Crossing all leadership roles are a series of necessary personal characteristics and interpersonal competencies that result in what has been called "referent power," a more subtle form of social influence that is crucial for success regardless of position. Leadership training that includes practice in cultivating these personal characteristics and interpersonal competencies should be an essential component of medical and graduate medical education. Studying the types and nature of power also would be a valuable contribution to courses on professionalism in medical practice. Examples are provided of the types and uses of power that may be applied in the various leadership roles that physicians hold.

Using speed dating sessions to foster collaboration in continuing interdisciplinary education

INTRODUCTION

There are numerous examples of care gaps that could be reduced through enhanced knowledge exchange and practice collaboration between medical specialist physicians. In this paper, we report preliminary results on using speed-dating sessions (SDSs) to stimulate the development of continuing interdisciplinary education (CIDE) activities.

METHODS

In 2007, a 35-minute SDS was carried out during a 2-hour faculty development workshop to provide continuing medical education (CME) directors of Quebec's 35 medical specialist associations with a formal opportunity to quickly share clinical issues and goals. A post-workshop survey was used to assess participants' satisfaction and whether they had met new colleagues, learned about interdisciplinary issues, and discovered opportunities for collaboration. CME accreditation files were audited to assess the occurrence of CIDE activities in the year prior and the 2 years that followed the workshop. CME directors were called to assess whether the development of these activities was directly attributable to their participation in the SDS.

RESULTS

CME directors of 26 specialist physician associations attended the faculty development workshop. The vast majority of survey respondents (n = 18/20) were satisfied with the SDS and believed that this method was a stimulating and efficient way to meet new colleagues, quickly share clinical issues and goals, learn about unexpected but important interdisciplinary issues, and identify opportunities for CIDE collaboration. Sixty percent (12/20) reported having identified at least 1 opportunity for collaboration that was worth pursuing in the near future, and 19% of attending CME directors (5/26) developed a CIDE activity within 2 years, as compared with none in the previous year and for the 9 nonparticipating associations.

DISCUSSION

Results suggest that SDSs enhanced networking, knowledge exchange, and collaboration in continuing education among CME providers who participated in a faculty development activity on CIDE.

The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context

PURPOSE

This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting.

DESIGN/METHODOLOGY/APPROACH

Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives.

FINDINGS

This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives.

ORIGINALITY/VALUE

This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

Barriers to patient care in southwestern Ontario rural emergency departments: physician perceptions

INTRODUCTION

We sought to determine the perceptions of physicians staffing rural emergency departments (EDs) in southwestern Ontario with respect to factors affecting patient care in the domains of physical resources, available support and education.

METHODS

A confidential 30-item survey was distributed through ED chiefs to physicians working in rural EDs in southwestern Ontario. Using a 5-point Likert scale, physicians were asked to rate their perception of factors that affect patient care in their ED. Demographic and practice characteristics were collected to accurately represent the participating centres and physicians.

RESULTS

Twenty-seven of the 164 surveys distributed were completed (16% response rate). Responses were received from 13 (81.3%) of the 16 surveyed EDs. Most of the respondents (78%) held CCFP (Certificant of the College of Family Physicians) credentials, with no additional emergency medicine training. Crowding from inpatient boarding, and inadequate physician staffing or coverage in EDs were identified as having a negative impact on patient care. Information sharing within the hospital, access to emergent laboratory studies and physician access to medications in the ED were identified as having the greatest positive impact on patient care. Respondents viewed all questions in the domain of education as either positive or neutral.

CONCLUSION

Our survey results reveal that physicians practising emergency medicine in southwestern Ontario perceive crowding as the greatest barrier to providing patient care. Conversely, the survey identified that rural ED physicians perceive information sharing within the hospital, the availability of emergent laboratory studies and access to medications within the ED as having a strongly positive impact on patient care. Interestingly, our findings suggest that physicians in rural EDs view their access to education as adequate, as responses were either positive or neutral in regard to access to training and ability to maintain relevant skills.

Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors

OBJECTIVE

To describe the views of residency program directors regarding the effect of the 2010 duty hour recommendations on the 6 core competencies of graduate medical education.

METHODS

US residency program directors in internal medicine, pediatrics, and general surgery were e-mailed a survey from July 8 through July 20, 2010, after the 2010 Accreditation Council for Graduate Medical Education (ACGME) duty hour recommendations were published. Directors were asked to rate the implications of the new recommendations for the 6 ACGME core competencies as well as for continuity of inpatient care and resident fatigue.

RESULTS

Of 719 eligible program directors, 464 (65%) responded. Most program directors believe that the new ACGME recommendations will decrease residents' continuity with hospitalized patients (404/464 [87%]) and will not change (303/464 [65%]) or will increase (26/464 [6%]) resident fatigue. Additionally, most program directors (249-363/464 [53%-78%]) believe that the new duty hour restrictions will decrease residents' ability to develop competency in 5 of the 6 core areas. Surgery directors were more likely than internal medicine directors to believe that the ACGME recommendations will decrease residents' competency in patient care (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.5-6.3), medical knowledge (OR, 1.9; 95% CI, 1.2-3.2), practice-based learning and improvement (OR, 2.7; 95% CI, 1.7-4.4), interpersonal and communication skills (OR, 1.9; 95% CI, 1.2-3.0), and professionalism (OR, 2.5; 95% CI, 1.5-4.0).

CONCLUSION

Residency program directors' reactions to ACGME duty hour recommendations demonstrate a marked degree of concern about educating a competent generation of future physicians in the face of increasing duty hour standards and regulation.

Doctors who become chief executives in the NHS: from keen amateurs to skilled professionals

OBJECTIVES

To investigate the experiences of doctors who become chief executives of NHS organizations, with the aim of understanding their career paths and the facilitators and barriers encountered along the way.

DESIGN

Twenty-two medical chief executives were identified and of these 20 were interviewed. In addition two former medical chief executives were interviewed. Information was collected about the age at which they became chief executives, the number of chief executive posts held, the training they received, and the opportunities, challenges and risks they experienced.

SETTING

All NHS organizations in the United Kingdom in 2009.

RESULTS

The age of medical chief executives on first appointment ranged from 36 to 64 years, the average being 48 years. The majority of those interviewed were either in their first chief executive post or had stepped down having held only one such post. The training and development accessed en route to becoming chief executives was highly variable. Interviewees were positive about the opportunity to bring about organizational and service improvement on a bigger scale than is possible in clinical work. At the same time, they emphasized the insecurities associated with being a chief executive. Doctors who become chief executives experience a change in their professional identity and the role of leaders occupying hybrid positions is not well recognized.

CONCLUSIONS

Doctors who become chief executives are self-styled 'keen amateurs' and there is a need to provide more structured support to enable them to become skilled professionals. The new faculty of medical leadership and management could have an important role in this process.

Are your docs management ready?

Hospital chief executives are tapping physicians for upper management roles beyond the traditional chief medical officer and other primarily clinical positions. But often, these highly educated, entrepreneurial and strong-willed individuals need help acquiring the business and people skills to successfully make the transition.