Introduction-A Brief History of the Healthcare Delivery System and the Physician’s Role
The Healthcare Delivery in The United States has been constantly changing requiring physician’s
to adapt into their ever-changing roles in patient care. When the United States was first
becoming established as a country, physicians would make house calls and be capable of
treating all family members no matter the age or medical condition. A Physician during these
times had a strong personal relationship with most of his patients (Gutierrez & Scheid, n.d).
Following the industrial revolution, there were increased population densities, cities were
formed and so was their infrastructure including Hospitals (Mann, n.d.).
Hospitals began to change the dynamics of physician patient care. With more hospitals being
built physicians started to congregate together. They began to organize and eventually
established the AMA in 1846. The AMA realized the need for physicians to organize and to
form a standard medical education that would be regulated by the organization. Throughout
the first half of the 1900’s, physicians also began to specialize with the emergence of the
American Boards into fields of Ophthalmology in 1917, Otolaryngology 1924 and at least 17
other specialties by the 1950’s. By the 1960’s, the US population continued to grow but the
medical profession did not. These changes lead to public dissatisfaction with the healthcare
delivery system. A few of the contributing factors were; patient care became disjointed and
depersonalized because of the increase of specialists in the healthcare system, decreased
accessibility to healthcare in both rural and inner cities and a shortage of physicians in the US
workforce. (Gutierrez & Scheid, n.d)
Both the Federal government and the AMA began to address the public’s discontent of the US
healthcare system. In 1965 the Medicare program was enacted and the federal government
began to subsidize medical education. These actions were intended to decelerate increases in
healthcare cost and to encourage an increase in the physician workforce throughout subsidizing
their education. AMA began to study the impact of family medicine and by 1969 The American
board approved Family Practice as a new specialty. (Gutierrez & Scheid, n.d) Family Practices
flourished. Physicians began to develop more therapeutic relationships with their patients and
there was less fragmentation of healthcare delivery with the family physician becoming
involved in patient care.
By the late 80’s and into the 90’s Managed Care began to influence the healthcare delivery
system in effort to control rising healthcare cost and improve efficiency of healthcare providers.
This had a negative effect on practicing physicians especially the Family Practitioners. Family
doctors were described as the “gatekeeper” of healthcare (Gutierrez & Scheid, n.d) Many
patients would blame the MD for not allowing certain procedures to be prescribed and the
physicians would blame Manage Care in limiting their scope of practice. Family doctors were
forced to document and provide evidence to the manage care providers demonstrating the
patient need for either a specialty service or procedure. Their roles began to slowly change
requiring more paperwork at times then hands on care of patients.
Further laws were enacted on August 21, 1996 the Health Insurance Portability and
Accountability Act (HIPPA) and the Patient Protection and Affordable Care Act (ACA) effective
March 23,2010. HIPPA added another element for the physician to manage. Strict guidelines
as to how medical information was to be shared/stored and used needed to be followed or
fines would be issued. This law again forced the physician into a more administrative role in
regards to management of their records and staying in compliance with HIPPA regulations.
Besides physicians managing legal compliance in office procedures, the ACA may have a large
drastic change for the healthcare delivery system.
According to the U.S. Department of health and human services website the following laws will
be enacted by 2013.
Linking Payment to Quality Outcomes The law establishes a hospital Value-Based Purchasing
program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to
improve the quality of care. Hospital performance is required to be publicly reported, beginning
with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care
associated infections, and patients’ perception of care.
Encouraging Integrated Health Systems. The new law provides incentives for physicians to join
together to form “Accountable Care Organizations.” These groups allow doctors to better
coordinate patient care and improve the quality, help prevent disease and illness and reduce
unnecessary hospital admissions. If Accountable Care Organizations provide high quality care
and reduce costs to the health care system, they can keep some of the money that they have
Improving Preventive Health Coverage To expand the number of Americans receiving
preventive care, the law provides new funding to state Medicaid programs that choose to cover
preventive services for patients at little or no cost.
Expanding Authority to Bundle Payments The law establishes a national pilot program to
encourage hospitals, doctors, and other providers to work together to improve the
coordination and quality of patient care. Under payment “bundling,” hospitals, doctors, and
providers are paid a flat rate for an episode of care rather than the current fragmented system
where each service or test or bundles of items or services are billed separately to Medicare.
