When physicians complete their medical training, they have the clinical skills and knowledge to care for their patients. What many have not been taught, however, is how to navigate the increasingly complex healthcare environments in which they deliver that care.
In today’s large, matrixed organizations, physicians are expected to collaborate closely with operational leaders, manage resources, lead multidisciplinary teams, and help shape the future of their practices. While these responsibilities are critical to delivering high-quality patient care, they are not always covered within medical school curricula or residency training.
“Most ambulatory practices run like small businesses, so physicians often need to understand how to work against a budget, collaborate with the operations team, assist in the hiring of new staff, lead through influence, teamwork and collaboration,” said Nancy Beran, MD, an internist, and vice president and chief quality officer for ambulatory at Northwell Health.
There is often a steep learning curve for physicians who are new to large health systems. Understanding how the organization is structured and what resources are available can be challenging. In fact, institutional knowledge often takes years to acquire through experience alone.
Recognizing this gap, Northwell Health established its Ambulatory Physician and Advanced Clinical Provider Development Program, (APDP) a six-week interactive program designed to provide early-career physicians and other health professionals with the tools, insights, and organizational knowledge they need to thrive in an ambulatory setting.
“The program helps physicians better understand how Northwell is structured, what systems are in place to support their practice, and how our operations and business teams work,” said Dr. Beran. “We’re filling a knowledge gap so they don’t have to spend years figuring it all out. Instead, they can learn this quickly and begin applying it immediately.”
Northwell Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians, and care teams with resources to help drive the future of medicine.
Commitment to physician development
The Ambulatory Physician and Advanced Clinical Provider Development Program is the latest example of Northwell Health’s longstanding commitment to physician growth and development.
This commitment runs deep within the organization. Nearly two decades ago, Northwell Health’s then-CEO Michael Dowling recognized that doctors and physician leaders can—and should—play a more prominent role in healthcare business decisions.
“To do this effectively, physicians need additional education and exposure to developmental opportunities to build the skills and develop the broad perspectives needed to participate in business decisions,” said Patti Adelman, vice president of learning and development at Northwell Health.
Dowling helped lead the development of Northwell’s formal leadership programs that provide physicians opportunities to learn the business side of healthcare, while expanding their purview beyond clinical practice.
Since then, Northwell’s learning and development programs have continued to grow.
“Northwell has a cadre of programs for our physicians from early career leadership development to first-time formal leadership education to executive leadership training,” Adelman said.
Beyond formal leadership programs, physicians also have access to mentorship opportunities, professional development resources, continuing education, on-demand learning, and research support.
“There are boundless opportunities, whether you want to enhance your clinical expertise, expand your leadership development, become a teacher to help guide the next generation, or develop your research skills,” said Adelman.
Filling a gap
Despite the breadth of existing leadership and development opportunities, Dr. Beran recognized an unmet need among early career physicians and advanced care providers (ACPs) in the ambulatory practice environment.
She saw an opportunity to better prepare physicians for success within the system’s dyad leadership model, which pairs physicians and ACPs with operational leaders to manage service lines and practices together.
Today’s new physicians are entering practice environments that are far more complex than those that more experienced physicians face early in their own careers.
“When I came out of residency, doctors were hired by somebody who ran the practice and was invested in teaching them how to run it,” Dr. Beran explained. “The practice had an accountant who taught them how to look at their profits and losses, and they learned how to do coding because it was essential for survival.”
Years later, when Dr. Beran helped form a multispecialty medical group, she saw firsthand how different the experience had become for newly trained physicians.
“I didn’t feel that our doctors who were just coming out had the necessary training to be effective dyad partners,” she shared. “They might come to the table and ask for something, but they didn’t know the parameters by which it would be evaluated.”
“It should be transparent how decisions are made about purchasing new equipment, adding new staff, or adjusting clinical schedules,” Dr. Beran said. “One cannot implement team-based care if you don’t understand the scope of the practice and the roles and responsibilities of everyone on the team.”
Similar to the national trend of over 70% of physicians working in employment models, Northwell employs over 6000 physicians and greater than 50% of the care delivered at Northwell is delivered in our ambulatory setting. Dr. Beran recognized the clear need to provide more intentional support for physicians working in these practices.
“We’re not trying to turn everybody into a traditional physician leader, but every physician influences the culture and performance of the practice through their actions and helps set the tone for that practice site” she said.
