Physicians Leading | Leading Physicians

Leadership Survey: Ability to Lead Does Not Come from a Degree

Insights Report · August 17, 2017

Analysis of the fourth NEJM Catalyst Insights Council Survey on Leadership. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.

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Advisor Analysis

By Stephen Swensen and Namita Mohta

Leadership is not an easy endeavor in this era of fast-changing and complex health care delivery. The breadth and depth of skills required to navigate toward fee-for-performance or address rising rates of physician burnout are far greater than just a decade ago.

Yet the foremost quality needed by health care leaders today is familiar and enduring, according to our latest NEJM Catalyst Insights Council Leadership survey, “Leading Physicians and Physician Leadership.” Interpersonal skills are by far the top attribute needed to successfully lead a health care organization (according to 82% of survey respondents) and to lead other physicians (90%).

Interpersonal skills outpace other critical attributes such as administrative skills and clinical training. (Administrative skills rank second most important to lead health care organizations but fourth to lead physicians, while clinical training ranks second for leading physicians and third for leading health care organizations.)

Physicians, who increasingly are employed by health systems or work in practices undergoing consolidation, must deal with complex financial and operational situations. Most of them do not have the formal training or experience to thrive in these environments and often find they are better off teaming with administrators who do. For these reasons, survey respondents strongly favor dyad leadership models, where physicians and administrators co-lead an organization. Three-quarters (72%) of respondents say their organization employs the dyad model, and 85% say dyads are an effective, very effective, or extremely effective leadership model.

Interpersonal Skills Are Key to Successfully Leading Health Care Organizations and Physicians Today

From the NEJM Catalyst Leadership Insights Report. Click To Enlarge.

What the dyad model does is address the gray space between the strengths of clinical leaders and administrative leaders by having them collaborate. Survey respondents see distinct advantages and pitfalls for each side.

Clinical leaders have the leadership advantages of clinical knowledge and experience (according to 97% of respondents) and credibility with the workforce (71%), while non-clinical leaders have operational expertise (54%) and are better at managing traditional functions like HR and finance (77%). However, when it comes to defining vision and managing people and teams effectively, the largest share of respondents say there is no difference between clinical leaders and non-clinical leaders.

This speaks to the importance of core leadership skills, independent of a formal degree. However, with any shared responsibility, such as in the dyad model, clarity of roles and defined decision-making processes are imperative. There is risk of confusion among teams and staff if the organizational structure is not clear.

More than half (53%) of respondents — many of whom are themselves physicians — think physicians make better leaders of health care organizations. Only 10% think physicians are worse leaders, with 37% saying there is no difference.

It may be a flawed framework. What makes one leader better than another at leading an organization is not whether he or she has been to medical school. Rather, a good leader has the interpersonal, strategic, and management skills to build and grow a successful organization. This is distinct from a clinical or administrative degree. Leaders who recognize their own strengths and create teams to complement their own skill sets are best positioning themselves, and their organizations, for success.


Do you think physicians make better or worse leaders of health care organizations than non-clinical leaders? Why?

“There is an understanding of what it is like in the trenches. Credibility and ‘been there’ goes a long way. The responsibilities one feels for another person’s life is something that cannot be imagined and helps lead in a ‘first among equals’ manner that empowers others to do their best.”
— Clinician at a large nonprofit health system in the Midwest

“Excellent leaders can come from either career background. I believe results are more important than the educational history.”
— Service line chief at a large nonprofit health system in the South

“Tough to straddle clinical colleagues and administration.”
— Director of a mid-sized for-profit physician organization in the Pacific West

Download the full report for additional verbatim comments from Insights Council members.

Charts and Commentary

by NEJM Catalyst

We surveyed members of the NEJM Catalyst Insights Council, comprising health care executives, clinical leaders, and clinicians, about physician leadership and leading physicians. The survey covers leaders’ attributes needed to successfully lead health care organizations today, leaders’ attributes needed to successfully lead physicians today, the training of top organizational leaders, leadership advantages of clinical and nonclinical leaders for different aspects, whether clinically trained leaders should continue practicing medicine, the use and effectiveness of a dyad leadership model, and whether physicians make better leaders of health care organizations.

Insights Council members consider interpersonal skills to be the key leadership attribute. When it comes to leading health care organizations, interpersonal skills come in at the top, selected by 82% of survey respondents; and an even higher percentage, 90%, say interpersonal skills are the most important attribute for leading physicians. Administrative skills (49%) and clinical training (44%) are next most important for leading health care organizations, while for leading physicians, clinical training (69%) and negotiation skills (59%) follow. Financial acumen and knowledge of health care legislation rank lowest in both categories.

These data clearly indicate that respondents believe social skills outweigh administrative and clinical capabilities. “Being a physician, or a gifted clinician, does not de facto make you a good leader or prepared to lead,” one Insights Council member says. Another says, “Leadership is about interpersonal skills and emotional intelligence. Not the degree you hold.” A higher percentage of clinical leaders (48%) and clinicians (47%) than executives (36%) responding to the survey consider clinical training a top attribute. One respondent disagrees with a low ranking of financial acumen: “If a physician has business acumen, they have an advantage over non-clinical leaders because they can address and relate to both administration and leaders.”

Download the full report to see the complete set of charts and commentary, including data segmentation, the respondent profile, and survey methodology.

Download Full Report

Check NEJM Catalyst for monthly Insights Reports not only on Leadership, but also on Patient Engagement, Care Redesign, and the New Marketplace.

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