My first experience with hospital administrative titles was in 1967 as a 2nd Lieutenant in the Air Force assigned to Wilford Hall USAF Medical Center in San Antonio. The Hospital Commander was a physician Brigadier General. That was the only title/ rank that mattered.
Returning to NYC in 1972 a typical hospital had a President & CEO, EVP & COO, and an SVP & CFO.
I was taught that President was a title and CEO was a function, nonetheless over time many hospital leaders started referring to their title as CEO, a trend that continues.
On a rapid trajectory we have seen hospitals become regional hospital systems focusing on becoming integrated health care delivery systems, to mega systems focusing on geographic reach, to super-size systems which have started or taken over medical schools, functioning almost like insurance companies and investment banks.
And with that an explosion of C-Level titles.
But I digress.
So now we have, for example (curated from hospital web sites. Really!)….. Chief Medical Officer, Chief Information Officer, Chief Revenue Officer, Chief Affiliation Officer, Chief Learning Officer, Chief Experience Officer, Chief Managed Care and Business Development Officer, Chief Quality Officer, Chief Development Officer, Chief Public Relations Officer, Chief Procurement Officer, Chief Human Resources Officer, Chief Legal Officer, Chief Corporate Compliance Officer, Chief Financial Officer, Chief Operating Officer, Chief Marketing and Communications Officer, Chief Administrative Officer, Chief Nurse Executive, Chief Academic Officer, Chief Strategy Officer, Chief Information Officer, Chief Population Health Officer, Chief Diversity and Inclusion Officer, Chief Risk Officer, Chief Investment Officer, Chief Medical Information Officer, Chief Clinical Integration Network Development Officer, Chief Technology Officer, Chief IT Officer, Chief Sustainability Officer.
“We are living in the age of flattening org structures with the hope of making organizations more fair and efficient, yet employees still want to feel important (like they are progressing up the chain). This is the environment where title wackiness is allowed and encouraged to happen.” (A)
“The snag is that the familiar problems of monetary inflation apply to job-title inflation as well. The benefits of giving people a fancy new title are usually short-lived. The harm is long-lasting. People become cynical about their monikers (particularly when they are given in lieu of pay rises).” (B)
“What began with a C-suite of corporate leaders has morphed into a full-fledged assault on traditional chains of command, with a seemingly endless cascade of increasingly specialized, yet amorphous, positions in an unwieldy hodgepodge of matrixed responsibilities. It’s title inflation at its worst and often counterproductive to effective management.” (C)
C-Level titles have become so pervasive in some mega-systems it is unrealistic that they all report to the CEO or COO. So to reflect the operating TO it is likely a new top-tier-title strata will be necessary to explain who is really in charge and has final authority. Starting with something like Deputy CEO which will later become First Deputy CEO and later Senior First Deputy CEO – then similar clarifiers throughout the C-Suite.
Skipping a level up we already see major hospital systems with numerous Presidents presiding over different types of entities (e.g., hospitals, insurance companies, physician practices, imaging & urgi and surgi centers) and again, at some point differentiators will need to be added.
The key to the future might be the designation of a “Chief Corporate Title Tracking Officer”, unless the rumored so-called “C-Level Title Non- Proliferation Treaty” being advanced by some major academic medical centers becomes a reality.
And of course I am guilty too…using four academic titles…Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; Adjunct Professor, Ziklin School of Business, Baruch College, C.U.N.Y.; Adjunct Professor, Rutgers School of Public Health; & Adjunct Professor, Rutgers School of Public Affairs and Administration.