Publication Date

Spring 2017

Advisor(s) - Committee Chair

Dr. Randy Capps (Director), Dr. Cecile Garmon, and Dr. David Ciochetty

Degree Program

Educational Leadership Doctoral Program

Degree Type

Doctor of Education


The Patient Protection and Affordable Care Act of 2010 (PPACA) drastically altered the healthcare industry in the United States. Along with multiple other directives, the PPACA mandated that physicians and hospitals work together in strategies known as clinical integration. For effective clinical integration to be achieved, interdependence among physicians and hospitals is required to provide the highest quality outcomes for patients at the best possible value. To this end, healthcare leaders have identified that the key to establishing successful clinical integration is the presence and commitment of physician leaders (Penlington & Marshall, 2016).

This study explores factors that influenced a sample of physician leaders to assume leadership roles in clinical integration. The qualitative phenomenology methodology was selected to study the experiences of physician leaders through their own perspectives. The theoretical framework is guided by the concept of meta-leadership, with a focus on the dimensions of leadership in context and trust.

Semi-structured interviews were conducted with 12 purposefully selected physicians holding leadership roles within hospitals, hospital-employed medical groups, and/or physician-hospital associations. Data collected from these in-depth interviews related to four research questions: (1) How do physicians make the decision to transition into leadership roles within health systems?; (2) What leadership skills are required for physician leaders within health systems?; (3) To what extent does healthcare reform impact physician leadership within health systems?; and (4) What are the perceived benefits and drawbacks of being a physician leader within health systems?

Based on the four research questions, a concept map was developed to code themes and patterns in participant responses. The overall key findings of this study include: (a) encouragement by mentors or friends, (b) career progression into leadership, (c) desire to impact change, (d) lack of prior leadership education or training, (e) the importance of change management, (f) acceptance and management of healthcare reform, (g) need for physician leaders in healthcare, (h) enjoyment in leadership responsibilities, (i) the importance of having influence and a voice in decision making, (j) giving up time devoted to other causes, (k) frustrations with the amount of time needed to impact change, (l) difficulties in work/life balance, and (m) difficulties in leadership/clinical balance.

Recommendations from this empirical investigation provide guidance to health systems seeking physician leaders. Understanding the leadership choices of current physician leaders is instrumental to inspiring, recruiting, and training additional physician leaders to meet clinical integration needs. If healthcare leaders can begin to understand the reason current physicians have accepted leadership roles, they may be better equipped to recruit additional physician leaders.


Business Administration, Management, and Operations | Health and Medical Administration | Leadership Studies