Julie Rosen, nonprofit practice leader at executive recruiting firm WittKieffer, recently wrote a report on building sustainable leadership in federally qualified health centers. She recently spoke with Healthcare innovation about some of the report’s findings and his experience recruiting FQHC leaders.
Prior to working at WittKieffer, Rosen served as executive director of the Schwartz Center for Compassionate Healthcare in Boston, a national nonprofit organization that advocates for improving the doctor-patient relationship. Prior to working at the Schwartz Center, she was associate vice president of public and community affairs at Tufts Health Plan and executive director of the Boston University Hospitals Conference. He also held leadership positions in the Massachusetts Hospital Association, the Massachusetts Medical Society, and the American Association of Dental Hygienists.
In addition to surveying FQHC leaders for this report, WittKiefer also conducted research of his own on the career paths of more than 350 FQHC CEOs across the country.
Healthcare Innovation: I think most of our readers know what FQHCs do, but what are some of the key challenges of serving as CEO of an FQHC?
pink: It’s interesting that you say that most people know what FQHC agencies are. I know a lot of people in healthcare who have never heard of CF, which I find surprising, because so many people get healthcare there now: almost 10 percent of Americans.
There are more challenges around the social determinants of health. Many FQHC patients are at risk, underserved, and have needs that include transportation, economic security, food, and protection from environmental hazards such as lead paint. So in addition to medical care, many FQHCs provide access to social supports like food and transportation.
The other thing that makes it different is that 51% of CF board members have to be patients.
When I do my searches, I insist on patient representatives, because that is the majority of the board. Board education is really important: making sure everyone is on the same page, making sure the board has enough information, and making sure the board is representative.
HCI: In your research, did you find any common themes about the demographics and educational background of CEOs?
pink: It’s interesting. Many of the retiring FQHC founders are social workers who created small community clinics. They started adding different medical offices and all of a sudden they had a $100 million operation. They gained business skills and now the organization is ready for something different. Many of the FQHCs did very well during the pandemic, because there was a lot of PPE and other money, but those funds dried up. That’s why they are struggling and need strong leadership.
We placed some CEOs who have never worked in a CF environment. In California, we just placed a woman who was a Kaiser executive at a very large outpatient practice and who wanted to contribute. We are seeing that many of our seniors with traditional healthcare careers now want to contribute.
HCI: Do you see many physicians taking on that CEO role?
pink: Yes. The first two CF searches we did were in Massachusetts and they were both doctors. In FQHCs, there are often significant physician productivity issues. They join FQHCs because they want to do good work. They need more time with each patient because their patients are more complicated. And because of the pay incentive system, they have to be more efficient, so there are issues around productivity and scheduling.
HCI: Your report found that there has been a 20% CEO turnover rate over the past two years. Are there any reasons why we are seeing this high turnover rate now?
pink: There are some reasons that are related to the FAQ and there are other reasons that are more related to demographics. People leave saying they’ve had enough. These searches are rewarding but really difficult. It’s hard to get everyone on the same page, because what CFs want is an outstanding, strategic person who is a visionary, great at operations, and great at clinicals, and great at finance, and who can be an emissary to the organization. And by the way, he raises money and has a lot of emotional intelligence. And yet, they don’t have the resources to compensate CEOs like hospitals and other healthcare organizations can.
HCI: The report also looks at whether they have succession planning and whether they are starting to prepare people internally to advance to that CEO position. And it seems like the report says that doesn’t happen very often.
pink: That’s how it is. The National Association of Community Health Centers (NACHC) has some mentoring programs where older, retired CF CEOs mentor younger ones.
I originally came from the hospitality industry and there is a lot more success there in terms of succession planning. Many of these FQHC organizations are working by the seat of their pants, so they don’t really have the resources to think about that. I think of the 30 positions we’ve been involved in, maybe six or seven were filled by people who were coming up through the ranks.
HCI: Are we seeing more FQHCs engaging in value-based care programs? And does that require an additional skill set on the part of the CEO?
pink: Every CF wants CEOs to understand what value-based care is. I think it depends on the state and how many CFs there are and how sophisticated the state is in terms of payment. We’ve done a lot of work in California and Massachusetts, and those are the most sophisticated states. But if you go to other states, they’re just not as sophisticated. They’re just now getting into value-based care.
HCI: Your report says workforce challenges include talent, attraction, retention and attrition. Are there some ways you’ve seen successful FQHC leaders address those issues?
pink: Generally through flexible schedules. But going back to what I said earlier about productivity, it’s a huge topic. It’s a real balancing act. There has also been real tension in organizations between administrative staff, especially during the pandemic, and clinical staff, because administrative staff did not have to come. They could work from home. This is somewhat old news, but there is still a lingering tension in some of the FAQs between those on the front lines and those doing billing and coding.
HCI: Is there anything else you want to mention?
Rosen: Simply that CFs are great organizations. There are some really talented leaders out there. There are many CFs that are forming joint ventures with hospitals and associations around housing. I have done searches for homeless shelters that have CF attached. So there are a lot of different ways that CFs are emerging, and I think it’s really the wave of the future.
