The consulting firm McKinsey recently conducted conversations with almost 40 physician CEOs to gain some insights into how they navigated their journey to leadership and which skills they needed help developing. Amit Shah, M.D., M.B.A., a senior partner at McKinsey spoke in depth with Healthcare Innovation about a report he co-authored based on those conversations. 

Healthcare Innovation: In McKinsey’s conversations with physician CEOs, were there some common traits that you identified among the physicians who make it into these roles?

Shah: Our hypothesis going in was that we would end up with exactly what you said — a common set of traits — and to some extent, that's true. But what we actually found is that they were idiosyncratic and different in their own ways. Of course, there are some commonalities, which I'll share, but what stood out more than anything is that they were very deliberate about how they carry forward elements of their clinical training and experience. They were also deliberate about where those experiences and skills and habits need to be adapted to the CEO role. I also think they had some humility in the way they thought about rounding out their own profile. 

Finally, we saw incredible thoughtfulness about how they chose their path. There is lots of luck involved, of course, but there is intentionality in terms of how they thought about the journey and how they made decisions.

HCI: Is there any kind of research about how physician CEOs are perceived by employees and the clinical staff vs. someone who just has an M.B.A.? Do they earn more respect because they've come up through the trenches on the clinical side?

Shah: There is data, but I'd say it is inconclusive at the moment. But the data directionally points towards two things. In this handful of studies, the physician-led hospitals show improved or better performance on quality scores. Directional is the word to use here, because these are not comprehensive studies. Interestingly, there's some evidence that also shows that financial performance is actually not significantly differentiated between a physician-led hospital. Again it is inconclusive but directional. Now, your question was a bit more around the respect. I haven't seen literature on that, but I will say on this notion of how physician CEOs carry forward their strengths, they are intentional in thinking about amplifying the fact that they have a relationship with physicians that a non-physician CEO may not. They have the respect. They can talk the language. They can understand. They can be in your shoes because they actually were in your shoes. 

HCI: The report notes that the physicians often discover that the strengths that distinguish them at the bedside can either elevate or constrain them as they take more responsibility. Can you explain that a bit?

Shah: Yes. Maybe I'll start with one that that's the elevate side, which is for for many of the physician CEOs, regardless of specialty, they would describe something around the intensity they've had to go through in training and eventually practicing as a physician, and that has instilled in them this sense of calm and centeredness, the ability to act decisively in high-stress situations. Just spending time in the clinic creates this kind of centeredness. That is unique to the fact that they were a physician. 

Now the constraint. As a physician, at times you may pursue diagnostic certainty. You want more and more information. But as a CEO, you have an entire organization, thousands of people, waiting for you to make a decision. There are opportunity costs. If they have sufficient data to make a decision, and do no harm is not the ethos, are they weighing the trade-offs appropriately and understanding the opportunity cost?

HCI: In terms of identifying the skills they believe they need to learn or improve on, topics that came up repeatedly were delegation, the art of influence, and capacity for enterprise orchestration. How do they go about attaining those skills?

Shah: Let me talk about the tension that we found. When you ask physician leaders who are aspiring to be CEOs about rounding out their profile, they don’t mention those topics. But when you ask physician CEOs, they say those are the skills where we most often see physicians fall off the path. Those are also the skills that we believe are most critical, and that we had to grow ourselves the most. So I think that tension has real implications in terms of your question of how do they go about skill development. There are lots of different paths to this, but I think there are commonalities. First, we have this notion of learning velocity, which means aim for the role or the opportunity that allows you to learn, allows you to grow. We had examples of people actually saying I cut my salary in half because I knew that this role would teach me about P&L or sales or whatever it may be.

The second is this notion of humility and the idea of let's go and learn. They did not treat this as “I can read a book and I'm good to go.” They treated it as a discipline. They treated it as the idea of a specialty. If you're going to specialize as a physician, yes, you read. You also apprentice. You also see one, do one, teach one, right? They took that same mentality. They were very intentional about mentors. This really stood out in our work. The flavors of mentorship vary tremendously, but the intensity and intentionality with which they pursued mentors was quite common.

HCI: The report also said that rather than relying on a single mentor, many described creating a network of of mentors.

Shah: A network of mentors who change over time. Some said they could outgrow their mentors, so they were continuously refreshing their cohort of mentors. Sometimes they chose the person because of their view of where they needed the most support. Some would pursue a mentor who would help them around communications, around empathy, around listening, around how you influence.

HCI: Let’s talk about it from the health system’s perspective in terms of preparing physicians to lead. The report says that this preparation can't be left to individuals emerging at the right moment. Are there some clear ideas about what makes sense for the organization to do?

Shah: I think it is important as you build this leadership cohort, that it is not in isolation. The integration with other domains, with other expertise, is critical. Otherwise, frankly, you exacerbate some of the underlying misperceptions and silos. I think there are three things. First, how do you identify prospective leaders? Those who are visible, those whose names roll off the tongue — they are not always the only potential leaders. So using data, using intentionality, how do you identify who is going to be in your leadership program? No. 2, how are you putting physician leaders in roles that they are not ready for and that will stretch them on leadership dimensions?

Third is building skills and experiences that physicians otherwise may not get. One example: board and board management. CEOs may create opportunities for physician leaders to present to the board. You have someone four or five years away from the CEO seat who is getting exposure, who is building relationships, and understanding how the board and management work. Some CEOs also are very intentional in helping physician leaders sit on outside boards. 

HCI: Is making all that happen up to the current CEO, or is it up to the board, or is HR involved in planning out people's career paths, too?

Shah: Here’s my aspiration and what we see across industries is that this should be treated like an institutional capability. You don't develop a generation of leaders, some of whom will become CEOs, some of whom will lead in other ways, unless it is an institutional capability. That institutional capability will require probably all of the folks that you said to contribute in some way.

It would also require some of the analytics that we described. It may very well involve partnerships with academic institutions or others. But I think that one of the big opportunities for leadership generally and for physician leadership is building a capability that allows you to broaden the number of leaders. Right now, institutions oftentimes have a smaller set, and within that broad set, actually you develop your succession plan as well.

HCI: Are there forces at work that make it difficult for health systems to set up that institutional capability? Pressures they are facing that keep them from achieving that?

Shah: At this point, it’s resource allocation. Facing regulation and competition challenges, how do you create the time and space and resources to do it? We have learned a lot over the last decade, and I think that the attention toward leadership is growing. Where we see thoughtful but smaller scale efforts today, my expectation is that over the next 5 to 10 years we're going to see those capabilities building. Those who went through that experience will become CEOs. My expectation is you're going to start to see the investment grow over time, because they would have experienced that and benefited from it themselves.