For example, instead of a surgical procedure generating multiple claims from multiple
providers, the entire team is compensated with a “bundled” payment that provides incentives
to deliver health care services more efficiently while maintaining or improving quality of care.
It aligns the incentives of those delivering care, and savings are shared between providers and
the Medicare program.
Physicians will again have to be adaptable to their changing role in healthcare. Most
importantly they will not be able to do it alone. Physicians will need to lead and be leaders
within all aspect of the healthcare system. They need to learn how to implement and facilitate
team efforts in both caring for patients as well as playing a large role in administrative decisions
effecting patient care. Are Physicians ready for this challenge? What is the current core
curriculum of current medical students? Are they prepared? What core educational needs will
todays physician need to be prepared for the changing healthcare system? The intension of
this paper is to explore these questions and formulate strategies that will assist in preparing our
physicians for the role changing demands that will be placed on them in the near future.
The Current Medical School Curriculum
The Requirements for Becoming a Physician
The education of physicians in the United States is a lengthy process that includes
undergraduate education, medical school and graduate medical education (American Medical
Association). Entry into medical school requires a BS or BA degree along with a set of pre-
requisite coursework emphasizing the basic sciences such as biology, chemistry, and physics.
In order to obtain the doctor of medicine degree (MD), four years of education is required at
one of the U.S. medical schools accredited by the Liaison Committee on Medical Education.
Medical school consists of both pre-clinical and clinical components. The LCME accreditation
process is a voluntary, peer-review process of quality assurance that determines whether
programs meet established standards (Liaison Committee on Medical Education).
After students complete medical school they must complete additional training before
practicing on their own as a physician. Newly graduated MDs begin a three to seven year
residency program for professional training under the supervision of senior physician educators
(American Medical Association), also known as Graduate Medical Education. Residents care for
patients under the supervision of physician faculty and participate in educational and research
activities. Teaching hospitals, academic medical centers, health care systems and other
institutions sponsor residency programs. The length of residency training varies on the medical
specialty chosen. For doctors who want to become highly specialized in a particular field, one to
three additional years of training in a subspecialty is also an option.
What are the core competencies in medical education?
To achieve and maintain accreditation, a medical program leading to the MD degree must meet
the LCME accreditation standards contained in a document titled “Functions and Structure of a
Medical School” published by the LCME. Within this document is a set of standards regarding
the educational program at U.S. medical schools, including the content of the curriculum. Some
of the required content areas include the following (Functions and Structure of a Medical
- Behavioral and socioeconomic subjects in addition to basic science and clinical
- Content from the biomedical sciences that support students’ mastery of the
contemporary scientific knowledge, concepts, and methods fundamental to acquiring
and applying science to the health of individuals and populations
- All organ systems, and include the important aspects of preventative, acute, chronic,
continuing, rehabilitative, and end-of-life care
- The basic scientific and ethical principles of clinical and translational research, including
the ways in which such research is conducted, evaluated, explained to patients, and
applied to patient care
- Prepare medical students to function collaboratively on health care teams that include
health professionals from other disciplines as they provide coordinated services to
Upon examining the full list of required content areas for the medical curriculum, it appears
that education about the non-medical components of medical practice – such as finance,
personnel management, team leadership, and regulatory systems – receives limited emphasis.
Although there exists a requirement to prepare medical students to work collaboratively on
health care teams, there are great benefits that can be gained from additional training in health
care management skills.
Is there a lack of leadership training in medical schools? What currently exists?
Upon conducting a literature review, it became apparent to our group that there is a lack of
data and comprehensive reviews regarding leadership development programs at the medical
school level. It is important to note that the LCME accreditation standards reflect the minimum
requirements of a medical curriculum. Medical schools are given flexibility to emphasize their
own institutional missions and educational objectives.
