The COVID-19 pandemic demonstrated the importance of strong physician leadership within healthcare systems.1 To support GIM leaders in times of crisis and times of calm, we must understand the challenges facing physician leaders.
As physicians assume leadership roles in administration, research, or education, time allotted to direct patient care can decrease. Balancing managerial and clinical roles is therefore challenging. Time constraints, financial pressures, clinical credibility, and job satisfaction may influence the decision to continue clinical care; some physician leaders give up direct patient care altogether.2-4 Literature on physician leaders has not characterized the role direct patient care plays among leaders in academic general internal medicine (GIM).2-4 We sought to determine whether GIM leaders continue to provide direct clinical care and why, in order to understand how GIM leaders view their role as a physician and leader.
We performed a national cross-sectional survey of ACLGIM (Association of Chiefs and Leaders of General Internal Medicine) physician leaders, a leadership organization within the Society of General Internal Medicine. A questionnaire was sent to the 232 active ACLGIM members in February 2018, including demographics; leadership role; time spent in administration, research, teaching, and patient care; and how patient care influences their leadership. Burnout was assessed using a single-item measure.5 The survey was piloted for face and content validity with physician executives at Northwell Health. The project was deemed exempt by the Northwell Health Institutional Review Board.
The following is a list of what we discovered:
- 62 of 232 (27%) physicians responded to the survey; 55 (24%) completed the survey. Respondents were predominantly male (59%), white (80%), and middle-aged (age 45-64) 84%. 90% were employed by an academic medical center, with “Chief” being the title for the majority (67%). Most respondents reported holding a leadership role for less than 10 years (78.2%). On average, respondents spent 45% of time in administration, 19% of time in direct patient care, 14% of time supervising residents, 12% of time in research, and 9% teaching.
- 86% of physician leaders reported currently providing direct patient care. Among these, 35% spent less than 10% of their time on direct patient care a week. Of the physician leaders currently providing direct patient care (N=47), 87.2% reported that they had to decrease their clinical activity to accommodate their leadership responsibilities.
Respondents ranked their role as a clinician as the highest in personal importance, but reported their administrative role was of highest importance to their organization. Top reasons for continuing to provide direct patient care included personal fulfillment, clinical credibility, and maintaining clinical skills/knowledge. Further, we discovered the following:
- 91.3% of respondents who provided direct patient care reported it enhanced their leadership role.
- 25% of respondents reported burnout (a score of >3). There was no significant correlation between burnout and time spent on direct patient care.
A majority of ACLGIM physician leaders continue to provide direct patient care. The reasons for continuing patient care included personal fulfilment, maintaining clinical credibility, and preserving clinical skills. This echoes previous literature that continuing direct patient care contributes to higher rates of satisfaction among physician leaders and enhances credibility among peers.2,3
GIM physician leaders also maintain a strong attachment to their identity as a clinician, despite progression into leadership roles with less time dedicated to patient care. Although physician leaders spend most time on administrative work and their role as an administrator is most valued by their organization, physician leaders place highest value on their role as clinicians.
Despite leadership roles, a burnout rate of 25% in this population were below the reported for average GIM physicians (38%); percent time spent in direct patient care did not correlate with burnout levels.5
Our data was self-reported and response rate was suboptimal, both limitations. As the survey was administered within a single leadership organization within a larger single specialty organization, results may not be generalizable. We have been careful to not make causal inferences from cross-sectional data, instead focusing on themes.
Most academic GIM physician leaders in this national sample reported continuing to provide direct patient care and believe that direct patient care enhances their leadership role. In this pivotal time in health care, supporting physician leaders by allotting time and resources towards their continued involvement in patient care is critical.