Clinical Leadership for Practicing Physicians


            Reform is the byword for all health care organizations, with emphasis being placed on “value.”  Most people outside of medicine believe hospitals and doctors have spent too much time focused on the business of medicine, and have not paid sufficient attention to the mission—the actual results from providing care to patients.

In conjunction with “value-based purchasing,” CMS has been giving more explicit directions to providers regarding how quality improvement activities, (QAPI in government speak), are to be done.  QAPI regulations have been in place for dialysis units for some time, and are now being instituted for nursing homes.[i] Hospital regulations are coming soon.

            So what does it mean to a practicing physician and the organizations with which they interact? Many hospitals are trying to meet requirements currently by relying on their chief medical officer and a small cohort of nurses, but CMS will require a formal structure that pushes “clinical integration.” But the practicing physicians on their staff have little to no training in how to interact with organizations. When I joined my medical staff in 1983, the surest way to be noticed and marked for leadership was to stand up and argue with the administrator. I’m not sure it has changed all that much in the 30+ years since.   

            In my years of practice I have or continue to serve as medical director of dialysis units, a large multi-specialty medical group, and as chief of staff at a city-county hospital. Our push for clinical integration, begun in 2008, ultimately failed. I fear this has and will continue to have a negative impact on our ability to care for our patients. I also think the barriers encountered here are prevalent. Since I have written and spoken on issues I think are critical for success in our principal mission of taking care of the patient, I have posted these on this website. Take a look, and download what is of interest to you. Perhaps it will help you to be successful as we move into the brave new world of healthcare reform.