INTRODUCTION
Physician leaders are our best hope for a high-quality, equitable, and sustainable health system. The healthcare sector is increasingly looking to physicians to meet its urgent challenges, including the need to move to value-based care, to reduce health and healthcare disparities, and to address the confounding social determinants of health.(1)
These and other challenges that hospitals and health systems face require system-level change. Physicians must be key participants in or leaders of the complex work of transformation. Unfortunately, unlike other professions where leadership skills are embedded into instruction, medical schools and residency programs typically do not train physicians how to effectively lead teams or entire organizations to meet such challenges. Consequently, physicians complete their training prepared to treat patients but not necessarily to lead large-scale change.(2)
To address this gap in education, health systems, hospitals, and individual physicians are increasingly investing in physician leadership development programs.(3) The array of programs, from brief seminars and workshops to multi-year degree and credential programs, has grown rapidly in the past few decades.
While the value of physician leadership development is exceedingly clear, there is a dearth of research related to the value of physician leadership development programs (PLDPs) to physicians’ organizations and their patients.(4) However, emerging research based on program assessments does suggest how and why PLDPs can support three organizational goals: culture, quality improvement, and the leadership pipeline.(5)
IMPORTANCE OF PHYSICIAN LEADERSHIP
The value of physician leadership in U.S. healthcare organizations is well-documented.(6)
The passage and implementation of the Affordable Care Act triggered many hospitals and health systems to have heightened interest in employing physicians and encouraging physicians to become leaders. Meanwhile, physicians have become increasingly willing to be employed, in part because they need the bargaining power with payers that comes from being part of a larger organization.(7)
As of 2022, the share of physicians working in practices wholly owned by physicians dropped to 46.7%, down from 60.1% in 2012.(7) As hospitals and health systems increasingly employ physicians, they need physician leaders who serve as “interface professionals” who bridge medicine and management. Physician leaders understand the perspective of their fellow clinicians but are also trained to respect the symbiosis between clinical care and administrative functions. Thus, they can connect the front-line clinicians with the organization’s management, leadership, and governance.(1)
Meanwhile, private practices were growing, requiring more leadership and more sophisticated management than previously. The share of physicians working in practices with 50 or more physicians grew from 12.2% in 2012 to 18.3% in 2022.(1)
The evolving physician-employment landscape is one of many changes that hospitals and health systems are navigating as they grapple with workforce shortages and resource constraints while facing new responsibilities including addressing the social determinants of health, combatting workplace violence, and more.(1) The respect and authority conferred on physicians give them inherent influence in their organizations, supporting physician leaders’ important role as change agents.(8)
Perhaps the most important mark of physicians’ leadership is their quantifiable expertise. Physician-led organizations outperform their non-physician-led peers on measures of quality of care, patient experience, and cost of care.(9) As far back as 2009, a research team at McKinsey & Co. conducted a study that found higher organizational scores on several management dimensions are associated with reduced rates of hospital-acquired infection and hospital readmissions, greater patient satisfaction and better financial margins. Importantly, the study revealed that hospitals with more physician leadership scored higher, on average, in performance management and Lean management, and had higher average overall management scores.(10)
Other studies have bolstered that assessment, including:
Quality of care
Physician-led hospital systems had better U.S. News and World Report quality ratings and more inpatient days per bed than non-physician-led hospitals did, according to a 2019 study.(11)
Patient experience
A review of Healthgrades hospital data for 2022 revealed that 55 of the 399 hospitals recognized for outstanding patient experience were physician-led. This is particularly noteworthy because although physician-led hospitals account for fewer than 5% of hospitals with patient experience ratings, they received nearly 14% of the outstanding-performance awards.(12)
In the most recent Centers for Medicare and Medicaid Services (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) report, physician-led hospitals had an average patient experience rating of 3.9, compared to 3.2 for all hospitals. Just 6% of hospitals overall received the highest rating in this category, yet 41% of physician-led hospitals did.(12)
Cost of care
CMS reported that nearly 60% of physician-led hospitals had lower Medicare costs per beneficiary than did the national median hospital in 2022. This compares to 51% of all hospitals.(12)
Importantly, physician leadership is driving the move from fee-for-service medicine to value-based care. The accountable care organization (ACO) model, which has generated more than $21 billion in gross savings for the Medicare program since its inception, is the largest alternative payment model. Physician groups, rather than hospitals, have taken the lead in ACO ownership. In 2018, ACOs led by physician groups accounted for about 45% of all ACOs; 30% of ACOs were jointly led by hospitals and physician groups, and 25% were hospital-led.(13)
VALUE OF COMPETENCY-BASED DEVELOPMENT PROGRAMS
Extensive AAPL research conducted over the past two decades suggests that physician leaders need specific types of training to be optimally effective.
