Question

What is the relationship between the physician leaders of the service lines and the medical staff organization and the chief medical officer (CMO)? Can the CMO represent the interests of management and the physician organization at the same time?

Answer 1

The relationship between physicians and healthcare organizations (HCOs) has often been problematic, but it doesn’t need to be. Thanks to protocols, service lines, and evidencebased medicine, leading organizations are developing stable, effective physician groups and physician-led clinical teams. This chapter presents the following lessons:

Lesson 1: Physician loyalty is as important as any other associate loyalty. Physicians are internal customers and partners, not adversaries. Learning the language of physicians and having effective communication strategies are keys to building loyalty.

Lesson 2: The physician-organization relationship is not a blank check. HCOs provide capital and human resource that are essential for most medical practices. Physicians are associates on the terms implied by the mission, vision, and values. They have an agency duty to their patients that they share with the HCO. Service lines allow alignment and accountability. Goals can be negotiated, performance can be measured and improved, and rewards can be shared.

Lesson 3: A sound relationship begins with clear rules that are mutually understood and accepted (the bylaws); screening to eliminate candidate who don’t understand, or can’t fulfill, the contract (credentialing); effective use of the hospital’s right to control supply, ensuring neither too many nor too few physicians (planning); high performance from the rest of the team (nursing, clinical support services, supplies, information, and marketing teams are particularly critical); and maintenance of high levels of communication so that any physician question is promptly and effectively answered. (Governing board membership is only the beginning of a communication system.)

Lesson 4: Pay for performance works. Physician compensation is wildly complicated. Most physicians work under multiple compensation schemes; most schemes should be reviewed by legal counsel. The criterion for compensation—what a similar effort would earn elsewhere—holds for physicians as for all other associates.

These four lessons go a long way toward an effective medical care system for a community. They don’t solve every issue, but they provide a framework for solving most issues. Different strategies can be used to convey the information in this chapter. Traditional lecture is used to explain the medical staff credentialing process, medical staff bylaws, medical staff structure, models of physician-hospital integration, and the physician’s role in clinical quality and safety. Students can be paired with a third-year medical resident(s) for a 24-hour shift with an accompanying assignment.

Physicians are the clinical leaders of the healthcare organization. They are associated with the organization principally by a contract for the privilege to treat patients, but also by employment, joint ventures, and volunteer activities. They are accountable for the quality of care through service lines and monitoring of their individual performance, but they are given substantial autonomy to fulfill their role as agents for individual patients. The physician organization implements systems for improving the quality and efficiency of care, approves the credentials and monitors the performance of individual physicians, assists in planning the number and kinds of doctors, conducts continuing education for its members and other caregivers, facilitates communication between physicians, the organization, and the governing board, and participates in designing compensation and other features of employment contracts. The performance of physicians is measured directly from patient care; the performance of the physician organization is measured primarily by its effectiveness in recruiting and retaining it members