There is plenty to argue that physicians make outstanding health system leaders, and that anesthesiologists make the best CEOs. This is because of the training in their specialty, which orients anesthesiologists as part of a health care team rather than a solo practitioner. As anesthesiologists, you are skilled collaborators, problem solvers and multitaskers.

Other physicians often ask physician executives, “How did you get where you are?” In anesthesiology, this question usually comes from young practitioners thinking about their career options or older physicians who want to contribute in a different way. A Harvard Business Review article discusses how to train physician leaders, stating that it takes a combination of intentional, internal and external leadership experiences.

In 2019, Dr Amol Gupta, then a clinical researcher, furthered the debate over physician versus nonphysician leadership. He opined that current evidence suggested that hospitals with physician executives outperform those without, thus recognizing the positive impact that physician CEOs have on the quality of hospital care. There is a need to build a foundation of CEO characteristics that are essential to guiding positive change at hospitals and refocusing health care back to its original intention: patient care.

Certainly, an understanding of any business is critical to running it. Being clear on what makes money – to further support the mission and to care for more patients – and what loses money is what makes a successful physician, business leader, administrator or CEO. The process of how health care works and what does not work is foundational to any level of leadership in today’s health care systems. A more specific question is why might anesthesiologists in particular make great leaders?

Anesthesia specialist training – including being highly observant to changing circumstances, data-analytical from multiple sources, and precise in decision-making – is not only unique to the role of anesthesiologists in patient care but also the best foundation for a system CEO. Health system leaders have to think broadly, across the needs of the entire system; and as an anesthesiologist, one cannot be successful in the perioperative world without understanding this system-level thinking. “Management of a ‘system’ requires knowledge of the interrelationships between all of the components within that system and of everybody that works in it,” famous words from Dr. W. Edwards Deming. Systems theory has greatly influenced how we understand and change organizations. Basically, it is a way of helping one to view systems from a broad perspective that includes seeing overall structures, patterns, and cycles, rather than seeing only specific events in the system.

To give a specific current challenge we all face: as health systems begin to think beyond coronavirus disease 2019 (COVID-19), many are facing staffing issues in the OR and inpatient units. Some of this has to do with the nursing crisis that has been looming for years, but there are other variables too, including pandemic exhaustion, childcare challenges, and new working situations. When we look across our system of care, the vacancies in care management, transportation, and postacute staffing have as much to do with the ability to get patients the right level of care as bedside staffing. And the solution to our staffing challenges is more than recruitment; it will certainly involve new staffing models and new ways of interacting with external partners.

A core value of anesthesiologists is problem-solving. When we see an issue that will impact patient care, we are programmed to move into assessment, collaboration and innovation to manage the problem successfully for both the short term (get the case done safely in the patient’s best interest), and the long term (eliminate the problem that required a workaround). These attributes translate well to the skills needed by a CEO to be successful.

Physician Leadership is More Effective

Why is it that physicians are better suited to lead health systems than nonphysicians? The answer is delegation skills, communication skills and the ability to put ourselves in someone else’s shoes. It is also the credibility that comes through first-hand experience in the core functions of the purpose of the health system: keeping patients healthy. Statistics bear this out. According to the 2016 USNews & World Report (USNWR) ranking, the Mayo Clinic is America’s best hospital, and the Cleveland Clinic is the second best. The CEOs of both – Gianrico Farrugia and Tomislav Mihaljevic, respectively – are highly skilled physicians. In fact, both institutions have been physician-led since their inception around a century ago.

Other studies showed that hospital quality scores are approximately 25% higher in physician-run hospitals than in manager-run hospitals. These findings of course do not prove that doctors make better leaders, though the results are surely consistent with that assertion. In an analysis of the 2019 USNWR “Best Hospitals” list, higher ranked hospitals were more frequently managed by physician executives. Furthermore, of the 21 hospitals on the 2019 USNWR “Honor Roll,” 13 were physician-managed, and the top 6 – Mayo Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, Cleveland Clinic, New York-Presbyterian Hospital-Columbia and Cornell, and UCLA Medical Center – were physician-run.