We would like to highlight several examples of medical programs that do offer opportunities for
students to train in leadership development and management. One is the Frank H. Netter MD
School of Medicine at Quinnipiac University. This medical school offers a Scholarly Reflection
and Concentration/Capstone Course that allows students to pursue scholarly research in an
area of interest related to clinical medicine. One of these areas is called Healthcare
Management and Organizational Leadership, which give students an opportunity to focus on
leadership to understand the characteristics of leadership and how to manage people and
direct organizational change (Quinnipiac University). Students select a project mentor and take
three graduate courses from across Quinnipiac University schools to gain focused skills in
The Duke University School of Medicine offers a Primary Care Leadership Track that emphasizes
community engagement, leadership, and population help to prepare future physicians to work
as partners within the community and address population health needs (Duke University School
of Medicine). Featured coursework includes Inter-professional Case Conferences, community
engagement, health literature, and a curriculum in leadership.
Creighton University School of Medicine offers a Program for Leadership Development that
supports medical faculty, residents and students (Creighton University). This program seems to
offer a series of symposia on topics such as team building, situational leadership, Meyers-Briggs
Type Inventory and mentorship.
As seen in the three examples above, although leadership development is not a requirement
for accreditation it seems to be offered in various medical schools. However, most of these
opportunities are not a mandatory part of the curriculum, it is either an elective or specific
curriculum track that is not applicable to all students. Also there is no data that exists on the
outcome or effectiveness of these leadership development opportunities. This would be an
interesting area of future research.
It can be argued that because physician leadership and management skills are of great
importance in the future of health care these topics should become a mandatory component of
the medical curriculum.
Leadership Development in Graduate Medical Education and Beyond
About 9,500 residency programs in 140 specialties and subspecialties exist that are accredited
by the Accreditation Council for Graduate Medical Education. Twenty-seven Residency Review
Committees carry out the work of reviewing specific programs and making accreditation
decisions, one for each major specialty (Accreditation Council for Graduate Medical Education).
The public has a sizeable investment in physician education. Over two-thirds of public financing
for Graduate Medical Education, which costs $15 billion annually, comes from the Medicare
program (Institute of Medicine, 2014). Therefore it is critical that physician training reflects the
changing needs of our nation’s health and health care system.
The ACGME establishes program requirements for the various residency specialties. They
outline a long list of ACGME Competencies outlined in a document titled ACGME Program
Requirements for Graduate Medical Education for each specialty. Some of the competencies
related to leadership include (ACGME Program Requirements for Graduate Medical Education
in Internal Medicine):
- Residents are expected to demonstrate the ability to manage patients in a variety of
roles within a health systemwith progressive responsibility to include serving as the
direct provider, the leader or member of a multidisciplinary team of providers
- Residents must demonstrate interpersonal and communication skills that result in the
effective exchange of information and collaboration with patients, their families, and
- Work in interprofessional teams to enhance patient safety and improve patient care
Based on these competencies required by the accrediting body, it seems as though there is
more emphasis on leadership development at the Graduate Medical Education level compared
to the medical school level. However, there seems to still be a lack of emphasis on some
management skills related to finance, IT, and human resource management.
Our group was not able to find any information regarding formal leadership development
programs in Graduate Medical Education programs. There was one report that evaluated the
impact of a 1-day retreat focused on leadership skills and team building for an internal
medicine residency-training program. The conclusion was that participants universally found
the opportunity to be beneficial in helping to develop teamwork (Stoller, 2004). The authors
acknowledge that the issue of teaching leadership and teamwork skills in residencies has
received little formal attention.
There seems to be increasing opportunities for leadership training once physicians have
completed their Graduate Medical Education. The Association of American Medical Colleges
provides a free resource titled National Leadership Development Programs that lists executive
management and leadership programs across the country. Some of these include the Executive
Leaders Program through the American College of Physician Executives, Women’s Leadership
Program through the Center of Creative Leadership, and various MBA programs (National
Leadership Development Programs, 2009). However, a majority of these programs seem to be
geared towards mid-career and senior-level individuals. This perhaps indicates a need for
earlier career leadership development opportunities.
What is Leadership?
