The Evolving Role of the Physician Leader

00;00;00;26 - 00;00;35;13
Tom Haederle
One hallmark of a rapidly changing health care system is the evolving role of physician leaders, health care professionals who choose to wear two hats as both a doctor and administrator. Their ranks are growing, as is their impact on the future direction of health care. But treating a patient and leading a department can be a delicate balance as the jobs require different skill sets, and the training for one can be almost contrary to the training for the other.

00;00;35;16 - 00;01;01;18
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA Communications. Physicians must often make quick, decisive clinical decisions about a patient's care. This is a strength encouraged in medical school. But physician administrators who lead staffs and entire departments often face longer arc challenges that require problem solving approaches well outside of the sphere of traditional doctor-think.

00;01;01;20 - 00;01;16;24
Tom Haederle
In this podcast, the American Hospital Association senior vice president and chief physician executive, explores how today's physician leaders reconcile the demands of two different jobs. As he points out, not every challenge that you're facing has a code.

00;01;16;27 - 00;01;40;29
Elisa Arespacochaga
Thanks, Tom. I'm Elisa Arespacochaga AHA vice president, clinical affairs and workforce. And today I'm joined by Dr. Chris DeRienzo, senior vice president and chief physician executive at the AHA. We're going to talk a little bit about the evolving role of physician leaders and how to plan for the future needs of a health system. So, Chris, welcome. And I'm hoping you'll tell us all a little bit about yourself and how you got to the AHA.

00;01;41;01 - 00;01;57;18
Chris DeRienzo
Will do, Elisa. It is a pleasure to get to join you on the podcast this week and welcome to all of our listeners. I'm Dr. Chris DeRienzo. So I'm a neonatologist by clinical training and I got to spend the better part of the last ten years in hospital and health system Chief Medical and Chief Quality Officer roles.

00;01;57;20 - 00;02;21;06
Chris DeRienzo
Most recently I got to be the Chief Medical Officer, Wake Med Health and Hospitals, which is based in Raleigh, North Carolina. And it was through that work that I got exposed to the incredible team here at AHA.  I got to spend a year sitting on AIG's Committee on Clinical Leadership, which brings together chief physicians, nurses and APPs from across the country to help guide our our governance on on policy advocacy and operational issues.

00;02;21;14 - 00;02;47;24
Chris DeRienzo
And then was lucky enough to join the team here in in January. And so I'm meeting with our amazing teams and our amazing members. And one of the things that that is most amazing about that is getting to spend time with Elisa and her team because the Clinical Affairs and Workforce group here really is top notch. And when it comes to the kinds of topics that we're talking about here on today's podcast are really sort of setting the tone for where we're going as a nation.

00;02;47;27 - 00;03;07;24
Elisa Arespacochaga
Great. And we're thrilled to have you on board the team. So you came from a chief physician role. You've seen physician succession planning in a couple of organizations. What's been your experience in how that's worked and how it's been done and where it's maybe succeeded and where it maybe had some opportunities?

00;03;07;27 - 00;03;42;20
Chris DeRienzo
You know, just like the chief physician roles themselves, which have undergone substantial evolution over the last 30 years, I think succession planning is is really doing the same. When I joined Wake Med, for example, we had a number of terrific physician leaders who were stepping into pretty significant roles. And as as any good leader does in an organization, you know, realistically on day one, you need to begin thinking about what happens if you had Mega millions tomorrow and and you become America's next billionaire and you don't want to work anymore.

00;03;42;24 - 00;04;05;21
Chris DeRienzo
Right. And so and I love taking it from that positive frame perspective, you know. So so the folks who do this best, I really find them kind of very intentionally on day one doing two things. One, getting an understanding from the team members who identify as as their their direct reports. And you have a lot of leadership potential as one.

00;04;05;24 - 00;04;23;05
Chris DeRienzo
What do they want? Then I've talked to physicians who are extraordinarily happy doing the physician leader role that they are. They do not want to take on more responsibility from an administrative perspective because they don't want to perhaps give up more of their practice or they're just at a place in their life or career with it that wouldn't work for them.

