In 1935, it was estimated that the majority of U.S. hospitals were led by physicians. In contrast, fewer than one in five U.S. hospitals is led by a physician today.^1,2 However, there appears to be a growing recognition of the value of physician-based leadership in hospitals and health systems, and more than a few of these newly appointed physician leaders have a background in emergency medicine.

Dr. Carr

“Emergency medicine, as a specialty, has arrived,” said Brendan G. Carr, MD, MA, MS, an emergency physician and chief executive officer. “The way emergency physicians are wired is with a ‘can-do’ mentality where failure is not an option. We know how to operate efficiently with a broad perspective of things that can impact health outcomes.”

That broad perspective, once applied to clinical diagnosis in the ED, must broaden even more in leadership positions, Dr. Carr explained. “Our health care system is in distress and that manifests in the emergency department [ED],” said Dr. Carr, who still works clinical shifts in the ED. “The best way to advocate for the ED is to improve health care in America.”

Common Goals

Dr. D’Angelo

With emergency physicians operating on the frontlines of health care, there may be a perceived disconnect between the aims of the hospital or health system, its leaders, and emergency physicians, acknowledged John D’Angelo, MD, FACEP, an emergency physician and president and chief executive officer of Northwell Health.

“Sometimes within hospitals there is talk as if there are ‘haves’ and ‘have nots,’ but the reality, on my side, is that all providers are dealing with the same challenges,” Dr. D’Angelo said. “That is, mainly, that the reimbursement for services we provide collectively on the clinician side has not kept up with the expense of providing those services, that the demand for those services is going up, and that the workforce and the pipeline to meet that demand is more and more strained.”

Hospital and health system leaders are tasked with trying to figure out how to do more with less.

How can leadership best do that when the goals of different health care teams are not aligned? Dr. D’Angelo said that he tries to apply two rules, a concept he first heard years ago at an ACEP conference. First, do what is best for the patient. Second, do what’s best for the people who take care of the patient.