Northwell Health places a premium on physician leadership. As two of its leaders explain, the health system fosters a strong teamwork approach to ensure that physicians have an active voice in organizational strategies and decisions, and a supportive platform for well-being.
For 30 years, Northwell’s mission for clinical excellence has been a direct reflection of the leadership of longtime CEO Michael Dowling. Drawing on his unique background as a social worker and an Irish immigrant, he forged a foundational culture centered on patients while simultaneously elevating physicians into key executive leadership roles.
"That legacy of physician collaboration has now led to a celebrated new chapter," said Jill Kalman, MD, executive vice president and chief medical officer, referring to John D’Angelo, MD, as Northwell’s first physician CEO.
“Now we have a physician leading our organization,” Dr. Kalman noted, “but we still have the same principles. It’s the patient first.”
Physician, talent and recruitment under Northwell’s leadership has been remarkable, she said. The organization has recruited physicians at multiple levels, from senior leadership to mid-level and emerging leaders.
“The trajectory by who we have been able to recruit over the past ten years is an incredible source of pride,” Dr. Kalman said. “Clinical excellence is the foundation. Clinical sophistication is what becomes possible when you combine outstanding clinicians with data, technology, research, precision medicine and integrated leadership.”
Mark A. Talamini, MD, senior vice president of Northwell Health and executive director of Northwell Health Physician Partners (NHPP), agreed that having a physician as CEO sends an important message to physicians considering joining the organization.
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. It is also a Silver-level recipient of the AMA Joy in Medicine® Health System Recognition Program, which empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.
Partnering with other experts
Physicians don’t work in isolation to create strong leadership, noted Dr. Talamini. Northwell leaders approach efficiency as a team-based construct, working with clinical and administrative staff to optimize workflow and improve patient care.
“A tremendous aspect of Northwell’s success over time is our ability to partner physician clinical leaders with great nursing, operators, administrators, financial experts,” he said.
Senior executives such as the chief digital officer and chief experience officer may not be doctors, but they work closely with physician leaders to accomplish goals on behalf of physicians and patients.
“It is fabulous that we have our first physician CEO,” Dr. Talamini said, “but it doesn’t really change the fundamentals of the model—we partner with our nonphysician colleagues to lead Northwell.”
Physicians are specifically trained to take excellent care of patients. At the same time, complex health systems require complementary and collaborative expertise to navigate every aspect of the patient journey.
“We’ve always understood the power of that, and that is a big part of the secret sauce,” said Dr. Talamini.
Making sure physicians have a voice
Northwell’s medical group governance structure through Northwell Health Physician Partners works in both directions: It brings the physician perspective to senior executives while also giving senior leaders opportunities to bring their questions and perspectives to doctors, said Dr. Talamini.
The organization has a vast committee structure and a board designed to incorporate physician perspectives. This has been especially important with Northwell’s adoption of a market-oriented model. Each market has a physician executive leader who works with the market president and other executives.
As Northwell’s footprint expands geographically, needs and concerns of physicians can vary from place to place. The system now extends from Connecticut and Staten Island to the eastern end of Long Island and Pennsylvania. From the beginning, the market-based structure has included a physician executive voice, supported by teams of doctors within each market.
Dr. Kalman shared that the market structure becomes increasingly important as Northwell grows. Physician, nursing, clinical, and administrative leaders need to work together to carry out the system’s strategy while remaining connected to what is happening on the front lines.
“The balance is having strong leadership, while staying connected to the front lines,” she said.
This structure allows physician leaders to develop additional leaders and teams that can go into individual practices to understand what is happening at the office level. Those local leaders can then advocate for what’s needed for a particular group of physicians. The same principle applies within Northwell’s hospitals—each has a chief medical officer.
Northwell is a heavily matrixed organization, Dr. Kalman explained. Rather than operating as a simple “hub and spoke” system, she said, Northwell has sought to ensure that each part contributes to the whole.
“That is also how the physician voice becomes part of those strategic decisions,” Dr. Kalman said. Physicians are represented across different groups and perspectives, allowing the organization to look at an issue “in multiple different ways to see a point of view.”
To further promote institutional knowledge, Northwell has its Ambulatory Physician and Advanced Clinical Provider Development Program. The six-week interactive program helps early-career physicians and other health professionals understand how Northwell’s systems and structures work, including its operations and business teams.