The program focuses on helping physicians become more effective leaders who can collaborate and innovate within their practices.
“Physicians find a lot of joy in medicine when they feel like they own their environment—and that it is collaborative and supportive,” Dr. Beran explained. “Physicians create and contribute to that culture, so we want to help them do that.”
A holistic approach to development
This summer, Northwell launched its first cohort of the Ambulatory Physician and Advanced Clinical Provider Development Program. The goal is to help participants build high-functioning practices that can effectively prioritize patients’ needs.
The program combines asynchronous and synchronous learning experiences to provide participants with both foundational knowledge and practical application. The asynchronous component includes 20- to 30-minute videos that are designed to be thought-provoking, informational, and easy to fit into a busy clinical schedule.
Meanwhile, the synchronous sessions focus on discussions and real-world applications. Participants work through scenarios they are likely to encounter in practice, such as responding to patient complaints, addressing office challenges, or interpreting profit-and-loss data.
“Because these sessions are designed for discussion, having both physician and operational leaders demonstrate the perspectives they bring and how effective collaboration drives practice success is key, both for having meaningful discussion and for modeling the operational behavior we want to see within our practices,” Dr. Beran said.
Goals for the program are twofold. First, participants should complete the program with a deeper understanding of Northwell, including resources, support structures, and opportunities available to them. Second, participants should have the foundational skills needed to effectively work with colleagues, staff, and operational partners within their practice.
The program takes a holistic approach to development, with each week covering different aspects of ambulatory practice success:
- Week one focuses on Northwell’s culture, organizational structure, and ambulatory design. Participants gain a clearer understanding of the matrixed organization and how to navigate it.
- Week two centers around practice operations, team-based care, scheduling, and access.
- Week three explores the patient experience, patient communication, and what it takes to be a five-star physician.
- Week four covers the financial fundamentals of practice management, including revenue cycles, profit-and-loss reports, coding, and reimbursement models.
- Week five helps physicians understand how to build their clinical reputation and online presence.
- Week six highlights professional development opportunities, including pathways to expand their clinical expertise, pursue academic interests, participate and lead research, and engage with professional societies and networks.
“We’re hoping that they come away with the foundations that they need to thrive, find areas that spark their curiosity to explore deeper and discover opportunities within Northwell,” Dr. Beran said.
The curriculum is designed to help physicians understand how to wear the many different hats needed to influence a successful practice environment, while also exposing them to the diverse career paths available to them throughout Northwell.
“Everybody’s on their own career journey,” said Dr. Beran. “We map those journeys intently for our employees. This is also about helping new physicians succeed early in their careers while also introducing them to the many different pathways available at Northwell.”
Building shared understanding
The cornerstone of the program emphasizes the relationship between clinical and operational leadership and the importance of understanding each other’s perspectives. The experiential learning model helps participants see how clinical and operational considerations intersect in everyday decision-making.
For example, if a physician wants to introduce a new procedure within the practice, it can be helpful for the physician to understand the operational and financial considerations leadership will evaluate before investing in it. Similarly, operational leaders benefit when they understand the clinical rationale and patient-care implications behind those requests.
One of the program’s key objectives is helping physicians recognize the value that their operational counterparts bring to the practice and how those relationships contribute to the practice’s long-term success.
The foundation of that partnership is a clear understanding of accountability.
Dr. Beran explained that when an office manager understands a physician’s responsibility for clinical quality outcomes, they can put the appropriate processes and workflows in place to support those goals. At the same time, when physicians understand that operations leaders are accountable for budgets and overtime, they try to be more efficient with their time because they understand the budgetary consequences.
Building this mindset into the new physician experience aligns with Northwell’s broader culture and dyad leadership model.
“Our Physician-in-Chief Dr. David Battinelli has said that Northwell is ‘clinically led and professionally managed,’” Adelman said. “We lead from the patient perspective based on sound clinical decisions. However, if we were not professionally managed on the operational side, we probably wouldn’t be around very long to provide that excellent clinical care. There’s power in doing it together.”
By helping physicians better understand how ambulatory practices operate and how clinical and operational leaders work together, Northwell’s physicians are poised to not only deliver excellent care, but to also help develop collaborative, well-managed practices that make that care possible.
