Much has been written about effective governance within organizations, especially concerning the chief executive. A single leader must be empowered to make decisions for the organization on matters for which he or she will be held accountable. Having multiple individuals within a single office holding top leadership positions would not be functional and certainly not sustainable.

The United States Army highlights the importance of this issue, termed “unity of command” as one of the nine essential principles of war. This is identified as requiring “a single commander with the requisite authority to direct all forces in pursuit of a unified purpose.” Resurgens Orthopaedics has been successful by intentionally violating this principle for more than a decade. This article describes how a team approach to group leadership can be highly successful.

About Resurgens
Resurgens Orthopaedics is a large single specialty orthopaedic practice serving patients in the metro Atlanta area. The basis of the current practice took shape in 1999, when Resurgens merged with five other orthopaedic practices. It currently has 95 orthopaedic surgeons and physiatrists covering 21 offices with approximately 1,000 employees. 

After several years, our physician board realized that the executive work load was too much for the physician president to perform without surrendering his or her orthopaedic practice. As the complexity of modern medicine increases the administrative burden on private practices, many groups will be faced with this dilemma.

Leadership options
At this point, orthopaedic groups can choose among several different options. A common solution is to employ a nonphysician chief executive officer (CEO) to perform the day-to-day leadership tasks of the practice. The physician president of the group is ultimately in charge, but the division of duties enables the physician president to continue an active (albeit less active) medical practice. This is an effective option that meets the needs of the group while maintaining a reasonable degree of physician control.

Another option is for the physician president or CEO to withdraw from the practice of orthopaedic surgery and devote all professional time to group leadership. However, this option is only practical for physicians moving toward the end of their careers.

The Resurgens board decided that it only wanted physician leadership and that the physician leader(s) had to maintain an ongoing practice. In no way is this statement intended to be negative toward nonphysician CEOs, but this model just didn’t seem to work for our group. Our board decided that a co-president model would be optimal. We present this model as an alternative groups may want to consider.

Orthopaedic surgeons D. Kay Kirkpatrick, MD, and Steven B. Wertheim, MD, were selected as the first co-presidents and successfully served in this role for 7 years. Currently, we (the authors) serve as co-presidents.

The co-presidents are completely equal in terms of authority and scope. Neither can make unilateral decisions without consent of the other. Although administrative responsibility is divided, this division is only for efficiency so that staff know which co-president to contact. Both co-presidents could step into the other role at any time and are equally empowered to make decisions. This model has a true bipartite executive leadership in that neither co-president can act independently except under unusual circumstances.

It works!
Looking from outside the group, there is no way that this model should work. The group leadership should be paralyzed with indecision, and the potential for conflict is significant. The personality characteristics of confidence and self-sufficiency required to become an orthopaedic surgeon are counterproductive to this model. Yet, Resurgens has successfully employed this model with two different pairs of co-presidents for more than 12 years.

One of the integral requirements for this model to work is for both co-presidents to have successful, mature, busy surgical practices. We are both so busy that we have had to develop a culture of trust to accomplish all of our work! As co-presidents, each of us needs to understand what the other would do in a certain situation, and we have to communicate frequently and effectively. As orthopaedic surgeons, we know how to get to the point without drama or excessive explanation.

Sometimes interactions can be complicated. The overall strategy of expansion is primarily Doug’s responsibility. John runs the development meetings and is the point leader to open a new site. Doug then recruits the new physicians to staff the office that John just opened.

The difference between the Resurgens model and a CEO/president model is that we are complete equals. We are both integrally involved in all efforts, although each defaults the lead to the other when appropriate.

The modern practice of orthopaedic surgery requires leadership and vision. We believe that our model incorporates the best of all possibilities. As the strain of administrative burden from governmental mandates continues to distract physicians from patient care, orthopaedic surgeons will need to consider innovative methods of leadership.

Douglas W. Lundy, MD, MBA,and John R. Gleason, MD, are the current co-presidents of Resurgens Orthopaedics. Dr. Lundy is also a member of the AAOS Now editorial board.

Additional Information:
https://en.wikipedia.org/wiki/Principles_of_war