Between 2004 and 2023, AAPL conducted personality assessments for 4,044 physician leaders using the DiSC assessment tool. The DiSC model of personalities places individuals in one of four main behavioral styles that reflect the specific mix of their inherent personality traits: Dominance, Influence, Steadiness, and Conscientiousness. No single behavioral style is better than another, and each style has its own defining characteristics:
Dominance personalities tend to be confident and focus on accomplishing bottom-line results.
Influence personalities are generally more open and place an emphasis on relationships and influencing or persuading others.
Steadiness personalities typically are dependable and emphasize cooperation and sincerity.
Conscientiousness personalities are most concerned with quality, accuracy, expertise, and competence.
Consistently, the largest percentage of physician leaders have fallen in the Dominance and Conscientiousness categories. This is not surprising because the traits inherent in those two groups are key to success in the rigorous educational path required to become a physician.
Smaller percentages of physician leaders fall in the Influence and Steadiness groups, the two categories most associated with cooperation, influence, dependability and an emphasis on relationships. Those personality traits are particularly important for today’s complex healthcare environment, in which multidisciplinary team building and collaboration are essential to an organization’s success.
Of course, physician leaders with each of the four behavioral styles can be excellent leaders. However, the approximately 60% of physician leaders who have inherent behavioral styles in the Dominance or Conscientious categories will benefit from 1) becoming aware of their personal behavior style and 2) learning how to strengthen the attributes that are not inherent to that style, such as cooperation and the ability to influence.
Separately, AAPL partnered with the Myers-Briggs Co. to customize its CPI 260® leadership personality test specifically for physician leaders.
Based on the California Psychological Inventory, the CPI 260 is a self-assessment but it does not measure an individual’s learned or technical skills, values, attitudes, or good intentions. Rather, the tool, which has been found to be reliable and valid, is used to explain how other people perceive the individual and would judge his or her leadership style.
The CPI 260 assigns an individual to one of four “ways of living” that best describes their interpersonal style and other attributes important to leadership.
Implementers tend to see themselves as ambitious, efficient, industrious, and organized. They are seen by others as active, ambitious, enterprising, and organized.
Supporters generally see themselves as conscientious, modest, patient, and reserved, while others see them as cautious, inhibited, peaceable, and retiring.
Innovators typically view themselves as complicated, humorous, pleasure-seeking, and spontaneous. Others tend to see them as clever, frank, impulsive, and witty.
Visualizers often see themselves as detached, frank, reflective, and unconventional. Their colleagues typically see them as dreamy, modest, quiet, and unassuming.
After providing the CPI 260 assessment to approximately 4,300 physician leaders, AAPL found that:
67% of physician leaders fit the Implementer category.
16% are classified as Supporters.
13% fit the Innovator profile.
4% are categorized as Visualizers.
The key insight here is that, at a time when healthcare requires leaders with vision, leaders who embrace innovation, and leaders who support their teams in a spirit of collaboration, the vast majority of physician leaders are not inherently strong in those domains.
Of course, physician leaders in all categories can be excellent leaders — and they can best fulfill their leadership potential when they understand how other people perceive them and how to balance their inherent strengths and weaknesses. This is most effectively accomplished through competency-based leadership development programs. Such programs, including all AAPL courses, are designed to provide training and education about specific competencies that the leader aspires to develop.
