Association for surgical education
Physician leadership is essential to the survival of teaching hospitals

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Abstract

Background: Academic medical centers (AMCs) face severe financial constraints because they must now compete directly with private providers that focus exclusively on cost-effective healthcare delivery. Educational and research capacities developed at AMCs have been supported by government and third party payers, but government support is diminishing. Physicians are ill-equipped to respond to market pressures.

Data sources: Analyses of cultural change and restructuring in corporate giants such as Greyhound, IBM and FedEx are relevant to teaching hospitals. To succeed, organizations must flatten hierarchy, empower staff, train leaders, and mobilize intellectual capital. Effective leadership is essential.

Conclusion: Physicians must educate themselves on forces impacting the AMC, understand changes needed in the structure and processes of AMC governance and acquire competencies for leadership and management if AMCs are to survive and thrive. Surgeons should acquire competencies that will enable them to become leaders in the process of AMC transformation.

Section snippets

Forces confronting the academic medical center

Academic medical centers presently face many new challenges, the greatest of which may be financial constraints due to market forces and changes in reimbursement. AMCs “must still compete with managed care. Studies indicate that in areas where managed care penetration is the highest, [AMCs] are not faring well.”4 Theoretically, the difference between AMCs and their private counterparts is the former’s mission of education and research; in reality, without patient care, neither of these

Corporate America: a primer for the health care industry

Why should the health care system pay attention to the recent history of American corporate industry? The entry of the US health care system into the classic economic marketplace is akin to the impact of the global economy on the American business enterprise almost 2 decades ago; for various reasons, both systems had been protected from larger market forces and each has suffered culture shock with the new environment. It simply stands to reason, given the tremendous success of the American

Primary features of the future AMC

Souba13 believes that the main focus of AMCs must remain educating future medical professionals, offering quality health care, and continuing pertinent research. An additional, vital component must be added, however, that integrates the tripartite mission of the AMC: creating solid business ventures, for both internal and external customers. In doing so, strategic advantages will be created that are unique to AMCs; this is the market niche that only the AMC, with its extensive intellectual

Successful leadership competencies for the AMC

The leaders within AMC have an exciting future ahead of them as they visualize, articulate, and implement the changes imperative for the success of such organizations. Their major role is “to create a powerful vision that allows room for things to occur that are as yet undreamed of.”21

The following nine traits, in varying combinations, are typical of most successful leaders: (1) charisma, (2) individual consideration, (3) intellectual stimulation, (4) courage, (5) dependability, (6)

Conclusion

Now that the health care industry is, for the first time, subject to classic market forces, “those attempting to direct their organizations proactively are recognizing that they cannot succeed without a higher degree of physician leadership than the health care system has previously demanded.”31 Clearly, “physician executives have unique roles to play in the changing medical division of labor and restructuring of delivery of services…physician executives fill a new set of managerial vacancies

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      Further to the system benefits, it has been suggested that surgeons who have the skills necessary to lead improvement tend to be more satisfied, thereby providing benefits on a personal level as well.23 The acquisition of successful leadership skills is therefore a desirable endeavor, and contrary to the old adage that “leaders are born, not made,” there is ample evidence that leadership skills can be acquired.24-26 Urology has traditionally been a male dominated specialty, and this discrepancy is highlighted among positions of leadership as demonstrated here.

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