As changes in health care are making it increasingly difficult for physicians to take the reins in policy decision-making, the need for ob-gyns to step into leadership roles is greater than ever, two ACOG leaders told ob-gyns Monday, May 6, at the Annual Clinical Meeting.
Sandra A. Carson, MD, and Barbara S. Levy, MD, discussed “Your Personal Path to Leadership: The Road Less Traveled,” during the Anna Marie D’Amico Lecture, part of the President’s Program.
Dr. Carson, vice president designate for ACOG’s Education Division, told the thousands of physicians in attendance that the evolving health care landscape is gradually removing the physician perspective from many care systems.
She pointed to leadership reorganizations around the country where non-physician CEOs have replaced doctors as heads of hospital systems and major care organizations. In many such instances, she said, ob-gyn departments have lost stature. “Now the ob-gyns are left with a voice, but not with a dialogue,” she said.
The Affordable Care Act threatens to further diminish the physician role through provisions such as accountable care organizations (ACOs), which evaluate care based on a checklist of factors, including performance, quality, and cost, Dr. Carson said.
“What’s happened in the past is, the keepers of the checklist began to assume authority,” she said. “Now we’re subjected to rules unrelated to quality medicine that sometimes even obstruct the practice of quality medicine.”
In the case of ACOs, patients will “get in” via routes such as hospital admissions, group practices, and primary care providers, but reimbursement will go directly to the ACO and be distributed to providers “at a set fee unrelated to the hours you work,” Dr. Carson said.
“Physicians must lead American medicine into the future. We can’t shrug this off. We must develop the skills necessary for leadership…stop putting our heads in the sand and take back health care.”
Doing that may require that ob-gyns turn inward to remind themselves why they practice medicine and what they need to do to ensure the delivery of quality care in the face of obstacles, according to Dr. Levy, ACOG’s vice president for health policy.
Dr. Levy said ob-gyns should recognize that becoming leaders “requires us to stretch our boundaries” and face potentially daunting challenges.
Echoing a theme of Sunday’s Congress Advisory Council meeting on leadership in the 21st century, Dr. Levy said individuals sometimes have trouble recognizing that the path toward one’s goals does not necessarily mirror the steady, upward incline of an escalator; often, the route changes directions during the climb to the top. “It’s not an escalator, it’s a jungle gym,” she said.
Dr. Levy detailed some of the differences between men and women in terms of how they learn to approach goals and the influence such differences have on the development of leadership skills.
Men learn at an early age to have tunnel vision about their careers and regard anything that diverts them—including family and other life interests—as interference from external sources. The result is that men attribute failure to outside sources while gaining confidence in themselves, she said.
Women typically learn they are expected to be “collegial and collaborative” and make sacrifices for the benefit of others, Dr. Levy said. They learn to internalize failure and assume that when their career path goes awry, it’s because they did something wrong.
Both men and women should learn to cut themselves some slack and remember that allowing time for contemplation is “critically important for leadership,” Dr. Levy said. Everyone should have a long-term career plan, “but also be comfortable with the 18-month plan, because things happen along the way,” she said.