Generic leadership development programs may focus on the competencies that a physician leader has already acquired from inherent personality traits, lived experience, or prior training. Competency-based programs are essential for physician leaders who want to optimize their effectiveness by focusing on the skills and attributes that they need to develop.
PHYSICIAN LEADERSHIP DEVELOPMENT PROGRAMS: ARE THEY WORTH IT?
AAPL believes physician leaders who are pursuing leadership education and training — and the organizations that are supporting their effort — should be able to clearly see the value of their time, money, and effort.
To that end, AAPL in 2023 conducted an initial survey of physician leaders who have completed the Certified Physician Executive (CPE) credential program, one of the longest-running and most respected educational opportunities for physician leaders. Insights gleaned from the results are presented later in this white paper.
More than 4,000 physicians have earned the CPE credential since the AAPL introduced the program in 1997. The CPE differentiates itself from other types of advanced degrees or credentials by offering practical, clinically relevant leadership and management education targeted specifically to physicians. The CPE is geared for both physician leaders who want to propel their careers and for those who want to enhance their leadership skills to better serve their current organizations.
Certified Physician Executive Program
The CPE is awarded after a candidate successfully completes the CPE Capstone. To be eligible for the CPE Capstone, the candidate must:
Be a licensed MD or DO.
Be an active AAPL member for at least one year.
Have at least two years of healthcare leadership experience and significant managerial oversight.
In this context, leadership is defined as having responsibility for establishing, articulating, and executing the team and/or organizational vision. This includes coordinating and balancing the various interests of all team members and stakeholders and having the ability to lead and participate in strategy, finance, staffing, recruitment, hiring, firing, and other executive duties.
To participate in the CPE program, participants must attest to experience in these areas: talent management, data management, fiscal responsibilities, and organizational impact.
Be licensed to practice and be (or have been) board-certified in a clinical specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association or an equivalent commission in the country in which they live.
Have three years’ experience in clinical practice beyond residency and fellowship training.
Complete the CPE curriculum or hold a qualifying graduate management degree such as an MBA, MMM, MNA, MPH, MS-HQSM, or MS in management.
Candidates who have a graduate management degree must complete two of these core courses from the CPE curriculum:
Fundamentals of Physician Leadership-Negotiation
Practical Principles of Change Management
Resolving Conflict
Managing Physician Performance
Transforming Healthcare through Quality Improvement
CPE candidates who do not have a master’s level management degree must complete a core curriculum of 14 courses totaling 125 CME hours. In addition to the courses listed above, the CPE core curriculum includes:
Fundamentals of Physician Leadership, a series of five courses that delve deeply into the essential information that physician leaders must know in these areas: communication, finance, influence, quality, and negotiation
Science of High Reliability
Essentials of Health Law
Finance — Budgeting and Forecasting
Financial Skills for Executive Decision Making
Building a Path to Leadership Excellence
In addition to the core curriculum, CPE candidates who do not have a master’s level management degree must complete 30 CME hours chosen from a list of 38 elective courses such as Assessing the Health of Your Organization, Engaging Physicians for Results, Project Management Overview for Physician Leaders, and Value-Based Care.
The final requirement is the Capstone, a 3.5-day program in which the candidate completes exercises with a cohort group to practice skills in preparation of their individual CPE leadership summary presentation. The Capstone is designed to be a collaborative experience that allows CPE candidates to create a professional network of highly competent leaders.
SURVEY RESULTS: THE CPE AND ORGANIZATIONAL BENEFITS
One way to determine the impact of a physician leadership development program on organizations is to track and measure outcomes from program graduates. AAPL took an initial step toward that goal in 2023 when it surveyed physician leaders who have earned its Certified Physician Executive (CPE) credential after completing AAPL’s comprehensive physician leadership development program.
Responses revealed that physician leaders who completed the CPE have used the skills and education they acquired to 1) improve patient outcomes through quality and patient safety initiatives and 2) enhance organizational outcomes, including financial performance, culture change, physician engagement, and leadership during the COVID-19 pandemic.