00;04;23;12 - 00;04;43;13
Chris DeRienzo
And then for those who do understanding what are the gaps? What are the intentional experiences as a leader that I can create for you and/or share with you so that you're able to, you know, punch that part of your dance card and you get an experience that would perhaps be more common if you were to step into a different or larger physician leader role.

00;04;43;16 - 00;05;05;12
Chris DeRienzo
And that really, frankly, should be occurring at every level of leadership, you know, at the medical director level, at the division chief, at the chief medical officer level, and then all the way up through the the organization. And so that that's how I walked into my role at Wake Med. And I'm happy to say that the person who succeeded me there is exponentially better at the job than than I ever could have been.

00;05;05;14 - 00;05;30;02
Elisa Arespacochaga
And I know we've talked about this a little bit as you've come on board and we started to do this work. Your training as a physician really encapsulated making decisions rather quickly by yourself and owning those decisions. That's that's part of what your training really instilled in you. And yet as an administrator, none of those things are good at getting activities done, changing things, moving people along.

00;05;30;09 - 00;05;41;18
Elisa Arespacochaga
You have to be able to have those conversations along the way, share that decision making. So how did you bring some of those skills to yourself and then your team members?

00;05;41;20 - 00;06;10;27
Chris DeRienzo
Yeah, it's it's interesting. You see a lot of physician leaders who wind up having dual degrees. And I think one benefit of spending time early in your graduate-level education outside of medical school is sort of remembering how not doctors think, because what you described, Elisa, is true. You are taught to think and then taught to act in a very specific way throughout medical school as it relates to creating a differential diagnosis, designing an assessment and plan and going and executing on it.

00;06;11;02 - 00;06;40;10
Chris DeRienzo
And in my specialty of neonatology, sometimes there's a long arc to being able to craft that plan. But sometimes the baby's coding. You need to act now. And so the challenges that you face on the the administrative side of the table are definitely typically longer arc challenges. And I think for for many of us who've been fortunate to pursue medical school as well as have a master's degree leaning on that side of our education and training is kind of a reminder that not every challenge that you're facing is a code.

00;06;40;13 - 00;07;05;07
Chris DeRienzo
Right? And we can sort of take a different approach to that. I will say, interestingly, you know, during the COVID pandemic, especially the early acute days of it, I think the training that physician and some nurse leaders lean on as well served us very well. Because within the administrative team, we oftentimes got to sort of lean into our strength of being a gas pedal and saying we need to move to action.

00;07;05;09 - 00;07;24;21
Chris DeRienzo
You know, and the other members of the team served their roles importantly as well. And I think as we've now transitioned into a different phase of our work, it's crucial to remember the roles that we play around that leadership table and to recognize that for me, sometimes my bias has to be that gas pedal. Sometimes it's to be a brake.

00;07;24;24 - 00;07;35;12
Chris DeRienzo
And as long as there's sort of shared respect and understanding around, you know, whatever leadership table that you're sitting at, then there's room for everyone from that background.

00;07;35;15 - 00;07;52;06
Elisa Arespacochaga
So let's talk a little bit about you mentioned the evolution of the role of physician-leader. It has gone through a number of different roles, even in your tenure, your ten years. Talk a little bit about what you've seen as where that role started and where you see it today.

00;07;52;08 - 00;08;15;09
Chris DeRienzo
Yeah, my thinking on this has evolved substantially. I've only been living in these kinds of roles for about ten years. I started medical school about 20 years ago, but the friends and colleagues I have who've been in this space now for for 30 plus years, even on the recruiting side, express it's sort of gone in three phases of evolution.

00;08;15;11 - 00;08;56;24
Chris DeRienzo
So the V1 data role of a physician leader on a hospital or health system leadership team, and I'll distinguish that from we've had medical staff privileges and credentials and a medical executive committee for for decades and decades and decades since time immemorial. So I'm not really talking about the elected leadership role. And what I'm talking about is the kind of the earliest members with protected administrative time who sit on that leadership team. In perhaps the eighties and nineties that looked like someone who typically was an incredibly well respected physician, had been on staff for maybe 20 or 30 years, was loved by the community, was loved by the team.