Northwell has worked to maintain a unified physician culture across its markets, even as individual markets have different needs. Communication is essential to making this model work.
“The physician voice is never one way,” said Dr. Talamini. “It’s got to be two ways.”
Northwell stays connected with its doctors through a robust internal communications strategy. All physicians receive a newsletter every Tuesday that delivers content relevant to physicians and their practice. Leadership is also present at physician networking events and engagement opportunities, allowing physicians to directly interact with them. This creates a singular physician culture at Northwell, one of its most important assets.
Northwell’s “listening culture” helps enhance the physician perspectives in organizational decisions. Our physician group, NHPP, helped reframe the organization’s approach to physician well-being by looking both outside the health system for best practices and within the organization to understand what doctors needed.
Additionally, Northwell is using physician input as it develops systemwide initiatives involving access, network integrity, and the patient experience in its practices.
“As we develop the strategy and metrics, we can pressure test across different geographies of physicians,” Dr. Kalman said. The goal is to ask physicians whether a proposed approach makes sense and whether the organization is “thinking about this the right way.”
One of the clearest examples of this approach is Northwell’s transition to Epic, a major enterprise effort that consolidated dozens of legacy records and will transition the whole organization into one system.
Physician surveys identified the old EHR system as by far the most common complaint, while the most requested change was also clear: “Please give us Epic,” physicians frequently said.
“We can say with absolute fidelity, we heard your voice,” Dr. Talamini said. With great assessment, Northwell made the investment in Epic, with the investment in time, talent, and finances.
Epic implementation also demonstrated the importance of physician-nurse-administrator collaboration. At one point, Northwell leadership made the decision to pause the planned go-live because the organization determined they were not ready yet.
The health system subsequently changed its organizational structure and paired physicians and administrators to drive the implementation. The physician group’s ability to translate what doctors needed to be successful during the go-live was “critical to the success,” Dr. Kalman said.
Physician leaders bring an additional perspective, said Dr. Kalman, because they understand firsthand the burdens doctors face. They are familiar with regulatory requirements, administrative demands, and the challenges of delivering care day after day. This can shape the way leaders approach solutions, including new augmented intelligence (AI) tools, decision support, and precision medicine.
“It is a different lens to look through,” she said.
Dr. Talamini sees technology as an especially important opportunity. With the transition to Epic, Northwell now has a platform that can support emerging technologies designed to reduce administrative burden, improve care, and allow physicians to spend more of their time on uniquely human aspects of medicine.
“If we do it right, we can meaningfully reduce the burden on our physicians and allow them to be far better caregivers for their patients,” he said.
Ambient AI listening is already proving transformational, Dr. Talamini said, but he sees it as only the beginning. Over the next decade, he expects technology to transform how physicians care for patients.
“Northwell is one of the leaders in the country. It’s on us to help do it right for us and for the country,” he said.
Physician input also led to changes in Northwell’s credentialing process. Annabella Salvador-Kelly, MD, Northwell’s experienced deputy chief medical officer and senior vice president of medical affairs who oversees credentialing, noticed that questions physicians were required to answer could discourage them from coming forward about mental health challenges.
“She took action to change that,” Dr. Talamini said. He described the change as another example of physicians bringing forward an important initiative—“very, very important for our physician well-being.”
Enhancing the patient experience
Having physicians in senior leadership reinforces Northwell’s continuing focus on quality, safety and patient experience, Dr. Kalman said.
One example is the use of patient stories at every system-wide meeting. Whether the meeting involves finance, the board or the clinical enterprise, Northwell begins with a story that highlights an important aspect of the patient journey and experience.
Environmental services maintaining clean, safe, and disinfected patient care environments, transporters taking patients to scans, revenue-cycle teams and finance professionals all have a connection to clinical care and the patient experience. Clinical excellence, she said, is “the given, the foundation, and the expectation.”
But Northwell is now positioned to move beyond clinical excellence toward what Dr. Kalman called “clinical sophistication,” because of the strength of the physicians, nurses, and other health professionals the organization has recruited.