The definition of leadership can be as simple as being in charge of a group of people working
towards a common goal. There are many facets of leadership that make up complex
definitions. Kevin Kruse of Forbes.com defines leadership as “a process of social influence,
which maximizes the efforts of others, towards the achievement of a goal.” The key elements
of Kruse’s definition is that “leadership stems from social influence, not authority or power,
leadership requires others, and that implies they don’t need to be “direct reports.” There is no
mention of personality traits, attributes, or even a title; there are many styles, many paths, to
effective leadership, it includes a goal, not influence with no intended outcome.” (forbes.com)
A common misconception is that management and leadership are synonymous. A manager
does not automatically exhibit leadership qualities and vice versa. Leadership characteristics
can be taught and training can be provided to coach employees to aid them to manage teams
and help employees reach common goals. The definition of leadership is always evolving and
will never be all encompassing, however there are a number of shared characteristics between
people that are viewed as successful leaders. Being a charismatic speaker, articulate, educated
and influential tend to be traits of good leaders. They are also generally open-minded, driven
and decisive, however, just because someone has these characteristics don’t automatically
make them a good leader.
The Physician Bridge to Leadership
No matter what specialty or practice of the Physician, leadership skills will be needed in either
their private practice or to assist hospitals in developing systems and programs in-patient
related care changes. According to Healthcare Leadership Alliance there are five critical
domains of which leadership intersects all.
According to the ACHE Healthcare Executive Competencies Assessment Tool, HLA defines the
above categories as the following:
Communication and Relationship Management
The ability to communicate clearly and concisely with internal and external customers,
establishes and maintains relationships, and facilitates constructive interactions with
individuals and groups.
The ability to inspire individual and organizational excellence, create a shared vision and
successfully manage change to attain the organization’s strategic ends and successful
performance. According to the HLA model, leadership intersects with each of the other four
The ability to align personal and organizational conduct with ethical and professional standards
that include a responsibility to the patient and community, a service orientation, and a
commitment to lifelong learning and improvement.
Knowledge of the Healthcare Environment
The understanding of the healthcare system and the environment in which healthcare
managers and provider’s function.
Business Skills and Knowledge
The ability to apply business principles, including systems thinking, to the healthcare
Knowledge of the
Where are the gaps?
After considerable review of medical schools curriculum there have been large identifiable gaps
in education related the needed future skills of our physician.
In general, core medical school curriculum is based on anatomy, physiology and treatment of
disease. It is evident that there is minimal education and attention to basic business
fundamentals, communication/team work skills and leadership development for present day
It is surprising that there is no business education considering a good percentage of these
Physicians will be expected to run their own practices including running the front office staff.
Another disadvantage in not having business fundamentals, as part of their education, will be
their inability to help assist in financial decisions affecting care in hospitals and nursing homes.
Physicians that do acquire business fundamentals will allow them to make better decisions on
how to organize their own practice. This fundamental business base can also be powerful asset
in in helping larger organization make financial decisions related to patient care. Only the
physicians and other medical professionals, who provide care, can understand how decisions
made in the boardroom can change processes that will affect patient care. It is imperative that
Physicians and other healthcare professionals be a part of decisions affecting patient care.
There is a large gap that needs to be filled for there to be success in the decision making
process. Business fundamentals education for Physicians will help fill that gap
Communication and teamwork is another identifiable gap in medical school curriculum that will
need attention. With nursing shortages, physician’s shortages and a changing reimbursement
rate on patient care, physicians need to utilize a teamwork approach to addressing their
patient‘s needs. They will need to work at their highest capacity of practice. This will also
include other’s involved in patient care to work at the highest level of their professional
abilities. Teamwork will be essential. No longer will the role of the Doctor be the “captain of
the ship”. He will need to lead, facilitate, and be a participating member of a team in
administrating patient care. Communication and teamwork skills will be essential in making the
healthcare team of the future be autonomous and efficient in healthcare delivery.
Leadership is a both a skill set and learned behavior. Leadership can be taught. It is the
individual that needs to choose if they can lead. It is only natural that the providers of care
including nurses and patients receiving care look to the doctor as the leader of their care.
Unfortunately most physicians have had little leadership developmental training. Leadership
training can be a very affective tool and component to a physician’s success in the future
healthcare arena. However, leadership’s true success is having competence in the knowledge
of focus and planning. Developing services and programs including teaching and research is a
complex process that requires vast collaboration with other experts for these programs to be
successful. Communication, teamwork and financial analysis are the core domains required to
accomplish the top ten administrative tasks performed by physician executives. As illustrated
by the nature of Medicine VS Leadership, physician’s current skill base does not match the skill
base required of executive physicians. In fact physicians who are interested in becoming
leaders will not only need more education, but they will also need to change their frame of
reference 180 degrees on how they view/solve problems and situations.