00;08;56;27 - 00;09;19;21
Chris DeRienzo
They were given a small office somewhere in the corner and said, Go listen to the doctors and, you know, keep them out of administration, right? And that was, you know, early phase efforts at engagement. And obviously, you know, I'm over generalizing and there's a spectrum. But but truly, it really was a very tightly focused position on just medical staff in medical affairs.

00;09;19;23 - 00;09;44;23
Chris DeRienzo
And that evolved pretty substantially in the 2000 and the early 2010s as we saw the ACA passed and the quality movement in in health care began to reach a fairly significant crescendo to where, you know, CEOs and boards said, okay, doctor, we need you to lead quality as well, oftentimes in partnership with a chief nurse. And so we saw the first dyad roles beginning to emerge then.

00;09;44;25 - 00;10;09;03
Chris DeRienzo
But again, that sort of clinical focus on quality and still medical staff, right. Don't give that up. Still have to do that. But now take on this more quality and safety and sometimes patient experience focused work kept those roles largely out of the strategy and operations of health systems. And today, frankly, that that is is an untenable solution as we look at, you know, what the landscape looks like.

00;10;09;04 - 00;10;36;17
Chris DeRienzo
By and large, the shift has been to having physician leader roles that are true core partners to the not only the chief nurse, but the chief operating officer, the chief strategy officer, the CFO, when it comes to things like strategy and operations. And that's not because the physicians themselves have changed, but it's because our environment has changed as we've seen tremendous shifts into the ambulatory and outpatient arena, as we've seen shifts in the trends of physician employment.

00;10;36;19 - 00;11;14;07
Chris DeRienzo
And that has meant that that the most forward thinking and/or integrated systems have needed to bring their their chief physician into the fold, as it were, on making the the key strategic and operational decisions of the organization. And and again, on the physician side, you know that that means that the kind of person who we might have appointed to a VP admiral in the nineties or lifted into a chief of quality role in the early 2000s might not be the same kind of person now who is is perhaps willing to engage in the kind of strategy and operational learning that we need to do in order to be fundamental partners at that kind of

00;11;14;07 - 00;11;15;08
Chris DeRienzo
a table.

00;11;15;10 - 00;11;37;29
Elisa Arespacochaga
Absolutely. Absolutely. So you've had a chance to get a little bit of a national perspective on some of these opportunities. You just laid out sort of the evolution of... you're no longer forgive the term, just the doctor. You are now also part of the strategy team and the operations team and the financial team. And you need to be able to have all of those skills in your bag.

00;11;38;02 - 00;11;46;03
Elisa Arespacochaga
What do you see as some of the opportunities to help grow some of those physician leadership skills as part of your role at the AHA?

00;11;46;06 - 00;12;15;16
Chris DeRienzo
I was incredibly impressed by every team member I met at AHA, when I got to sit on our Committee on Clinical Leadership, and I wish there was a person who was a member of that team who nationally we could all look to and say, you know, who's helping bring us together as chief physicians in in America? And, you know, truth be told, there are lots of different organizations who focus on either physician advocacy or on developing leadership skills.

00;12;15;16 - 00;12;40;16
Chris DeRienzo
But there really isn't a natural home for doctors who have said, you know, I've gone through the door from being a leader in my specialty to now my specialty is leadership. So one of the things we are working to do here at AHA  - and we spent the better part of the last several months validating this concept with our members - because we are nothing if not an incredibly member responsive organization.

00;12;40;16 - 00;13;18;28
Chris DeRienzo
For those of you who are members and listening to this let me be clear, we take your feedback incredibly seriously and it drives much of what we do to try to provide value to and to support you. And what we have now heard loud and clear from hundreds upon hundreds of chief physicians throughout our membership, be they at the hospital, chief medical officer level, at the large employed clinic level, at the EVP operations level, and even from physician CEOs of some of the largest health systems in the country, that there is a need for a space that helps bring together these chief physicians from within our membership for a lot of reasons.

00;13;19;00 - 00;13;43;21
Chris DeRienzo
One, we know that sometimes that job can be very lonely when you're a chief physician, and no matter what level you are, you're oftentimes the only doctor sitting at a table with folks who have reached the peak of their professional pyramids. Chief nurses and chief financial officers, chiefs of strategy, chief of operations. They are all incredibly good at what they do, and they also share very different backgrounds and experiences than we do as physicians.