Survey respondents were able to tie their performance to measurable outcomes in many ways: improved quality and safety metrics, improved patient-, staff- or physician satisfaction, reduced employee turnover, program or organizational growth, and dollars earned and dollars saved.
The 365 respondents to the AAPL survey held a wide range of positions in a variety of organizational types. More than half worked in a local hospital/health system or a multi-hospital system, and more than half had the job title of “medical director” or “chief medical officer.”
Respondents showed a strong consensus that their CPE participation supported organizational improvements. The vast majority (90.3%) of CPE holders agreed with this statement: “The AAPL CPE program empowered me to achieve leadership goals both individually and organizationally.” Moreover, 42% of respondents strongly agreed with the statement.
Further, 70% of respondents agreed with this statement: “The organizational changes I made were largely a result of the knowledge and skills acquired from the AAPL CPE program” and 20% strongly agreed with it.
The survey included two open-ended questions designed to identify how respondents used the learnings from their CPE curriculum and capstone experience to influence their organizations:
What was the most significant organizational impact resulting from your leadership since completion of the CPE?
Were you able to quantify the results from your program (e.g., dollars, savings, administrative time, quality improvement measures, practice efficiencies, EMR software integration, increased productivity)?
Responses revealed that physician leaders who have completed the CPE have used the skills training and education to advance their organizations in significant ways, including:
Quality of care
Patient safety
Financial performance
Physician performance and satisfaction
Culture change
Crisis leadership during the COVID-19 pandemic
See Sidebars 1-4 for verbatim survey responses that reveal the value of the CPE from the perspective of those who have earned it.
Sidebar 1. In Their Own Words… How Physician Leaders Put Their CPE Skills To Use
Survey respondents reported a wide range of program developments or improvements resulting from their leadership since completion of the CPE. Verbatim responses include:
Building an integrated population health services team for a $3 billion health system.
Implemented a program to address high utilizers of emergency and acute behavioral health services. The program was able to link members with the appropriate level of care and resulted in decreased utilization of emergency services and netted a significant cost savings.
Creation and implementation of a hospitalist and intensivist program in my hospital.
I credit the CPE curriculum in helping me understand a construct where communication, staff engagement and motivation, negotiation skills, and process improvement intersect. With these skills in combination, I started a program to improve preparatory training for new military commanders who are physicians and nurses, which has been utilized by 50 clinicians so far.
Development and implementation of medical management programs saving around $15 million dollars in medical costs.
As clinical director, I have been one of the key leaders developing a new first-of-its-kind freestanding clinical facility for individuals with disabilities.
Development of a new outpatient palliative care program.
I was able to utilize the skills learned to successfully create a neuroscience service line and a tele-stroke program within my healthcare organization.
Developed and founded an internal medicine residency program with a fully integrated and collaborative continuous improvement curriculum and several innovative features to modernize medical education.
Was the physician champion for an initiative to prevent vaccine errors in our medical group providing physician leadership.
The program provided me with the tools for new service line planning and execution for a lung nodule screening and management program, a new allogeneic transplant program and an emergency department-bypass program for patients receiving chemotherapy.
Launching the hospital’s Center for Health Equity, bringing together programs, data analytics and research.
Implementation of a system-wide process and electronic health record tool to improve capture of relative expected mortality.
Development of graduate medical education program in our for-profit hospital system.
Revamping medical staff bylaws in my hospital and creating a new leadership structure within it.
Redesign of the Department of Defense/Veterans Affairs disability evaluation system.
Successful implementation of a clinical decision unit run by mid-level providers with physician oversight.
Development of Joint Commission-certified primary stroke and spine surgery programs.
Designed and implemented a school for family medicine residency directors that has been copied by multiple other specialties.
Development of a program designed to create a culturally competent staff who can provide high-quality services and support to a low-volume, high-risk population in a 93-hospital healthcare system.
Developing a physician advisor program; got some great pointers from my CPE cohort group.
Development of a regional pediatric antimicrobial stewardship initiative. I was able to gain the support to build the program from almost nothing.
