The Inside Change Agent: James McKiernan, Senior Vice Dean for Clinical Affairs and CEO of ColumbiaDoctors

James McKiernan and Columbia have some history. He started at the Vagelos College of Physicians and Surgeons as a medical student, stayed for a residency in surgery and urology, returned after fellowship as an assistant professor of urology, and became chair of the Department of Urology in 2014. But the story wasn’t over: In late 2022, McKiernan accepted a newly created combined position as senior vice dean for clinical affairs and CEO of ColumbiaDoctors.

The new role was created to support the growth of the faculty practice and meet the future needs of clinicians and patients, which to McKiernan means a transformation is required.

“We have existed for many years as 18 independent departments with very insular structures, and now we’re moving to centralize a lot of these operations,” McKiernan says. “I’m a lifer who’s been here forever, but that doesn’t mean I have a business-as-usual status quo kind of way of looking at things. I'm an inside change agent who knows and loves this place, but I've seen a lot of the warts. I cannot see us moving forward without some major changes.”

He intended to take over the role at the beginning of 2023, but a catastrophic flooding event in Herbert Irving Pavilion moved that timeline up. The day after Christmas in 2022, McKiernan had his first day on the job, wading through flooded procedure rooms and fielding questions about insurance, construction, and where exactly hundreds of patients waiting for their appointments were supposed to go. McKiernan hadn’t even met many of his new colleagues yet, but they dove in together to reroute patients to alternative locations and create new temporary clinical spaces wherever possible, including converting nearby hotel rooms and simulation rooms in the Vagelos Education Center to exam and operating rooms.

“It was, in all senses of the word, an immersive experience,” McKiernan says. “It's like I wanted to learn to speak Italian, so I was going to go to an Italian language class. And then someone just kidnapped me and dropped me in Rome with one dollar and said ‘Good luck.’ So I learned Italian really fast.”

The efforts undertaken to ensure continued access to care paid off. Completing all the necessary repairs took about six months, but clinical volume didn’t slow down. The first quarter of 2023 saw higher volume than the third quarter of 2022.

With crisis averted, McKiernan’s next step was to kick off a restructuring of the ColumbiaDoctors board of directors by rewriting the bylaws to afford department chairs more leadership responsibility and ownership over operations. The move was aligned with the Access to Care project, which aims to reimagine how patients access services, in partnership with NewYork-Presbyterian and Weill Cornell Medical Center. Through maximizing capacity and increasing operational efficiency, McKiernan is working to shorten wait times and serve more patients. Hiring more providers is just one piece of the puzzle, as even new providers’ schedules quickly fill up, leaving longer-than-desired wait times for patients to be seen.

“The demand is insatiable, and we can't afford to build a big enough health system to meet all the demand in our local and regional community,” McKiernan says. “We have to look at ways we can try to increase capacity in our existing system by practicing more efficiently and effectively as well as creating innovative new practice models that improve access to our world-class providers. We know we have an amazing group of physicians and surgeons here and it is our goal to make sure we can serve all the patients that want to seek care with us.”

More space, of course, is always welcome, and the faculty practice organization in partnership with NewYork-Presbyterian has an aggressive growth and development agenda for 2025, including construction of the Cancer+ building on the CUIMC campus, the Och Spine outpatient facility in Hudson Yards opening in January 2025, and 1111 Westchester Ave., a 26-acre 200,000-square-foot multi-specialty campus opening in September 2025.

Another top priority during McKiernan’s early tenure has been the implementation of new quality and patient safety measures, including the appointment of Jason Adelman as the director of the new quality and patient safety program. (Visit Rebuilding Trust to learn more about Columbia’s efforts in quality and patient safety.)

Allied with patient safety and quality efforts has been a drive to improve equity for both patients and providers. In partnership with NewYork-Presbyterian, ColumbiaDoctors has integrated the ambulatory care network with existing operations to ensure consistent standards of care across the board for all patients. In an effort led by Katrina Armstrong, dean of VP&S, in close collaboration with NewYork-Presbyterian leaders Steven Corwin and Brian Donley, McKiernan is helping to establish a new approach to clinical compensation for clinical faculty for the next fiscal year. This newly created VP&S model will strive to create a transparent, equitable, and benchmarked system that measures clinical productivity against a national standard to determine compensation. Five departments were involved in the successful pilot program during the past year, and the system was adopted across VP&S beginning July 1, 2024.

“We want to retain our best talent and we strive to approach compensation through an equitable and transparent model that is tied to national benchmarks and can remain competitive with the ever-changing market forces in physician compensation,” McKiernan says.