He was a seasoned family doctor and one of the chief medical officers for a health system. I was curious about his opinion because I imagined he had experienced years of evolution with EHRs.

"Physicians here say it's pretty functional compared to other EHRs," he said.

But what did he personally think of the EHR?

"Oh, I'm not in the EHR much," he said. "I don't see patients anymore."

In my naiveté, I was somewhat surprised. A physician leader who doesn't see patients at all?

That CMO elaborated on his role, which included recruiting and interviewing applicants like me, driving quality improvement projects, evaluating physician compensation models, leading committee meetings on topics ranging from patient safety to ethics to disaster preparedness, expanding service lines and access, and increasing transparency of physician performance data.

Physician leadership roles have no shortage of responsibilities. It's no wonder that, from a practical standpoint, many physicians who take them on choose to eliminate patient care from their job descriptions.

It's an interesting conundrum. Physicians should be key leaders in health systems. When physicians run hospitals, their facilities score 25% higher in overall quality compared to hospitals run by nonphysicians with management backgrounds.

Physicians have deep insight into multiple aspects of health care and research also shows employees have higher rates of job satisfaction when their leaders have technical expertise in their field. This gives physician leaders the peer-to-peer credibility a businessperson will never have in health care settings.

Historically, nonphysician senior leadership would rely on key physician "influencers" to socialize ideas and achieve buy-in. Change management often took a "command and control" approach with cascading information. But as health organizations see the benefits of physician leadership, they are encouraging physicians to move into roles beyond CMO, including chief strategy officer, chief innovation officer and even CEO. With the increase in physician executives, doctors are able to drive decisions rather than being relegated to the role of middlemen. That's why frontline physicians depend on their physician colleagues in leadership to advocate for them and their patients.

But how important is it to stay involved in active patient care for a physician to be an effective advocate? One physician leader told me she saw patients for 27 years before taking a role focused exclusively on leadership. She felt she couldn't be a meaningful primary care physician with limited patient care hours, so she preferred to give it up altogether. Additionally, given her decades of experience, she said she will always be able to relate to other physicians. She also pointed out that doing a half-day of patient care versus no patient care likely wouldn't make much of a difference in her leadership approach.

But a growing trend for many organizations is for physician leaders do at least a little bit of clinical care, even a half-day per week. Other organizations have their physician leads (such as senior medical directors) take on a heavier lift, splitting patient care and administrative duties 50/50.

Regardless, with limited patient care, physician leaders should lean on other tools to build credibility and rapport with their physician colleagues. They should not assume they are "in the trenches" exactly like other frontline physicians, who are seeing patients 100% of their professional time. Frontline physicians naturally have larger patient panels. They spend significantly more time in front of an EHR. They field questions from staff while managing the complexities of insurance paperwork. A change that might seem innocuous to a physician leader doing a day of patient care per week could be a burdensome disruption to a family physician with 40 hours -- or more -- of direct patient care weekly.

In a twist of fate, I've found myself in this position of balancing growing leadership responsibilities with ongoing patient care. Consequently, I've learned to make extra efforts to engage with frontline physicians and other team members regularly. I spend time in the exam rooms with them. I understand their priorities and ensure they are heard and valued. My approach to change is collaborative: When possible, I solicit input before change is implemented and then regularly incorporate physician feedback. I don't automatically assume that I understand any unique patient's or employee's own lived experience.

On the question of how active physician leaders should be in patient care, there isn't a clear answer -- and it's perhaps not even the right question to ask.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan.

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