Sidebar 2. In Their Own Words… How the CPE Influenced Organizational Performance
In response to a survey question, physicians who earned the CPE credential identified how their organizations benefited.
…the most significant was the integration of several markets into one cohesive whole after a company-wide reorganization. The outcome was a more efficient and cohesive market that leads the company in associate engagement and overall productivity.
As a physician leader for my organization, I helped navigate a new (and sometimes hostile) market to develop a new regional rural family practice hub — hospital service lines, OB service lines, surgery/endoscopy lines, and two clinics — all from literal scratch. It’s been a wild ride and I would not have had the confidence and presence of mind in terms of conflict management and strategy development without having completed AAPL’s CPE course.
Led the work to transition from a community-based service line with misaligned priorities to a hospital-employed service line that aligned strategy and individual position priorities. This allowed the hospital to be independent of the whims of the private practice group in order to stabilize its hospital-based services.
We expanded specialty services to a rural market and reduced out-of-network costs.
We were put under a restructuring agreement by our board for failure to meet bond covenants. I led the clinical charge to redesign our care delivery system and to regain our footing and return to solvency. I also led us out of (a CMS) termination pathway after a series of poor outcomes.
Creation and successful execution and launch of value-based contracts and strategy (for our) 1 million-member health system-owned health plan, leading to $65 million in savings to plan as well as multi-million-dollar payouts to four clinically integrated networks comprising over 4,000 physicians.
Having the CPE gave me credibility…. The coursework was phenomenal. I used the Financial and Accounting coursework to design an Excel spreadsheet for our freestanding ambulatory surgery center that has tracked and monitored our costs, current ratios, and days cash on hand for the past 10 years.
Growing the infrastructure to support a full-risk bearing Independent Physician Association along with growing the network from 350 to 1,250 providers.
ACO founding medical director. Started from scratch. Now the most important way we get paid.
My hospital achieved Top 100 Designation (now Fortune/ Meritive — was Truven Top 100 at the time) six times, which relied heavily on my division to optimize mortality rates, complication rates, length of stay, utilization, infection rates, and spending per patient.
Coding efficiency went up from 60% to 95% within two years.
Leading the closure of our long-term care “basic” nursing home unit. This unit had averaged losses over $600,000 annually for the last 10 years. We also were able to convert the space to revenue-producing services, producing income beyond simply cutting losses.
Changed from a $250,000 subsidy and extremely low HCAHPS scores to a $500,000 profit with 8-10 HCAHPS scores.
Moved a 30,000-covered lives, $75 million contract from one payor to another because of unfavorable contract terms from the former. Grew the organization by 50% in 4 years.
Savings of $3-5 million in length-of-stay reductions.
Cash on hand went from 51 days to >120 days in less than 1 year. Leapfrog C to A in two cycles. #76 to #6 on Vizient list of AMCs in the area of Efficiency while #26 to #16 in Safety.
Transplant service improved by $7 million net over past two years.
Moved the organization from CMS 1 to 3 stars, Leapfrog D to A, and mortality from 300% of predicted to 60% of predicted over a four-year period while also rewriting the medical staff bylaws/rules and regulations to strengthen medical staff oversight and leadership.
Sidebar 3. In Their Own Words… Quality Improvement After Earning the CPE
Many physician leaders cited quality improvement as the most significant organizational impact they have had on their organizations since completing the CPE.
Multiple coordinated quality improvement initiatives resulting in improved Hospital Compare ratings from 2 to 4 stars, and value-based purchasing (VBP) bonuses instead of penalties.
(Our hospital was) named among Leapfrog’s Top Hospitals For Patient Safety and Quality and ranked among “Best Hospitals” by U.S. News and World Report and Ranked as No. 1 Hospital in (our area.)
Leading multi-functional team to improve quality and safety, e.g. achieving top decile performance on Vizient quality scorecard and A grade on Leapfrog.
Creation of House Officer Quality Council for our large teaching hospital. Also, creation of a Distinction in Quality and Leadership Curriculum for house officers training in all specialties and subspecialties.