Leadership as we know it
As hospitals and healthcare systems continue to grow in size and complexity physician
leadership is more important than ever. Medical schools and hospitals, ideally, should be
instilling leadership skills in doctors from Day 1. Instead
"We do just the opposite with doctors," Hertling recalled his CMO, David Moorhead's
saying at the time. "We beat leadership out of them from their undergraduate to their
graduate schooling to their residencies to their first assignments in a hospital. Anything
that might be perceived as leadership, we tell them to knock it off because they're
always competing with each other. They're not building teams and they're not doing the
kinds of things that you would expect leaders to do." (Stempniak, 2014)
Capable leadership is essential for any organization to survive and thrive into the future. The
current healthcare climate in the United States is changing rapidly. Many new challenges have
emerged that are changing the direction and subsequent structure of healthcare delivery
systems in the public and private sectors. Political and economic trends are fueling the debate
about the high costs and inefficient structures and processes that characterize our current
healthcare delivery system. The advent of the Affordable Care Act, the rise of Accountable Care
Organizations and other models to transform healthcare delivery are rapidly changing
expectations of patients of providers and patients. All of these trends challenge current
leadership and performance models and mandate the implementation of such if currently non-
existent. (Department of Veterans Affairs, 2015)
Physicians are not immune to this changing landscape; these challenges need to be addressed
in a comprehensive fashion. There needs to be a more systematic, coordinated, and
strategically aligned approach to leadership development. The knowledge, skills and abilities
that are required of all leaders, physicians included, to attain any organizational goals need to
be consistently addressed and reinforced. In order to transform the current culture, there
needs to be a transformation in the approach to leadership development amongst physicians.
In search of potential leadership programs to implement many CEOs have been looking to
institutions that have distilled leadership development into a science, the U.S. military.
The Military Medical Model and Government Programs for Leadership
ARMY - ArmyMedical Department(AMEDD) officersdonotparticipate inBasicTrainingthatenlisted
Soldiersgothrough.TheyattendanOfficerBasicCourse (OBC),abasic orientationcourse tothe Army
HealthCare systemand the Armyway of life.
Air Force - CommissionedOfficerTrainingisafive-weekprogramdesignedtohelpease transition
from the healthcare,legal orreligiousprofessionsinthe private sectorintomilitarylife.Through
physical conditioning,trainingandclassroomstudiesthe goal istodevelopthe personintoanOfficer
and a leaderinthe UnitedStatesAirForce.The course isalignedinafour-phase approach.
NAVY – All Medical officersattendsome formof Officertraining.The statesgoal isto developnewly
commissionedpersonnelmorally,mentally,andphysicallyandimbue themwiththe highestidealsof
honor,courage,and commitmentinordertoprepare graduatesforservice inthe fleetasNaval Officers.
The purpose of thiscourse isto provide Officersthe trainingnecessarytoprepare themtofunctionin
theirrole as a newlycommissionedNaval Officer. Itprovidesabasicintroductionintofundamental
Officer Basic Course
One WeekPrepCourse- Thiscourse isdesignedforinitial-entryofficerswho
CommonCore : Phase 1-4
I – GENERAL SUBJECTS
Phase One –
on fundamentals of
Phase IV- Transition
from a training
environment to the
COMMISSIONEDCORPS OF THE U.S. PUBLIC HEALTH SERVICE - Officersattendingthe 14-dayOfficer
Basic Course (OBC) will receive anintroductiontothe CommissionedCorps.Emphasisisplacedonthe
Corpsas a uniformedservice.Thiscourse isdesignedprimarilytoassistthe transitionof new officersto
awards,and resource utilizationare some of the manytopicsintroducedduringthiscourse.
(CommissionedCorpsof the U.S. PublicHealthService,2014)
Leadership training is an integral part of how all of our uniformed services train their
physicians. Each aspiring physician must attend some form of Officer training prior to even
being accepted into the medical corps. A look at their curriculums shows that each is steeped in
a tailored version of the five critical domains of leadership. Leadership training is incorporated
in the ground floor of every practitioner’s indoctrination. Regardless of past experience or prior
achievements, leadership, not only the ability to display leadership but cultivate it as well, will
be an omnipresent requirement throughout their uniformed career.
