Why Psychiatrists Should Lead Hospitals and Health Systems

What do these medical centers—Harvard Partners System, Mount Sinai in New York, UCLA System, Georgetown/Medstar, and New York Presbyterian—have in common? World-class care and excellence, yes, but another common feature is that their CEOs are (or, in the case of New York Presbyterian, were until recently) all psychiatrists.

Putting aside the talk of isolation and marginalization that occurs when psychiatry’s place in medicine is questioned, psychiatry is quite well represented in health and hospital administration. Yet in general, physician leaders are a rare breed; currently only 4 percent of hospitals are led by physicians.

If psychiatrists make good leaders, why has no one told us that this is a career option? People who enter medical school and subsequently pursue residencies have a wide variety of career goals: some wish to have research careers, some want to teach, and others intend to provide direct clinical care. But what about those who are interested in administrative and leadership roles? Do psychiatric residency programs provide the training necessary to prepare the next generation of medical directors and CEOs?

Some programs in internal medicine are moving toward having specialized tracks for residents who want more exposure to leadership roles. These tracks largely focus on three components: specialized curriculum, experiential learning in the form of a project, and mentorship by a physician leader. This is important because, as Clay Ackerly and colleagues explained in Academic Medicine in January, the larger part of the current generation of physician leaders obtained their current positions in a way that can be described as “accidental administrators.” That is, physicians are often identified and promoted to leadership positions based on their career achievement. The article argues that we need to move to “cultivated leadership,” in which medical students and residents are exposed early to leadership training and opportunities.

The goal would not be to prepare every psychiatrist to be a CEO, but to cultivate leadership skills as an important component of our profession. Daniel Blumenthal and colleagues, also in Academic Medicine, explained that frontline clinician leaders, the ones delivering day-to-day services, are as important as the CEO to the success of a medical center, because they are the catalysts for effective medical teams: there is strong evidence that good leadership skills lead to good clinical outcomes. Once we understand that leadership traits are essential to delivery of effective clinical services in our increasingly complex medical care systems, then it is natural to think that leadership should be one focus of our training.

Leaders are made, not born. Leadership requires not only business experience but also elements of self-control. Daniel Goleman and colleagues in the Harvard Business Review concluded that a leader’s mood and behavior drive the mood and behavior of everyone else in the organization, which ultimately affects the bottom line. Their research showed that managing for financial results begins with a leader managing his or her inner life, so that the right emotional and behavioral elements appear.

A leader’s mood has the greatest impact on performance when it’s upbeat, but it is also must be attuned with the people around him or her, which is called “resonance.” The Goleman article argues that the process of self-awareness and mood management can be taught. I maintain that psychiatry trainees are implicitly immersed in a “boot camp” that trains them to manage their mood and understand the subtleties of resonance. By that I mean how their mood affects their patients.

As part of our training, we are familiar with these skills. Is it possible that this ability makes us better leaders, not just for psychiatric hospitals, but for general hospitals and medical centers? Obviously not all psychiatrists will have this ability, and many may not be good leaders or have any interest in administration, but if we emphasize the importance of these skills for residents both for the success of their clinical duties as well as potential leadership roles in the future, I am sure we will have more trainees willing to take managerial roles.

Our services depend on having resources to serve patients, but since resources are scarce, we need to advocate for them. Advocacy requires an understanding of the system and awareness of the available resources. This is not a time to hide in the sand: structural changes that will affect the way we organize and deliver services are coming, so either we take a proactive stance and start training residents to become clinician leaders or we will become the first casualty. Psychiatrists need to become system changers and sit at the table rather than appear on the menu. ■