The Envision Difference

Envision Physician Services encourages physicians to pursue their passion, whether clinical practice, teaching, leadership and/or clinical research. Experienced physicians are also offered the opportunity to help new physicians through mentorship programs. MAC (Medical Anesthesia Consultants), based in Walnut Creek, CA, has several outstanding opportunities for anesthesiologists at premier facilities in San Francisco, the North Bay, the South Bay, and the East Bay with a growing and well-respected practice of over 130 physicians.

“Envision Physician Services offers the tools and skills I need to be an effective doctor, leader and person.” – Meg Prado, M.D., MBA

Envision Physician Services’ support for physicians is unparalleled. The far-reaching national network offers coast-to-coast opportunities across 800 healthcare facilities in 48 states and the District of Columbia. Currently employing more than 25,000 physicians and advanced practice providers, each one is empowered to develop and realize their professional goals.

Sources:

Anesthesiologists as Health System Leaders: Why It Works. journals.lww.com

The Envision Difference. envisionphysicianservices.com

The delivery of high-quality health care at the lowest possible cost is no longer an aspiration; it is the expectation. It takes more than just excellent clinical skills to drive exemplary physician achievement for surgeons and anesthesia specialists, you need strong mental skills.

The importance of mindset, and the mental skills that comprise it, has been a staple of training in high-expectation, high-risk occupations for some time now. Often evolving from sports psychology, the military, police and firefighters understand the potential benefit of mental skills to elite performance in high-stress situations. This recognition is also suggested to be important in training for medical emergencies and surgery. 

More than 20 years ago, surgeons agreed that mental skills are a large component of performance excellence. More recently, this perspective has been reinforced in the surgical literature for performance and procedural preparation. Mental imagery may be the most frequently cited technique, but critical skills such as emotion regulation, negative thought stopping, affirmations, self-talk, breathing techniques and others are also effective, as are individual, group and comprehensive curricular approaches.

In an attempt to objectively document the growing surgical focus on the value of training and use of mental skills through the frequency of relevant publications, Michael J. Asken, PhD, Elizabeth Morgan, MLS, and R. Scott Owens, MD surveyed the surgical literature from 1990 to May 2021 for articles published on this topic.

A search of the literature was conducted in the databases PubMed, Web of Science and Google Scholar. Two thousand articles were retrieved and assessed for specific relevance. Their analysis was limited to articles that focused on psychological performance concepts and skills such as mental training, mental practice, mental skills and mental toughness.

There has been steadily increasing growth, with a positively accelerating trend in the past decade, of publications related to mental skills for training and performance in surgery.

Putting the Right Mindset into Positive Action

In the field of perioperative pain management, the implementation of multimodal analgesia in the pre-, intra- and postoperative periods is an effective and proven method of accomplishing the delivery of cost-effective, high-quality care. Although slight variations exist, “multimodal analgesia” can be defined as the use of several classes of analgesics with varying mechanisms of action used together to improve pain control, decrease over-reliance on opioids for analgesia, and reduce side effects associated with each class.

Because the characteristics of pain vary both between patients and within a given patient at different times, it is unreasonable to expect a single category of analgesics to adequately treat all pain. Strong mental skills are a large component of performance excellence when working in high-pressure and quick decision making conditions. 

Consistency and standardization are important when implementing a multimodal analgesia pathway for a particular surgery. Standardization based on evidence allows for the largest number of patients to receive the best treatments available. Flexibility with protocols is also needed, allowing for tailoring of pain management to the individual patient. A positive mindset for thinking outside the box may be necessary if a complication arises or a commonly used agent suddenly becomes unavailable. Anesthesiologists must expand their knowledge and clinical experience to include agents that have not been traditionally used, and so perioperative plans must be designed with flexibility.

Providing better pain control and using other modalities that result in lower opioid doses should theoretically put surgeons and other prescribing physicians in a better position to reduce doses, write shorter prescriptions or both for patients after they leave the hospital.

Given the innovative integration of mental skills training in other disciplines and the encouraging impact of mental skills and such training on surgical performance (and careers), this increasing interest and emphasis is welcome and should be disseminated and encouraged in all surgical education and training.

Sources:

The Surgical Mindset – Increasing Interest in Mental Skills for Training, Performance Excellence. generalsurgerynews.com

Multimodal Analgesia: The Foundation of a Successful Perioperative Experience. anesthesiologynews.com