Part 1 of 2
With all eyes on clinical quality and safety, it makes good sense for health systems and freestanding hospitals to select physicians to serve on their organization’s board. Physicians’ experience and knowledge make them ideal candidates to offer insight in these capacities, and more.
Which physicians make the best board members? The short answer is that there is not “one size fits all.” Physicians arrive at boards multiple ways; some offering much more latitude for vetting (e.g., by nomination committee) than others (e.g., by political assignment). In addition, organizations have different needs, missions and strategic goals. A physician candidate who would be ideal for a mid-size, nonprofit community hospital board would have different qualifications than one for a large, for-profit system board.
We’ll share qualifications of physicians who are best suited to serve on your hospital or system board. Then, we’ll provide tips so you may make the most of your physician board members and keep this team invaluable and engaged.
In this two-part series, we’ll review:
- The prevalence of physicians on boards
- Ways they arrive to this governing body
- Situations that make physicians more attractive to certain boards
- Selection criteria
In good company
Today, a board without physician members is the exception. Physicians make up nearly one-fifth of the membership of most healthcare organization boards, according to a 2007 study conducted by The Center for Healthcare Governance and The Health Research & Educational Trust¹. Of that group, 80% actively practice at their board’s organization; 7% are retired; 7% are employed elsewhere; and 6% are nonclinical employees.
The roads most traveled
Physicians come to serve on boards through various avenues and different levels of vetting. They include:
- Board nominating committee that generally (depending on bylaws) identifies and interviews candidates. This group presents a final slate of recommended candidates to the board for approval and voting.
- Ex officio, that is, the physician holds a leadership position (e.g., medical staff president) that has a seat on the board by default. Freestanding hospitals are less likely than health systems and networks to appoint ex officio physician board members (35% vs. 53%, respectively)¹.
- Election by his/her colleagues. Freestanding hospitals also are less likely than health systems and networks to defer to medical staff elections (28% vs. 43%, respectively)¹.
- Political appointment, affecting county and district hospitals mostly.
An organization’s mission and strategic goals, size, location and structure influence the type of physicians boards seek and attract. Below are examples.
- Physicians who are in touch with their community and market demographic may greatly appeal to community and nonprofit hospitals.
- There are pros and cons to selecting physicians who are employed members of the medical staff. However, given their representation, it appears that many organizations believe benefits outweigh calculated risks. Physician board members employed by the organizations they govern have direct access to the medical staff. Since their colleagues’ perceptions of the organization and quality of care delivery ultimately impact the bottom line, having ambassadors on the board is a good thing. Measures must be taken to address any personal or collective conflicts of interest.
- Due to IRS rules and Intermediate Sanctions, tax-exempt organizations may favor retired physicians or those employed by other organizations. These are two avenues to avoid physicians categorized by the IRS as “disqualified persons,” potential conflicts of interest and connections to internal politics. Boards also could keep physician members from serving on certain board committees, namely finance.
- Regarding supply, the explosion of retiring Baby Boomers presents a fertile landscape for finding future physician board members. Retired physicians also may have more time to devote to board responsibilities.
When considering physician candidates for your board, selection criteria should be comparable to that of non-physician members. For a starting point, please refer to this list.
- Experience and knowledge in quality, safety and patient care weigh heavily among most boards. Other knowledge, such as reimbursement trends or IT applications, also come in handy.
- Board service. Source physicians who served on one or many boards.
- Manageable or no conflicts of interest. Some conflicts of interest are not manageable, and preclude board service, such as ownership interest in a competing facility. All must be disclosed, documented and managed appropriately. This includes recusal from board discussion and voting on conflicted matters.
- Achievement. Do achievements reflect contributions or elections to local, state or national medical societies or groups? Does anything stand out that would benefit the board?
- Management skills. Check for nonclinical education. This could include an MBA, MHA, MMM or other relevant advanced degree. Demonstrated skill as a managing partner of a group practice could be an asset, as well.
- Team-player ability. Some clinical specialties (like critical care and family, internal and emergency medicine) tend to promote teamwork and collaboration more than others.
- Personal traits, including intelligence, common sense, compassion, integrity and ability to listen.
- Open-mindedness. Physicians must be objective system-thinkers who place the needs of the organization first.
- Willingness to learn and be evaluated. Many physicians are experts within their respective fields, but haven’t been properly trained to wear a governance hat. Be sure physician candidates are willing to engage in an orientation and continued governance education, as well as willing to be evaluated.
- Special considerations. Boards of smaller hospitals in rural communities face more challenges due to supply. County and district hospitals also hit roadblocks as their board members usually are elected or are political appointments. Keep trying to source and recruit. Your organization and board are bound to benefit!
In part 2, we’ll review ways to maximize physicians’ involvement on your board and make the best of what you have. Pointers in the next section may be applied “across the board” to improve governance overall.
Frank D. Byrne M.D., MMM, FACHE, FACPE, FACP, FCCP, offers more than 40 years of experience in leadership and governance roles. In addition to being an associate at Practical Governance Group, he is president emeritus of St. Mary’s Hospital in Madison, Wis. Among his accolades, Modern Healthcare and Modern Physician magazines named Frank in 2011 one of “50 Most Influential Physician Executives in Healthcare.” He began his career in pulmonary and critical care medicine. Follow Frank on Twitter, and reach him at 904-606-5744 or firstname.lastname@example.org.
¹Justice, Jay, Kastel, A. Kurt, and Van Dyke, Kevin Van. “Creating a Healthy Board/Medical Staff Relationship: Current Trends and Practices.” American Hospital Association’s Center for Healthcare Governance (Chicago). 2008. 3-20. <http://trustees.aha.org/physicianissues/archive/08-4_Healthy-Board-Monograp.pdf>