A Qualitative Study Defining Physician System Citizens: Expanding the Physician Role

Abstract – Purpose – The role of 21st-century physicians must change to meet the needs of evolving health care systems, including meeting societal needs by ensuring equitable distribution of resources, improving health care systems inclusivity and care delivery safety, and providing value-based care. The authors define the characteristics and behaviors of physicians who are currently meeting those needs, termed physician system citizens (PSCs). This study explored and defined the personal characteristics and behaviors of PSCs and the environmental factors that facilitate system citizenship. Method – The authors used the concept of positive deviance, a method to identify individuals in a community with uncommon but successful behaviors, to identify faculty physicians from a consortium of 5 U.S. academic institutions and their associated health care delivery systems considered to be exemplary PSCs. From April to June 2022, semistructured, open-ended interviews were performed with each physician and 1 to 2 of their interprofessional colleagues to explore the characteristics they demonstrate within clinical practice. Content thematic analysis was performed on interview data to identify patterns, with final themes triangulated across the research team. Results – Twenty-one interviews of 9 exemplar PSCs, 6 of their interprofessional colleagues, and 6 resident physicians who worked with the physician were performed. Four main themes were identified: (1) PSCs’ personal characteristics are in alignment with existing core physician competencies, in particular superb communication and teaming skills; (2) PSCs’ behaviors exhibit the presence of systems thinking; (3) PSCs’ behaviors exhibit exceptional emotional intelligence; and (4) mentors were the key learning environment factor in PSC development. Conclusions – These findings provide novel insights into the knowledge, skills, and attitudes required by 21st-century PSCs. More traditional physician-based competencies remain critical for physician development. However, systems thinking and emotional intelligence emerged as meta-competencies that highlight a broader scope and responsibility for physicians to embrace in health care delivery.