A question that ends virtually every meeting is, “What are we doing to improve the care of our patients?” This comes up even in budget meetings. It’s part of the broader culture, and it connects directly to another principle that Northwell emphasizes, which is taking care of the people who take care of patients, said Dr. Talamini.
Giving physicians greater agency
Physician leadership also addresses the pressures physicians face, including administrative burdens and burnout.
The role of physicians has changed dramatically, noted Dr. Talamini. Historically, physicians often worked independently, owned their own practices, and had considerable control over their professional lives.
Today, many physicians work within large organizations. For highly motivated professionals, that transition can create a risk of losing a sense of agency.
“The risk is that you go from being somebody who dreams of—and wants to—execute your life and your ability to make the future better, to somebody who has lost a certain amount of control,” he said.
To ensure that physicians don't get buried, it’s important to give them as much agency as possible over their careers, futures, and professional identities. Northwell tries to create opportunities for physicians to gather, build relationships and support one another through events such as doctors’ lounges, dinners, and cultural events.
“These are not terribly expensive things to do, but they have taken on tremendous meaning with our physicians,” he said.
In other actions to reduce burnout, Northwell’s Center for Traumatic Stress, Resilience and Recovery implemented a program called Stress First Aid, a network that helps physicians and other health professionals recognize and manage stress. The program has significantly improved metrics in recognizing stress while increasing awareness of well-being resources and organizational support.
Recruiting the next generation of physicians
The physician-led model also plays a role in attracting and retaining talent. Dr. Kalman noted that doctors increasingly want opportunities to make an impact at scale—to lead within their specialties while influencing a large geographic area and diverse communities of patients and physicians.
“They are looking for that impact so they can match their passion and talent with a health system,” she said.
Culture is equally important. Physicians are looking for a culture of positivity, support, collegiality, and relationships. Northwell combines highly talented and competitive physicians with “a sense of humility and collegiality that you don’t find everywhere,” Dr. Kalman said.
Northwell’s medical school and research infrastructure also strengthen its ability to recruit, she said. Establishing a medical school fundamentally changed the organization’s position in recruiting physicians. Its research partnerships add another dimension.
Dr. Talamini offered that Northwell’s appeal comes from the combination of those elements.
“Northwell is the model for the 21st century,” he said. Physicians are attracted to the organization because they love it here, “it’s growing. It’s having impact.”
Additionally, “Northwell is committed to giving back to the community through amazing programs that speak to mission-driven physicians in a way that's endearing and attractive,” Dr. Talamini said.
Looking ahead
As healthcare continues to change, Drs. Kalman and Talamini see an expanding role for physician leadership, particularly in technology and AI.
Dr. Talamini emphasized the need for Northwell to have a close partnership between its technology and clinical organizations. Emerging technologies can be powerful, but they can also create problems if healthcare organizations fail to guide and implement them appropriately.
Northwell’s enterprise digital team already includes informaticists and physician leaders deeply involved in this work. Dr. Talamini expects that role to grow as technological opportunities expand.
For the next generation of physician leaders, Dr. Kalman said the organization needs people with “a complete drive for innovation.”
Physicians must be comfortable with rapid change, technology, data, and uncertainty, she said, noting “we can’t be certain where things are going, but we can be certain that this could be a truly remarkable time.”
Dr. Talamini added that Northwell’s size, continued growth and market-based strategy will create an ongoing need for physician leaders. The organization has multiple programs designed to develop leaders from within and help physicians who join from outside grow into leadership roles.
“We need a lot of physician leaders,” he said. For those attracted by opportunities in many domains, Northwell has cultivated an appealing environment “for physicians to want to come and have their careers here.”
As the leader in physician well-being, the AMA provides organizational solutions that help physicians and health systems optimize practice efficiency, reduce burnout, and rediscover the Joy in Medicine.
AMA STEPS Forward® offers real-world solutions to common challenges in healthcare today. Explore a variety of innovative, physician-developed resources designed to help prevent physician burnout, optimize workflows, improve well-being, and enhance patient care.
Drs. Kalman and Talamini also emphasized optimism. Healthcare faces significant challenges, but physicians remain part of a profession focused on helping patients, families and one another, as well as advancing discovery.
“We want that balance of the reality of what we’re up against, but knowing what our goals are, be clear, mission, and that comes from leadership,” Dr. Kalman said.
