Psychologists are challenging leadership norms in health care settings

Pediatric psychologist Amy R. Beck, PhD, had finished her stint as chair of the Equity and Diversity Council at a large hospital in Kansas City when she started looking for another opportunity to lead. When the medical director of the hospital’s Office of Equity and Diversity announced plans to step down, Beck was eager to apply for the role. She was versed in reducing biases, behavior change, and analyzing system processes, but there was one problem: The position was only open to physicians. She asked the hiring leaders—who had witnessed firsthand her qualifications and impact—if she was eligible, and the answer was no. At that point, she had a choice to make.

“I could accept the rules because applying for the role might disrupt my relationships with the current leadership, or I could apply anyway,” Beck said. She decided to submit her application. She was granted an interview, but the job was offered to a physician. Though Beck is now in private practice, she later learned that her willingness to challenge leadership norms changed minds: After the physician left the position during the Covid-19 pandemic, the eligibility requirements changed to include PhDs, and a psychologist was hired as the medical director.

Although top leadership jobs in health care are often reserved for physicians, psychologists are uniquely prepared for these roles with their training in equity and diversity, social determinants of health, effective communication, and more. “Physicians, nurses, and other direct care providers are skilled in assessing symptoms and diagnosing patients’ medical issues, but unlike psychologists, their training is not focused on relational skills and problem-solving at a systems level,” said Kathleen Brown, PhD, a psychologist in independent practice in Fort Myers, Florida, past chair of APA’s Leadership Institute for Women in Psychology, and APA’s recording secretary. “All of those skills have been shown to be essential for effective leadership” (Knight, R., Harvard Business Review, 2023opens in new window). Brown formerly rose to one of these roles at Tripler Army Medical Center in Honolulu.

The psychologists leading the charge into roles as department chiefs, hospital administrators, and other upper echelon positions in health care are improving not only the quality of care for patients but also the business bottom line. While some of these pioneers must convince organizations that they are qualified to fill executive roles, sometimes psychologists are the ones who need convincing that they can do the job. “Even though psychologists have been trained in relationship management, motivating others, resilience, self-awareness, and other critical leadership skills, they are not usually taught to identify themselves as leaders,” Beck said.

Racial health disparities exposed by the Covid-19 pandemic and the racial reckoning following the 2020 murder of George Floyd have contributed to health care systems being more open than ever to considering psychologists for roles that help nurses, doctors, researchers, and others create a more equitable health care system. “Once other disciplines see who we are and what we do in high-level leadership, they are fans,” Beck said. “But psychologists are the only ones who can change the status quo by advocating for ourselves as valuable leaders.”

One key to unlocking leadership opportunities in a health care setting is finding a high-level staff member with influence who shares your mission and is willing to advocate for psychologists as leaders, said Eboni Winford, PhD, MPH, director of research and health equity at Cherokee Health Systems in Tennessee. Winford was inspired by a leader from Cherokee Health who spoke at a conference about how Cherokee Health was providing comprehensive care to patients regardless of their financial status, gender, ethnicity, or racial background. During the conference session, Winford sent an email to the leader, clinical psychologist Parinda Khatri, PhD, asking if she could work for her.

Khatri, who is now CEO of Cherokee Health, hired Winford as a clinician, and the duo met weekly to discuss professional development goals and how to improve care for patients with low incomes. Winford joined the health care system’s quality improvement committee, a team that worked to reduce rates of depression, diabetes, hypertension, and other conditions by addressing social determinants of health. In 2020, Winford spoke to Khatri about her desire to dedicate more energy to reducing health disparities, and Khatri invited her to write a job description for this type of new role. Two weeks later, Winford became the first director of research and health equity at Cherokee Health, which includes 20 clinics throughout eastern Tennessee.

One of Winford’s especially significant accomplishments has been improving the health care system’s method of analyzing patient data—a skill she learned during her doctoral training. Winford started stratifying patient data based on race, ethnicity, gender, income, and preferred language. “Before, the data suggested that all the clinics were doing really well,” she said. “With the new method of analysis, the data started to tell a very different story.” For example, it became clear that the majority of the patients receiving obstetric care were Latine, and they were accessing care late in their pregnancies. The delays were increasing the risk of gestational diabetes, low baby birth weight, premature childbirth, and postpartum depression.

With funds from a $2 million grant from the Health Resources and Services Administration, Winford partnered with a local community organization to develop a prenatal support group for Latine women to learn about childbirth, postpartum care, commonly reported mood changes in pregnancy, warning signs for when to seek help, and more. They also meet with their OB-GYNs during the session. “These women do not need only medical care, they also need social support,” Winford said. “We provide transportation, childcare, and food to help them access care and reduce the chances of isolation.”

Like Winford, Angela Dugan, PsyD, LP, executive director of behavioral health for forensic services for the state of Minnesota, applied her expertise in research to create a more rigorous method of evaluating programs for patients. She was hired in 2017 when the medical director—a psychiatrist—and the CEO decided to expand the executive team to include a nurse, a psychologist, and a chief operating officer. Dugan’s division serves patients who have engaged in an overt act that was deemed dangerous by the court system and have serious mental illnesses such as schizophrenia, borderline personality, or bipolar disorder. She oversees 130 clinicians, including psychologists, mental health practitioners, social workers, physical and occupational therapists, and vocational rehabilitation and education staff.

“My background in research methodology, interpreting data, and monitoring outcomes was crucial,” she said. “I discovered that there was significant variability in how treatment was provided unit to unit.” Some units were unsure how to offer gender-affirming care, which created delays in patient services. Dugan helped rewrite the facility’s policies for transgender and gender-diverse patients, and she created a multidisciplinary gender-affirming care team that follows these patients across their stay.

