Reframing Contemporary Physician Leadership: We Started as Heroes

Grace E. Terrell, MD, MMM, CPE, FACP, FACPE

The practice of medicine, today, requires transformational skills. Healthcare challenges are no longer adequately addressed by the traditional paternalistic physician role. Healthcare must be physician-led, but patient-centered. Effective leadership must be collaborative rather than authoritarian, proactive rather than reactive.

• Most physicians work in environments where current cultural paradigms, such as physician as hero, lead to burnout.

• Physicians have not been adequately trained in many of the skills necessary for leadership competence and therefore lose agency with respect to important decisions.

• The pace of technological change impacts physician work in ways traditional workflows cannot accommodate.

This book is a broad analysis into the history, limitations, and possibilities of the healthcare delivery system. Reframing Contemporary Physician Leadership: We Started as Heroes readies physicians for making the necessary changes to transform a system of accelerating cultural and technical changes. Dr. Grace Terrell jumpstarts the conversation about how physicians need to prepare to lead in this complex adaptive system.

You’ll learn about the transformation that helps physicians strengthen their ability to lead. You’ll take a historical journey through the medical profession and the transitions that brought it to where it is today. You’ll gain insight necessary to think through the implications of leadership and current health policy considerations.

Dr. Terrell profiles 11 physician leaders through real-life vignettes to provide concrete examples of physician leaders (and their successes) in the current delivery system. These inspiring vignettes will give the reader a deeper understanding of the historical sources of our current situation and the trajectory of the future state of the healthcare delivery system.

TABLE OF CONTENTS

Preface: Physician Identities and Leadership Roles 

PART I: CONDITION RED: SITUATION TODAY

Chapter 1: Where We Stand

The Impact of the Boomer Generation

America’s Medical Profession

The Physician’s Compact

Riding the Waves of Change

Chapter 2: Powershift and Teambuilding

Force One: The New Physician-Patient Relationship 

Force Two: Health Information Technology

Force Three: From Cottage Industry to Corporate Medicine

Force Four: Healthcare Macroeconomics

Healthcare Is Now a Team Sport

Chapter 3: Varieties of Leadership Experience 

Three Theories of Leadership

Good Physician Leadership Requires an Understanding of Governance

Effective Healthcare Organizations Require Collaborative Clinical Leadership

Quantitative Skills Are Crucial Assets for Physician Leaders

Chapter 4: Barriers to Healthy Change

Structural Barriers

Psychosocial Barriers

Other Impediments to Progress

Chapter 5: We Started as Heroes

The Heroic Model of Contemporary Training

The Heroic Academic Journey 

The Ecosystem for Training Heroes

 New Paradigm for Learning 

Spectrum of Motivations 

An Inflection Point 

PART II: THE FUTURE IS OURS TO MAKE

Chapter 6: The Pace of Change Accelerates

Strengthening Communication

The Perils and Promise of Precision Medicine

Implications of Social Technology for the Therapeutic Relationship 

Improving Quality and Safety

Reflection Points

Chapter 7: Professionalism Is Redemption 

Competing Clusters and the Physician Leader

Professional Existentialism

Professionalism in Industry Relations

Redemption

Chapter 8: Physician Generation Next

Today

The Ongoing Physician Leadership Journey

Let’s Get Ready

PART III: LEADERSHIP PROFILES IN ACTION

Chapter 9: Real Physicians, Real Leaders

Situational Leadership

Servant Leadership

Transformational Leadership

Nostalgic Leadership (Traditional)

Entrepreneurial Leadership (Innovation)

Academic Leadership (Teaching)

Lifestyle Leadership (Physician Wellness)

Empirical Leadership (Research)

Activist Leadership (Policy) 

Tactical Leadership

Strategic Leadership

Conclusion

References

About the Author

Grace E. Terrell, MD, MMM, CPE, FACP, FACPE is a national thought leader in healthcare innovation and delivery system reform, and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. She is also a practicing general internist. 

She has served as CEO of Eventus WholeHealth, LLC, a company focused on providing holistic care to medically vulnerable adults. She is the former CEO of Cornerstone Health Care, one of the first medical groups to make the “move to value” by lowering the cost of care and improving its quality for the sickest, most vulnerable patients; the founding CEO of CHESS, a population health management company; and the former CEO of Envision Genomics, a company focused on the integration of precision medicine technology into population health frameworks for patients with rare and undiagnosed diseases.

Dr. Terrell has served as vice chair of the U.S. DHHS’ Physician-Focused Payment Model Technical Advisory Committee, the chairman of the board of the AMGA, is a founding member of the Oliver Wyman Health Innovation Center, and the co-author of Value-Based Care and Payment Models. 

She currently is executive in residence at Duke University School of Medicine’s Master in Management of Clinical Informatics Program and a senior advisor for Oliver Wyman management consulting firm.