Andrew Resnick, MD: Working in today’s healthcare environment is challenging regardless of your title. However, none may be more daunting than chief medical officer (CMO) because of the unique challenges we must navigate as the crucial bridge between the administration and medical staff. My colleague Roger Ray, MD Chartis’ Chief Physician Executive, draws on more than 2 decades of experience as a former CMO as he shares practical insights for leaders to be successful in this role.
A former practicing neurologist and experienced health system physician executive, Roger also leads Chartis’ Physician Enterprise Solutions. He leverages his 30 years of healthcare leadership experience to transform physician enterprises into value-drivers for hospitals and health systems. Outside of work, you can find Roger working on his latest woodworking project.
Chartis: How has the role of CMO evolved since you entered the field?
Ray: The role of CMO didn’t exist in most healthcare organizations when I entered the field 25 years ago. Some organizations engaged physicians in credentialing and medical staff relations, but very few had someone in the C-suite dedicated to physician oversight and change management. Now, the value proposition is clear. CMOs work everywhere, and the role has become both broader and more nuanced.
Chartis: To what extent has the day-to-day job of a CMO changed in the past few years?
Ray: It has morphed from a job of minor operational influence with some clinical responsibility to one of significant influence and direct oversight over sizeable parts of the organization, such as the medical group or multiple service lines.
Change management in the medical community is a focal point. Today’s CMOs must drive substantial change among doctors while simultaneously avoiding conflict. Oftentimes, CMOs do one or the other well but not both. The term of many CMOs is quite short. 64% have a tenure of less than 5 years. As you are seen neither as “fully” executive nor clinician, you’re basically a “person without a country,” so to speak. You attempt to straddle the executive and clinical worlds. It’s lonely. It’s hard. And it’s risky. Because of this straddling of worlds, you’re vulnerable—you don’t have the air cover that many other top executive jobs do.
Chartis: What role do CMOs play in navigating various forces that continue to dominate the healthcare landscape?
Ray: CMOs are sitting right in the middle of these forces, including population health management, health equity, technological revolution, healthcare disruptors, and the shift toward healthcare consumerism. CMOs are charged with ensuring the physician enterprise brings value to the organization as these forces evolve and as new forces emerge.
This is not a simple task because it may require an entirely new approach. In addition, CMOs need to convince doctors that change is necessary, and they also need to convince them that it is vital to drive that change. This is one of many reasons why the job of CMO is perhaps the toughest in healthcare.
Chartis: What must CMOs do to get physicians to actually drive the changes and not just passively accept them?
Ray: You need to leverage deputies. The number of deputies needed depends on the number of total physicians you’re trying to influence. I rely on a rule of thumb that it’s usually around the square root of the total. For example, for a community of 100 doctors, you need about 10 deputies who are organized, competent, credible, and able to influence others. Sometimes this has nothing to do with one’s title. On an informal basis, who are the doctors watching and to whom are they listening? It’s critically important for those informal leaders to be aligned with your goals.
Chartis: What change will be the most difficult for CMOs to navigate in the year ahead?
Ray: The toughest conflict is shifting from provider- to patient-centric care. Somewhat surprisingly, it’s often hard to convince doctors to give up some of their perceived autonomy for the sake of achieving better results for patients. Because of the ethical and emotional devotion to patients, you would think this would be an easy shift, but it’s not, and I think it’s largely because of physician burnout. Doctors are looking at the current environment and saying, “We’re losing influence. We need to reassert it.” However, reasserting physician influence often gets you physician-centeredness, not patient-centeredness.
Managing generational differences in the workplace is also a constant challenge. CMOs need to consider whether someone is a digital native, what specialty they chose and why, their personal communication and learning styles, what’s going on in their personal lives, and so much more. Doctors are composites of all of this, and CMOs need to take the time to learn them. Caricatures and generalizations don’t usually apply. You need to know what’s important to each doctor and why.
Chartis: What’s the best way for CMOs to obtain physician buy-in?
Ray: Physicians need to be involved in the design of whatever solutions the organization implements. For example, if the goal is to increase patient access, physicians should weigh in on patient self-scheduling or standardized workdays and templates to enable call center scheduling. Their subject matter expertise is critically important.
With that said, physicians also need to get comfortable with the real or perceived loss of control that comes with some of these solutions. That’s where the CMO can help. At most levels, high reliability requires some standardization, and that’s where the tradeoffs are worth it. In addition, addressing physician burnout will be paramount. It’s a core function and key part of the job. When physicians see that the CMO truly cares about their well-being, it becomes much easier to manage change.
Chartis: What about physician buy-in with new technology specifically?
Ray: When you bring innovation into the clinical space, you can’t always predict new failures. This makes doctors anxious. You need to talk about this and be authentic. Let them know that you’re hardwiring safety where you can.
Chartis: What “pearls of wisdom” from your career do you share with other CMOs?
Ray: Here are 5 lessons learned:
- Nothing is ever as good or bad as it seems. Get both sides of the story and any supporting data. When you have something to celebrate, recognize that there are likely elements others will perceive more negatively. Similarly, even in very negative circumstances, there likely are positive elements to notice. This balance is critical for supporting wise decision-making.
- Before you make any big change, ask this question: Who is going to hate this, and do they have a valid point? Organizations often talk about change being necessary “for the greater good,” but good CMOs know there’s always a cost—and someone will always be disappointed. Know the topic well enough so you can anticipate criticism and empathize with both supporters and detractors.
- When there’s disagreement, always circle back to the patient. The concept of “the patient” is the weightiest and most reorienting to introduce into difficult healthcare conflicts, as it should be. Simply, how would the patients and their families feel about this issue or change? Otherwise, arguments can spiral out of control—and someone always walks away feeling as though they’ve lost.
- Don’t underestimate the power of highly reliable communication. If there are two levels of clinical leaders between the CMO and front lines, the CMO needs to ensure those leaders communicate the same message—doing so clearly and effectively without losing anything in translation.
- Credibility is everything. Try to anticipate potential challenges and communicate them to doctors. If you don’t do this ahead of time, the challenges that inevitably arise will appear as mistakes, deficiencies, errors, or flaws. Ultimately, your credibility will be questioned and undermined. This is an influence role—credibility is everything.
Chartis: Any final words?
Ray: The role of CMO is ever evolving—and that’s what makes it exciting. Tapping into available resources can help CMOs thrive and be the agents of change on which organizations can rely.