I took our hospital from number 126 ranked in quality to 16 in quality. (Progress was) driven by using quality metrics to engage doctors and staff to improve performance.
$5 million turnaround in quality incentives from $4 million penalty to a $1 million reward within one year.
Through building a culture of sustainable quality we were able to achieve many recognitions and over $1.5 million in quality (incentives.) A first for this org.
Sidebar 4. In Their Own Words… Crisis Leadership After Earning the CPE
When asked to identify the most significant organizational impact resulting from their leadership since completing the CPE, many survey respondents reported their leadership roles during the crisis years of the pandemic.
I was the clinical lead for our COVID-19 response, writing coverage policies for tests and medications as they came on the market, redrafting the health plan’s disaster response policies and transitioning the team to full-time remote work. To complete these responsibilities, I had to call upon much of what I learned in the CPE program: strategy, execution, timeliness, communication, and managing up.
Led the hospital response to COVID-19 as the incident commander in a manner that reflected my style as remaining “calm in the face of chaos.”
Leading through the COVID pandemic. Transforming an ambulatory clinic to a 24-hour alternative care site for patients in April 2020 for COVID patients wanting palliative care.
Led the national COVID response. Designed and implemented the national, regional, state, and local operations and clinical response to COVID. Skills I acquired during my CPE training helped me lead clinical teams through the crisis of the pandemic.
PHYSICIAN LEADERSHIP DEVELOPMENT LANDSCAPE
The CPE credential program and AAPL’s other educational offerings are part of a wide and growing array of PLDPs that have emerged to meet the demand for physician leaders.(14) Many hospitals and health systems offer PLDPs, either internally or externally. Programs are available through professional associations, state medical societies, national medical specialty societies, universities, state hospital associations, and health plans, among other groups.
Despite the plethora of programs, the field has not yet matured sufficiently to have a standard way of assessing how an individual PLDP influences organizational and patient outcomes.(15) AAPL conducted a systematic review of peer-reviewed studies and other articles published between 2010 and 2023 to learn what is known on this topic. The search identified articles through research databases including ScienceDirect, Academia.edu, ResearchGate, NIH, National Library of Medicine/PubMed, BMJ/BMJ Leader, and Semantic Scholar. Studies that described the impact, value, or benefits of PLDPs on organizational and patient outcomes were included in the review.
The review documented PLDP participants’ self-assessed increases in leadership skills and knowledge.(14) However, the literature on how the programs positively impacted organizations and patients is sparse, and more research is needed to understand how organizations can best measure the value of PLDPs.
Importantly, the literature review showed growing interest in documenting PLDPs’ impact on organizations and patients, even if the best methodology for doing so is not yet known.
For example, researcher Maarten Debets and his colleagues recently analyzed 35 PLDPs — 23 in the United States, five in the United Kingdom, and seven in other countries — to learn how, why, and under what circumstances PLDPs can affect organizations in three important domains: culture, quality improvement, and the leadership pipeline (Sidebar 5).(16)
Sidebar 5. How Physician Leadership Development Programs Influence Organizational Change
Analysis of 35 PLDPs shows how they can influence organizational culture, quality improvement, and the leadership pipeline.
Acquiring self-insight and people skills
If PLDPs include constructive feedback on physicians’ personality traits and leadership behavior, physicians become more self-aware and acquire insight into the needs and preferences of the people they lead. Accordingly, they adopt a people-oriented leadership style that benefits communication and collaboration and thereby the organization’s culture.
Intentionally building professional networks
If PLDPs stimulate interaction between program participants, physicians build professional networks, which may affect the organization’s culture, quality improvement, and leadership pipeline. Professional networks seem most effective for realizing organization-level outcomes when participants are from the same organization.
By building professional networks, physicians better understand the perspectives of others (e.g., administrators, other medical disciplines) and collaborate better. Networks also function as support structures, benefiting the organization’s culture.
Professional networks mobilize resources. Physicians know where to go and who to turn to for collaborations or when facing challenges, leading to more effective quality improvement.
Building professional networks makes physicians more visible within the organization and more likely to be promoted, strengthening the organization’s leadership pipeline.