00;13;43;21 - 00;14;00;11
Chris DeRienzo
So sometimes it can be hard to just sort of share the challenges that you're facing when you have to then go back and negotiate with a room of 40 hospitalists on contract metrics or, you know, talk to the orthopedic surgeons about the continuous improvement project and how we're going to drive it through care process models and the like.

00;14;00;14 - 00;14;21;09
Chris DeRienzo
So there really is no space for that kind of networking, for that kind of mentorship and growth and for also that kind of sharing of experience. To be blunt about it, we think that there's a, there's a really great opportunity for us at the HRA to help create that space. And we're well on our way to bringing that to reality.

00;14;21;11 - 00;14;43;00
Elisa Arespacochaga
Very excited about giving folks that opportunity. So for those who are listening, who are physician leaders, who are thinking about I want to advance my career, I like this idea of my specialty is leadership. And, you know, how do I move beyond the role I might be in? How can they start to be ready? Where are there some opportunities they can start to take?

00;14;43;02 - 00;15;09;07
Chris DeRienzo
My gosh, there are there are so many great opportunities in terms of growing and expanding as a leader. The biggest lesson that I learned very early in my career was in trying to be a good partner and a good listener. So I had the tremendous benefit in my very first job outside of fellowship to work in the Mission Health organization based in Asheville, North Carolina.

00;15;09;07 - 00;15;40;13
Chris DeRienzo
At the time that we were serving about 900,000 people in in the western part of the state. It was very rural and I was very green and I was just out of fellowship. I'd been blessed to get to do a lot of stuff in in training, leading in quality and patient safety. But I had never done the work of an attending and as you know, a health system chief and I had a person who reported to me who is a seasoned nurse executive, you know, 30 plus years in nursing and 20 plus years in leadership, in quality and safety.

00;15;40;19 - 00;16;07;16
Chris DeRienzo
And even though she reported to me, I learned more from her than I probably will from every book that I have ever read on things like accreditation and infection prevention. I had a tremendous leader in risk management to also report in to me, and she has taught me more about risk management than, again, I could ever learn. Even though we have many great books here at HP, you know, she will forget more about claims management than I could ever hope to learn.

00;16;07;18 - 00;16;40;29
Chris DeRienzo
And so I guess my my unifying point here for physicians who are looking to grow in their leadership journey is do not make the mistake that I've seen many physicians make, which is because I become an expert in my pyramid of pediatric endocrinology or interventional cardiology, to then assume that makes us experts in all of health care. There are so many things that we can still learn and so many people willing to teach them that all it really takes is being open to acknowledging I don't know a darn thing about supply chain management.

00;16;41;05 - 00;16;51;25
Chris DeRienzo
And you are a supply chain management expert. I am here to learn and I want to be a partner and help. And I've seen door after door after door open for physicians who are willing to take that step.

00;16;51;27 - 00;17;14;10
Elisa Arespacochaga
Absolutely. And I think that's one of the unique characteristics that the AHA has. Hospitals are the place where all of these different professions come together and must work together for the good of the patient. And so really, the more everyone can adopt that attitude of, hey, I know my stuff really, really well, but tell me about yours, Let me learn from you.

00;17;14;12 - 00;17;16;27
Elisa Arespacochaga
Well, Chris, thank you so much.

00;17;17;00 - 00;17;36;01
Chris DeRienzo
Elisa, it's been a privilege. And I will just close by saying, of course, that's a two way street. One observation I've seen over the last ten years, especially as it relates to things like finances and operations in order for physician leaders to be partners at our table, we've also got to be willing to to be partners with them.

00;17;36;03 - 00;17;44;13
Chris DeRienzo
And that means sometimes sharing decision making that previously we would have kept over here it in a box. And that can be scary for them as well.

00;17;44;15 - 00;17;48;08
Elisa Arespacochaga
Chris, thank you so much for joining me and for joining the AHA.

00;17;48;10 - 00;17;53;29
Chris DeRienzo
It's been a privilege, Elisa, and thank you for hosting the podcast and thanks to our members for all the wonderful things they do as well.