Other Governmental program for Leadership
Department of VeteransAffairs(VA) operatesthe nation'slargestintegratedhealthcare system, with
more than 1,700 hospitals,clinics,communitylivingcenters,domiciliary,readjustmentcounseling
centers,andotherfacilities.VA employsover300,000 employeesandprovideshealthcare, benefits,
and memorial servicestoapproximately25 millionVeterans.VA providesthese servicesthroughthree
majororganizational subcomponents:the VeteransHealthAdministration(VHA) with157 medical
centers;the VeteransBenefitsAdministration(VBA) with57regional offices;andthe National Cemetery
Administration(NCA) with130 cemeteries.
Division Officer Leadership
To create a continuum of leadership development, a four-tiered leadership development
strategy has been developed and implemented. The first tier is the Facility LEAD Program;
the second tier is the Veterans Integrated Service Network (VISN) LEAD Program; the third
tier is the Health Care Leadership Development Program (HCLDP); and the fourth tier is
the Health Care Executive Fellowship (HCEF) (Robert A. Petzel, 2012)
(1) Leadership Education and Development (LEAD) Certificate Program - The
LEAD Certificate Program offers "must-have" leadership skills and is delivered
through five courses. (United States Office of Personnel Management Center
for Leadership Development, 2014)
(2) Veterans Integrated Service Network (VISN) Leadership Development System
has 3 Components:
- A foundational core that aspires to educate those selected at the facility
level in the key concepts and practices of Leadership, Coach/mentoring,
ethics, LEAN systems, and Difficult Conversations.
- A core curriculum comprising 11 days of learning seminars that form a
cognitive foundation for the VISN LEAD program.
- VISN LEAD teaches how to lead organizations by utilizing experience in the
- Transformational Leadership Development Program TLDP) teaches senior
leaders how to strategically lead large organizations using transformational
(3) Health Care Leadership Development Program (HCLDP) - HCLDP is designed to
build individual leadership competencies to prepare participants to enter
executive ranks within VHA’s healthcare system. HCLDP is comparable in scope
to nationally recognized, executive-level leadership development programs,
such as the Harvard University Kennedy School of Government in-resident
Senior Executive Fellow program.
- Week 1: Focus: Personal Leadership
- Week 2: Focus: Leadership Agility and Leading Others
- Week 3: Focus: Organizational Leadership
(4) Health Care Executive Fellowship (HCEF) - The HCEF Program is a one-year full-
time fellowship designed to prepare individuals for health care executive positions.
HCEF is a new leadership program that provides the tools and strategies to
develop, grow and advance future Veterans Health Administration (VHA) in three
career tracks 1) Associate Director of Patient Care Services, 2) Chief of Staff, 3)
Assistant or Associate Medical Center Directors. (Departmentof VeteransAffairs,
The Civilian Medical Models
1). Are there any programs directly related to MD’s
Florida Hospital, which, since last year, has employed retired U.S. Army Lt. Gen. Mark Hertling
as its senior vice president for global partnering and physician leadership development. Lt. Gen
(Ret.) Hertling has been tasked with designing a program for docs that instills some of the
principles and methods of military leadership training. Florida is running an eight-month course
that trains physicians for five hours a month. Some doubted that busy docs would raise their
hands, but they've seen about three times the number of self-nominees that they expected,
proving MDs' strong desire to learn.
2). What are current Core curriculum/components?