She has also advocated for increased attention to the clinical needs of patients rather than focusing primarily on security, such as restraining difficult patients or sending them into seclusion. “I’m helping to lead an ongoing evolution in the division in which safety and good treatment are seen as mutually influencing one another,” Dugan said. Previously, nonclinicians could hold positions as program directors, but now applicants for these roles must have clinical training and licensure. With the new priority on clinical care, the department has also been more successful in recruiting and retaining mental health staff. The rates of physical interventions—such as restraint or seclusion—among patients have also dropped significantly.

For Wendy Ward, PhD, ACC, ABPP, certain top leadership roles seemed out of reach until she found a way to interact with academic deans throughout the University of Arkansas for Medical Sciences (UAMS). She applied for these positions several times and made it to the final round of interviews, but ultimately physicians were selected. “I was really frustrated,” said Ward. “It seemed like I had hit a ceiling.” A key leader and mentor suggested she work in a team skills training role that would give her the opportunity to not only meet deans and other leaders throughout UAMS but also showcase her expertise in helping groups work together more effectively. After building these relationships, she applied for and was hired as director of interprofessional faculty development in 2018 and 4 years later became associate provost for faculty overseeing institution-level faculty development, promotion processes, and awards.

Her psychology training is influencing how leaders at the university work together to improve the experiences for more than 2,000 faculty in medicine and other health professions. “In academic centers, leaders are often good at clinical care and teaching, and/or research, but this is not the same as being a good leader,” Ward said. Faculty from different disciplines are often frustrated about issues such as perceptions of inequitable distribution of salaries between faculty groups and insufficient protected time for research. Ward has helped groups engage in conflict management that reduces silos and heals institutional wounds. “As a psychologist, I know how to build committees with representatives from different colleges that share buy-in and responsibility. That kind of spirit in leadership is contagious,” she said.

One of the gaps she identified through focus groups was a need to better support medical sciences faculty who were planning to retire. She worked with the UAMS Emeriti Society to draft a policy allowing for transition options such as an individualized step-down process over 3 years to reduce work hours. Faculty can negotiate which activities they would like to spend time on, such as less clinical work and more teaching. She also advocated for the creation of a confidential mentoring program in which people near retirement are mentored by faculty who have already transitioned. The mentors provide support related to changes in professional identity and developing a social network outside the work setting prior to retirement.

One of her keys to success has been learning to make suggestions for improvement without threatening other leaders. Many times, people approach a department chair or dean with the attitude that “the sky is falling, and it is the leader’s fault,” said Ward. Her psychology training has taught her that leaders do not typically respond well to this type of negativity, so she takes a positive approach by welcoming input from the leader and highlighting potential benefits of making changes. She may then offer to lead efforts to identify concerns in a department and implement solutions to these issues.

Some settings are already seeing the value of psychologists in these top jobs. This was the case for Kari Stephens, PhD, who was the first psychologist hired as the research section head for the family medicine department at the University of Washington in 2022. Her predecessor, a family physician, thought Stephens would be ideal for the role because she had multidisciplinary research experience with advancing primary care through integrated behavioral health and leadership.

In her new role, Stephens recently partnered with a family physician who was eager to help patients struggling with loneliness, which affects a variety of health outcomes. She helped the physician develop a study to test two different interventions—one involving social navigation and the other with cognitive behavioral group therapy. She recently connected him with postdoctoral psychology and graduate student trainees who will assist with leading the interventions and analyzing the data.

Psychologists who take on roles historically filled by physicians may also find that there are fewer barriers because they are potentially seen as long-term leaders, said Stephens. “I am not vying to move up the ladder to the chair of family medicine as that’s not my discipline, so my colleagues know I am committed to this position for the long haul,” she said.

A willingness to learn the business of health care can also help psychologists maximize their ability to thrive in many high-level positions. T. David Elkin, PhD, executive director of the Center for Advancement of Youth at the University of Mississippi Medical Center (UMMC), learned this lesson when he started in his role a decade ago. “When I asked for more funding, I would implore potential funders to help these kids, but nobody in business responded to this argument,” he said. So, Elkin enrolled in a semester-long business program connected to the medical school. He gained an understanding of how to model the budget impact of new health care strategies in a way that business leaders and potential donors would respond to.

Elkin’s leadership team has since advocated for changes that have reduced costs to third-party payers by 40% for patients at UMMC. To strengthen ties with primary-care providers across the state, the center stopped accepting referrals from teachers and parents for conditions such as autism and attention-deficit/hyperactivity disorder. They started requiring primary-care providers to screen and refer patients for these conditions. They also helped these providers easily access psychologists and psychiatrists through telephone consultations for recommendations about medication and therapy. “We have shown that with this new system, referrals happen more quickly, medication compliance is more common, therapy is more consistent, and outcomes improve,” he said.

Similarly, Brown, who was previously the chief of the Interdisciplinary Pain Management Center at Tripler Army Medical Center in Honolulu, sought business training by approaching someone from the organization’s finance office who was overseeing the center’s budget. “I asked her how to translate health metrics into financial terms, and she was fabulous at helping me understand how to save the organization money,” Brown said.

Brown made the business case to shift the focus from pain medications and spinal blocks to a more comprehensive approach that included cognitive behavioral techniques, biofeedback, relaxation training, mindfulness, and other self-regulation techniques, and the move improved patient care outcomes. “We were able to demonstrate that a biopsychosocial care model improved sleep, increased functioning, and helped members of the military return to work earlier, which saved money,” she said. “By identifying themselves as leaders, psychologists can help systems recognize that quality care is also successful business.”