How many physicians should a hospitalboardhave?

A hospital or health system board benefits from having physician members who help the board understand clinically related issues and the perspectives of practicing physicians and their patients. From their practices, they bring a "real world" context to the board's work and help the board make better informed decisions.

A physician board member has the same fiduciary responsibility as every other trustee. Voting physician board members must make decisions based on the best interests of the organization, not the interests of medical staff members. With the exception of the president of the medical staff, physicians on the board may reflect but do not "represent" the opinions of the medical staff.

The medical staff president, however, is elected to represent the medical staff, and therefore, we believe this individual should be a nonvoting board member. (If the staff president currently is a voting member and no problems with this have occurred, there's probably no need to rock the boat. Maintain the status quo, but be aware that a voting medical staff president has a built-in conflict of interest that down the road, could be problematic.)

Next, ask what kind of physicians make good board members. Physicians elected to a hospital or health system board should be judged by the same criteria as any other board member. Among those qualifications, several are paramount: they need to be committed to the organization's mission and values, think strategically, communicate effectively, understand the difference between governance and management, and follow the board's rules of conduct, including its confidentiality and conflict of interest policies.

All that said, what's the appropriate number or percentage of qualified physicians on a hospital board? We believe an appropriate proportion of physicians for most hospital boards is around 15 percent to no more than 25 percent. The most recent survey by The Governance Institute, conducted in 2000 and published in Value Added Governance, indicates that the median hospital board had 12 members, including two medical staff members. Among the survey respondents:

+56 percent of hospital boards have 1-3 physician members

+26 percent have 4 or more physician members

+18 percent have no physician members

As an upper limit, keep in mind that the Internal Revenue Service says no more than 49 percent of a tax exempt organization's board should be "insiders," which includes management staff as well as physicians who have privileges at the hospital.

This information comes from GreatBoards.org, the online resource for effective governance.