Some of the key things they've emphasized include the importance of defining leadership as
influencing and inspiring your team (rather than motivating, since most people self-motivate);
providing leaders with the tools to carefully consider risks (rather than just taking gambles); and
the importance of an "after-action review" where. (Stempniak, 2014) Tom Kolditz introduced
this style of leadership development in his book “In Extremis Leadership: Leading as if Your Life
Depended on It,”
Thomas A. Kolditz, Brigadier General, US Army (ret) is the former chairman of the Department
of Behavioral Sciences and Leadership at West Point and is currently director of the Leadership
Development Program at the Yale School of Management. For Kolditz, the most crucial factor
for the in extremis leader is to concentrate on the external environment and learn from it what
action to take, rather than focus on motivating his/her team. The intensity of the external
threat itself energizes those exposed to it. (Francis Lethem, 2008)
Leadership training relevant to MDs:
As a group we have determined there are very few programs for medical school
students that offer leadership and/or management training. Many physicians will transition
into leadership positions as their careers progress, and are unprepared for these roles. Much of
the medical school coursework is spent on anatomy and tangible medical processes, leaving
little room for business or leadership training. Unfortunately physicians are unable to juggle
the management role as well as their patient responsibilities, so one is usually suffering and it is
predominantly the management role. This happens because physicians are promoted into
leadership positions without the necessary training, and there is little to no transition period
between working solely in direct patient care and then spending at least half your time handling
administrative duties. Communication and teamwork between departments to ensure
employees are prepared and staffing needs are met are vital to an effective leadership-training
To better prepare medical students for their future roles as managers and leaders, we
recommend incorporating leadership training into the course curriculum. To offer even one
class would better prepare students for their careers by ensuring they are informed of the
business side of a hospital and what is expected of them as both employees and physicians.
Having some leadership training would better prepare physicians to move into management
Our next recommendation is to offer a leadership-training program through the
organization’s human resources department. This would be a multiple week program for new
managers in order to help prepare them for their new position, and what responsibilities they
will be taking on as managers. It’s important this new role doesn’t cause patient care to suffer,
and the transition is smooth to ensure staffing needs are met. Most physicians are promoted
into leadership roles and have no guidance in transitioning from patient care to an
The lack of leadership training in medical schools and hospitals seems to be exclusive to
the civilian world. In the military, physicians are required to undergo leadership training, and
must prove their leadership skills before beginning to see patients. Each rank they move up in
the military requires additional leadership training to prepare them for the next level of
responsibilities, or they do not move up.
Given the success of military medical training, it would be ideal to use their model to
create leadership-training programs for civilian medical programs. Physicians with leadership
skills are holding positions at the highest levels and making decisions, and this has created an
efficient and effective system. In civilian hospitals business or financial professionals generally
hold administrative positions, and they are trained to act in the best interest of the business.
They know how to spend money and save money, and decisions are not always made on what
is best for the patient. If more physicians had ongoing leadership training throughout their
careers and were better prepared to take on management roles they could make decisions
based on what is best for patient care and the business simultaneously. The top five hospitals
in the United States are run by physician CEO’s 1. John Hopkins Hospital Dr. Paul B. Rothman, 2.
Massachusetts General Hospital Dr. Peter Slavin, 3. Mayo Clinic Dr. John H. Noseworthy, 4.
Cleveland Clinic Dr. Delos M. Cosgrove, and 5. UCLA Medical Center Dr. David T. Feinberg
(Angood,&Birk, 2004). This statistic shows a hospital run by a physician CEO is much more
effective, and creates more accountability as they are educated and trained in the medical and
administrative side of healthcare. With leadership development throughout school and career,
more physicians would move into leadership roles and increase this number to more than just
the top five hospitals in the United States being physician run.
AccreditationCouncil forGraduate Medical Education(n.d.).FactSheet.Retrievedfrom
ACGME ProgramRequirementsforGraduate Medical EducationinInternal Medicine(n.d.).
Accreditation Councilfor GraduateMedicalEducation
AmericanCollegeof Healthcare Executives& Healthcare LeadershipAlliance (2013). ACHE
Healthcare ExecutiveCompetenciesAssessmentTool. Retrievedfrom
Angood,P.& Birk,S.(2004). The value of physicianleadership. ThePhysician ExecutiveJournal
of Medical Management. Retrievedfrom
COMMISSIONEDCORPSOF THE U.S. PUBLIC HEALTH SERVICE COMMISSIONEDCORPSOF THE
U.S. PUBLIC HEALTH SERVICE . (2014). COMMISSIONED CORPSOFTHE U.S. PUBLIC HEALTH
SERVICE. COMMISSIONEDCORPSOFTHE U.S.PUBLICHEALTH SERVICE .
