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By Leon E. Moores, MD, DSc

According to the global executive search firm, WittKieffer, the demand for physicians to lead hospitals and health systems has been increasing over the past three years. What is driving this demand? Some say that it is the industry’s move to value-based care, which focuses on quality care versus volume-based care.

As a practicing pediatric neurosurgeon, I have spent much of my career serving in combined clinical and leadership roles in various healthcare organizations. In questioning whether care quality differs in healthcare organizations led by physicians I’ve found little evidence-based research measuring hospital performance relative to physician CEOs versus non-physician CEOs. As such, I chose this research topic as I pursued my Executive Doctor of Science in Healthcare Leadership degree at the University of Alabama at Birmingham. In 2021, my dissertation “Reported Clinical and Financial Performance of Hospitals with Physician CEOs Compared to those with Nonphysician CEOs” was published in the American College of Healthcare Executives’ (ACHE) Journal of Healthcare Management’s November/December 2021 issue.

Since existing leadership theory and some research suggest a relationship between technical expertise and success in leading highly technical organizations, I hypothesized that hospitals led by physician CEOs would report higher levels of clinical and financial performance compared to hospitals with non-physician CEOs. The single-year, cross-sectional analysis of U.S. acute care hospitals showed no differences in reported performance. The sample population included 190 hospitals, half (95) with non-physician CEOs and half with physician CEOs, randomly selected from over 1,900 AHA database U.S. medical surgical hospitals with more than forty beds. All CEOs had at least one year of tenure. Three standard reported quality measures were chosen: actual/ predicted central line-associated bloodstream infection (CLABSI) rates, acute myocardial infarction (AMI) 30-day risk-adjusted mortality rates, and pneumonia 30-day risk-adjusted excess readmission rates. Financial performance was evaluated based on hospitals’ return on assets and operating margin. The study also controlled for 13 hospital characteristics and market factor variables.

This analysis did not support the hypotheses that hospitals with physician CEOs report

better clinical and financial performance than hospitals with nonphysician CEOs (at the 95% confidence level). The data did demonstrate that physicians were more likely to be the CEOs of teaching hospitals, nonprofit hospitals, and larger hospitals. Physicians were also more likely to lead hospitals owned by a system.

This was a very focused review and therefore subject to a number of limitations. This study does not imply causality due to the retrospective nature of a cross-sectional data analysis. Second, this study used a single year of data, which for many reasons may not be representative of longer-term performance. CEO tenure is important, as there is often a lag between the CEO’s appointment and CEO-driven changes in organizational outcomes. This study included CEOs with more than one year in the position, resulting in over 25% of CEOs with less than two years’ tenure. Finally, the study did not examine additional hospital characteristics and/or CEO leadership traits which may be better predictors of clinical or financial performance.

As previously mentioned, there has been little empirical work done comparing the performance of hospitals with physician CEOs versus non-physician CEOs. More work in this area could be useful to inform hospital CEO recruitment and selection processes. Future studies may consider independent variables of hospital size, teaching status, not-for-profit ownership, or clinical leaders in other professions such as nurses, therapists, and technicians. This work adds to that discussion, and hopefully will be useful.

In conclusion, while it may be appealing – and would certainly be efficient – to be able to ascribe outsized impact of a single, measurable leader characteristic (such as being a physician), this study’s data do not strongly support that. It turns out that, like leadership itself, leadership selection is a complicated business and there are likely no simple solutions to help organizations choose the leader best suited to maximizing hospital performance.

Dr. Leon E. Moores is Professor of Surgery and Pediatrics, Uniformed Services University School of Medicine, and Professor of Medical Education, University of Virginia School of Medicine (Inova).