Supporting quality improvement projects
If PLDPs include well-supported quality improvement projects endorsed by the organization (e.g., coaching or mentoring, project management support, funding, protected time, facilities), this allows physicians to create buy-in and be more perseverant when facing challenges, thereby increasing the likelihood of successful implementation of the project and quality improvement.
Tailored PLDP content prepares physicians
If PLDPs’ content is tailored to physicians’ leadership needs and expertise, physicians perceive the PLDP content as relevant; consequently, the learning experience (including knowledge, skills, attitudes, confidence, self-efficacy, and identity as leader) prepares them for current or future leadership roles. They are more willing to assume leadership roles and be considered competent, leading to additional leadership roles and a strengthened leadership pipeline.
Valuating physician leaders and organizational commitment
If hospitals exhibit the value they place on physician leaders by facilitating PLDP participation, physicians feel appreciated, commit to the organization, and are more willing to adopt new leadership roles. This strengthens the organization’s leadership pipeline — especially for underrepresented groups in the leadership pipeline.(16)
This analysis included only PLDPs that specifically targeted physician leaders who work in hospitals. For most of the programs, the primary goal was training physicians to realize organizational change and improve healthcare or to strengthen the organization’s leadership pipeline. Topics frequently covered in these programs include leadership theory and styles, quality improvement, emotional intelligence, group dynamics, negotiating skills, and conflict management.
The main takeaway from this analysis is that a PLDP’s impact on organizational outcomes depends not just on the program or the participant but on the “leadership ecosystem” within the organization. In other words, a highly motivated physician who participates in a first-rate PLDP may not be able to effect organizational change if the dynamics within the organization do not support it.
This suggests that the organizational outcomes of a physician’s participation in a PLDP hinges on the leadership ecosystem in which the physician leader is working.
The Importance of the Leadership Ecosystem
An organization’s leadership ecosystem includes all the factors that surround a PLDP and contribute to a physician leader’s success — or failure — in influencing positive changes.(16) These factors include:
Funding to support the change the physician leader attempts to influence.
Infrastructure, including alignment with other training programs and clear career paths.
Cultural factors, including role models and appreciation of the value of PLDP participation.
Coaches, mentors, and educators.
Post-program activities such as alumni networks and follow-up sessions.
A healthy leadership ecosystem supports physician leaders in transferring the skills and knowledge gained in a PLDP to the workplace. Studies have documented that ecosystem support prevents skill attrition and contributes to the staying power of quality improvement projects.(17)
CONCLUSION
All healthcare organizations share two imperatives: to improve patient outcomes and ensure the sustainability of the nation’s healthcare delivery system.
Meeting these challenges requires every physician, regardless of job title, to be a highly effective leader. Physicians do not typically acquire leadership and management skills during their medical training; however, a wide range of PLDPs offering a variety of content, format, duration, and purpose has emerged to meet the demand.
Health systems, hospitals, and physicians need to know how a PLDP will help an organization meet its goals. AAPL took an initial step toward building that knowledge base in 2023 when it surveyed the alumni of its CPE credential program about how their CPE experience affected their organizations. Survey responses documented improvements in the quality and safety of care, new program development, operational gains, revenue growth, cost savings, leadership during a crisis, and many others.
Since its founding in 1975, AAPL has educated more than 250,000 physicians in 40 countries. During that time, we have witnessed the growing influence of physician leaders, whether they are leading a major institution or making a decision at a patient’s bedside.
Through its work with physician leaders, AAPL supports both professional and organizational development, and we know our constituents want to use their time and money wisely. As the only association solely focused on providing leadership education and management training for physicians, AAPL is well-positioned to further advance our understanding of the return-on-investment for PLDPs.
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AAPL has created this physician leadership white paper with sole sponsorship funding from Jackson Physician Search. While Jackson Physician Search has had no specific input into the content of this publication, Jackson Physician Search and the American Association for Physician Leadership have a shared belief that all physicians are leaders, and as such are especially vital in determining and effecting better healthcare delivery and patient outcomes.