CSPL turns 20
We asked three of our earliest board members — Donald H. Atkinson, Orillia, Ontario; Chris Carruthers, Ottawa, Ontario; and Dennis A. Kendel, Saskatoon, Saskatchewan — to look back over the years and reflect on the CSPL and physician leadership.
What was your original reason for supporting the creation of the CSPL?
Don Atkinson: “I had recently started in a senior leadership role and recognized the need to develop my leadership skills and to connect with other physician leaders. There were few educational opportunities in Canada at that time, and I had already completed the five available Physician Leadership Institute courses. Creating a national organization with the goal of providing education and networking for physician leaders was an ideal opportunity.”
Chris Carruthers: “The original idea was developed recognizing the need for such an organization in Canada, as physicians in management was just starting. I had taken on administrative roles at the Civic Hospital and also was quite familiar with the American organization [American College of Physician Executives, ACPE]. I recognized the need for a Canadian society and wrote to the CMA to propose a Canadian Society of Physician Executives (now CSPL). Simultaneously, but unknown to me, Dennis Kendel had similar thoughts and also wrote the CMA at the same time.”
Dennis Kendel: “As registrar of the College of Physicians & Surgeons of Saskatchewan, I felt ill-equipped to deal with some of the leadership challenges inherent in that role. I enrolled in the educational programs then offered by the ACPE and found that experience very helpful.
“That prompted me to wonder why we didn’t have something like the ACPE in Canada. I spoke with Joe Chouinard at the CMA who told me that Chris Carruthers, an Ottawa-based orthopedic surgeon who had participated in ACPE offerings, was asking the same question. Joe got me connected with Chris.” Top
How have your views on physician leadership changed in the past 20 years?
Don Atkinson: “Leadership is an ongoing process of learning, adapting, and changing to meet the particular needs of the day. It is very much a journey and not just a destination. With the complexity of health care, we need leaders with a variety of skills and styles.”
Chris Carruthers: “Physician leadership has been enhanced, recognized, and significantly advanced over the years. There is better recognition of the need for MD leaders by those overseeing responsibility for health systems. Some provinces are further ahead than others. Those who understand and know health systems need to be in roles to manage and oversee system change, and these are physicians. Improved formal education has been key, and the CSPL has played a major part in these developments. Networking, a key component of leadership, has been spearheaded by the CSPL. Our annual meeting has been a huge success. Many hospitals have physician CEOs, and this is a direct outcome of the recognition of boards selecting leaders who have credibility and health system knowledge.”
Dennis Kendel: “Over the past 20 years, through my service on the Board of Directors of the Health Quality Council (HQC) in Saskatchewan, I had opportunities to study and visit high-performing health care systems outside Canada. I gained an appreciation that such systems engage physicians in a wide range of leadership roles — a practice not common in Canada.
“Through a variety of channels, I then became an advocate for creating such physician leadership positions in Canada and helping physicians access the skill development they need to succeed in these roles. That skill development includes mentoring, and I have served as a mentor to a significant number of colleagues.
“I also came to appreciate that many physician colleagues who have the skills to be effective heath system leaders are very reluctant to give up the amount of time in clinical medicine that is necessary to effectively serve in these roles.
“Physicians who take on major system leadership roles without reducing their clinical workload are prone to burn out and also do poorly as system leaders. Their poor performance damages the view of others about the capacity of physicians to do this work and do it well. So, I strongly caution colleagues against taking on such roles as an add-on to an already excessive clinical workload. And, I have played a key role in convincing some physicians to ‘take the leap’ into an 80/20 split between non-clinical leadership and clinical work. For most physicians who do this, it turns out to be a healthy balance between non-clinical and clinical work.”
How has the CSPL had an effect on physician leadership in the past 20 years?
Don Atkinson: “At the annual conference, it is clear that more physicians are interested in leadership development. What hasn’t changed is that they are often struggling with common problems that existed 20 years ago as well as today.
“There is a greater awareness of the need to expand their skills, i.e., increase the number of tools in their ‘tool box.’ CSPL has opened the door for physicians to a multitude of leadership opportunities available today. The CSPL has provided common ground for physician education where they can learn new skills and be supported by their colleagues.”
Chris Carruthers: “CSPL has had a significant influence on leadership development and championing its importance. CSPL has been the prime Canadian champion of physician leadership, particularly encouraging the CMA (Joule) and provincial organizations to invest in leadership training and development. CSPL executive leaders have championed physician leadership very successfully. As CSPL leaders, they have been listened to and heard across Canada.
“CSPL would not be the significant player it is today without the efforts and leadership of Carol Rochefort, its first and only executive director.”
Dennis Kendel: “In my opinion, the CSPL has been the key ‘game changer’ in the advancement of physician leadership in Canada. Its collaboration with the CMA in offering high-quality educational programing has opened learning opportunities for physicians across Canada. Its publications help keep physician leaders informed about evolving trends and new opportunities. The networking development that occurs at the annual CSPL conferences is priceless.” Top
How would you describe physician leadership in Canada today? Tipping point?
Don Atkinson: “There are more physicians involved in leadership today; however, it is still not at the tipping point where it is routinely accepted. There is a need for more physician involvement at the strategic planning phase of health care. Too often physicians are asked to participate in the implementation of decisions that have already been made by others.”
Chris Carruthers: “Physician leadership is much improved and advanced compared with the past. A concern to me is that competent and experienced physicians are more reluctant today to step up to leadership positons for different reasons than in the past. In the past it was seen as going to the ‘dark side.’ There was also an economic loss.