CommissionedCorpsof the U.S.PublicHealthService.(2014). Opportunitiesand Training for
Physicians. CommissionedCorpsof the U.S.PublicHealthService.
Crites,G.,Ebert,J., & Schuster,R.(2008). Beyondthe dual degree:developmentof afive-year
program inleadershipformedical undergraduates. AcademicMedicine,83(1),52--58. Retrieved
CreightonUniversitySchool of Medicine (n.d.).LeadershipDevelopment.Retreivedfrom
Departmentof VeteransAffairs.(2014). Leadership DevelopmentSystem. Departmentof
Departmentof VeteransAffairs.(2015). VeteransHealth Administration Health CareLeadership
DevelopmentProgram. Departmentof VeteransAffairs.
Duke UniversitySchool of Medicine (n.d.) PCLTProgram.Retrieved from
Functions and Structure of a Medical School (2013). Liaison Committee on Medical
Francis Lethem. (2008). In Extremis Leadership: Leading As If Your Life Depended On It . In
T. A. Kolditz, In ExtremisLeadership:LeadingAs IfYourLife DependedOnIt (Vol.8).
Graduate Medical Education That Meets the Nation’s Health Needs (2014). Institute of
Gutierrez, C. & Scheid, P.(n.d), TheHistoryof FamilyMedicineand its Impactin US Health
Care Delivery Retrieved from
Kolditz, T. A. (2014, July 31). Leadership Development Programs for Physicians.(B. K. Cass,
Kruse, K. (2013). What Is Leadership?. Forbes.Retrieved 27 July 2014, from
Leadley, J. (2006). MedicalSchoolBasedCareerand LeadershipDevelopmentPrograms (1st
ed.). Retrieved from
Liaison Committee on Medical Education (LCME).(n.d.). LCME.Retrieved August 2, 2014,
Mann, B. (n.d.). Historyof Hospitals.Retrievedfrom
Medical Economics,.(2014). Medical students need more training in practicemanagement
and ownership, survey shows. Retrieved 28 July 2014, from
National Leadership Development Programs (2009).Association of American Medical
Quinnipiac University (n.d.).Scholarly Reflection and Concentration/Capstone Course.
Retrieved from http://www.quinnipiac.edu/academics/colleges-schools-and-
Robert A. Petzel,M. U. (2012, May 4). VETERANSHEALTH ADMINISTRATIONFOURTIERED
ACCOUNTABILITY,ANDDEVELOPMENT (LEAD).VHADirective2012-015.Department of
Veterans Affairs VHA DIRECTIVE 2012-015 Veterans Health Administration.
Stempniak, M. (2014, April 10). Taking a Pagefrom theU.S. Armyin TrainingPhysician
Leaders.Retrieved July 22, 2014, from Hospitals & Health Networks:
Stfm.org,. (2014). Home. Retrieved 30 July 2014, from
Stoller, J. (2008). Developing physician-leaders: key competencies and available programs.
TheJournal ofHealth AdministrationEducation, 307-328.Retrieved from
Sonnino, R. (2013). Professional development and leadership training opportunities for
healthcare professionals. AmericanJournalof Surgery,206(5),727-731.
Stoller, J. K., Rose, M., Lee, R., Dolgan, C., & Hoogwerf, B. J. (2004). Teambuilding And
Leadership Training In An Internal Medicine Residency Training Program. Experience With
A One-day Retreat. Journalof GeneralInternal Medicine,19(6),692-697.
United States Navy. (2014, May 15). Officer TrainingCommand.RetrievedJuly 22, 2014,
from OfficerDevelopmentSchool: http://www.ocs.navy.mil/ods.asp
United States Officeof Personnel Management Center for Leadership Development. (2014,
Leadership Education and Development (LEAD):
United States Air Force.(2014, 01 01). Commissioned OfficerTraining.Retrieved July 20,
2014, fromAir Force : http://airforce.com/joining-the-air-force/commissioned-officer-
United States Army. (2014, July 29). ArmyMedicine.Retrieved July 29, 2014, from
LEADERSHIP BECOME A LEADERIN ONE OF THE BEST HEALTHCARE NETWORKSIN THE
U.S. Department of Health and Human Services. (n.d.) KeyFeatures of the AffordableCare
Act. Retriieved from