“Today, with leaders in many organizations under attack (e.g., universities) and greater scrutiny, physicians are reluctant to take on these roles and the associated risks to their careers or their reputation. They don’t see this as an advancement for their careers. As such, potentially strong leaders will not step forward. The gender distribution, with more women in the profession, brings new challenges for developing and encouraging leaders. There is a worry of disengagement by the younger physicians. Potential physician leaders need to be engaged and mentored early to take on leadership roles and the benefits explained. Significant changes are needed in our health system and they will not occur without physician leadership.
“Mental health problems and burn out within the profession are more prevalent, directly impacting leadership and this will need to be addressed.”
Dennis Kendel: “Across Canada I see physician leadership as much stronger than it was 20 years ago, still growing but — sadly — still uneven. Top
“I see physician leadership much stronger in those provinces/territories where the profession has moved past its historical fixation on being ‘independent from the system’ and has embraced a culture that sees physicians as key players and partners with others in the system.
Some provincial and territorial medical associations have been more successful than others in helping our profession make that cultural transition. I would suggest that the association in Saskatchewan, Alberta, and British Columbia have been the most successful in this regard.
“As I live and work in Saskatchewan, I can speak most confidently about the changes that have occurred in this province. The Saskatchewan Medical Association (SMA) has been remarkably successful in radically changing its working relationship with government from a rabidly adversarial one back in 1979–80 (when I was the SMA president) to a responsibly collaborative one. That has yielded huge dividends in the transition to more active physician leadership in the health care system in this province.
“In 2016, I was privileged to be appointed by the Government of Saskatchewan to a three-member panel tasked with making recommendations for restructuring our health care system. In that capacity I made a concerted effort to educate my fellow panelists on the investment made by the SMA in supporting such a large cadre of MDs to complete the PLI programs that are foundational to obtaining the Canadian Certified Physician Executive (CCPE) credential. I explained that we had a significant cohort of physicians now well prepared to step into new senor leadership roles in our system, and we needed to create the framework for that to occur.
“My fellow panelists accepted my arguments/proposals, we collectively advanced them to the government, and they were accepted. The breadth and depth of physician engagement in key leadership roles in the new Saskatchewan Health Authority (SHA) is a true ‘tipping point’ in Canada.
“It simply would not have been possible for me to be successful in advancing these arguments for much-expanded physician leadership in our new health authority without the leadership capacity-building of the CSPL.
“I recommend that you interview Dr. Susan Shaw (our new chief medical officer) and some of the other recently appointed physician leaders in the SHA to get a better sense of the transformation that is occurring with respect to physician leadership in Saskatchewan.
“I do think the SHA is a ‘learning laboratory’ for physician leadership. What is happening in Saskatchewan can be replicated across Canada if the CSPL makes an effort to study it and learn from it.” Top
What will the CSPL look like in the future?
Don Atkinson: “Skilled physician leaders will result in a better health care system. CSPL will be seen as independent of political influence, unlike other physician organizations, and the best way to connect with other leaders to resolve challenges facing physicians today. The CSPL will have an important function in advocating for the role of physicians in leading health care reform. It will be a support to active physician leaders and a resource to the future of health care. I believe that there will be more opportunities for physicians to develop mentorship links through the CSPL.
“The focus of CSPL in the early years was to develop a high-quality national leadership conference. In future, I hope that physicians will be able to connect on a regional basis as well. This will provide opportunities to tackle the challenges that are unique to their regional jurisdiction.
“Physician leaders, with their front-line experience, will have the skills and the ability to improve the health care of all Canadians.”
Chris Carruthers: “In the future it will still have a strong role in promoting and supporting physician leaders. It will be done with more collaboration among several different health organizations and system governing boards. We will need to partner with many other stakeholders in improving the health system through leadership. We can’t do it alone. New leadership challenges will need to be addressed. There are significant opportunities. Failure to address the physician leadership need will significantly impede the sustainability of the Canadian health system.
“Carol will still be the executive director.”
Dennis Kendel: “I think the future for the CSPL looks very bright if it continues to be a strong builder of physician leadership capacity across Canada and an effective facilitator of physician transition into major non-clinical leadership roles in the system.
“I think the CSPL needs to focus at both ends of the medical career spectrum. It needs to work with our medical schools to offer leadership development opportunities to our medical students and residents. It also needs to harness and leverage the trust and social capital that is vested in physician leaders at the end of their careers.
“In December 2017, I resigned from the Board of Directors of the Health Quality Council, a position I held since the council was created in 2002. For the first time in my life I do not hold any official title or affiliation that designates me as a leader. However, I don’t think a week goes by that I am not asked unofficially for my opinion or advice on things that are happening in the health care system in Saskatchewan. I offer my opinions and advice freely and am often gratified to see good things happening to which I made some small contribution.
“I’m sure there are lots of colleagues across the country who are either doing or could be doing the same thing. I think the CSPL needs to market and support the concept that leadership is not always synonymous with a fancy title. If colleagues have led with integrity when they “held office,” they still have much to contribute when they ‘leave office.’ We should help them to see that reality.” Top
Donald H. Atkinson, MD, Chris Carruthers, MD, and Dennis A. Kendel, MD, are founding members of the CSPL and also recipients of the CSPL award for Excellence in Medical Leadership (https://tinyurl.com/y8b9qhvt).