How to train more physician leaders

In today’s healthcare environment, nearly half of all new physicians are salaried employees of a hospital or healthcare system. Now, more than ever, physician leadership is of paramount importance. With increasing pressure to increase care quality and simultaneously lower healthcare delivery cost, it is essential that physicians and administrators  work together. Physicians must continue to grow into executive roles and lead both healthcare systems as well as manage other doctors and clinical staff.

By the very nature of the practice of medicine, all physicians are leaders. Doctors direct clinical care on the wards, in the ER, in the operating room and in the office. However, physicians must begin to embrace roles where they are directing activities in a boardroom as well. Current medical education certainly falls short in formal leadership training and needs critical improvements immediately.

In 2010, Harvard Business Review addressed this very issue. Surgeon Atul Gawande is quoted as saying “most medicine is delivered by teams of people … yet we don’t train physicians how to lead teams or be team members. This [training] should begin in medical school.”

Medical schools must begin to formalize leadership training and help to create more graduates who are not only skilled as physicians but are also skilled as physician executives.

In order to train emerging physician leaders, we must identify those characteristics that are most important to develop. Much has been written about leadership in business. I believe effective physician leaders have many skills and traits in common with executives that manage Fortune 500 companies. I believe we should focus on identifying and cultivating these characteristics in medical school and residency in order to produce the physician leaders of the future. Although my list is not all inclusive, I have chosen to highlight 4 points I feel are most important to leadership in medicine.

1. Integrity, trust and respect. In order to be effective at motivating and inspiring others, a physician leader must be respected by his or her peers.

2. Skillful communication and effective conflict management. Team members composed of physicians are traditionally used to being in charge and their voices heard. An effective physician leader is able to listen to others and assimilate ideas quickly. In order to maintain trust and respect of team members, the physician leader must be able to quickly resolve conflict among physicians, among administrators and among staff. The challenge is to resolve the conflict in a way that is equitable to all, in the best interest of the team at large and does not alienate team members with dissenting opinions.

3. Clear and compelling vision. The effective leader must understand the goals of the team and work to develop a path to success. The physician leader must see the “Big Picture” and be able to clearly communicate the goals and strategies to the team. In order to guide the team to the ultimate goal the leader must see a world without boundaries. Sometimes problems are best solved by thinking outside the norm and utilizing novel strategies to solve big problems.

4. Judgement and accountability. A leader must be able to make decisions and live with the consequences of the choices that are made. Effective leaders accept personal responsibility for their actions and the actions of the team that works at their direction. This behavior helps to build a leader’s reputation of having integrity, trust and respect. Team members rally around leaders who do not “throw them under the bus”.

Medicine is in transition. Physicians must lead the way in order for the highest quality healthcare to be effectively delivered going forward. Physicians in training must learn to lead. We must prioritize the training of physician executives. Medical schools must develop formalized training in team building and students must learn to be both effective team members as well as team leaders. The great physician leader will make good healthcare systems great. As physicians, the fate of the US healthcare system is squarely in our hands. We can choose to sit back and watch things develop around us or we can begin to lead the way today.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • http://www.facebook.com/people/Quanta-His-Kim/100003199486642 Quanta-His Kim

    Well said..

  • Lucy Hornstein

    Interesting how there is absolutely no mention of the patient in this article, which states that “the team” is the physician’s highest responsibility. I wonder what happens when everyone on “the team” agrees on a given course of action but the patient does not. That’s where these business-type models fail when applied to medical care.

  • http://www.thehappymd.com/ Dike Drummond MD

    Dr. Campbell – thanks for this post. Leadership skills are a massive need and equally large black hole in the modern physician’s skill set.

    Some of the challenges are obvious like the complete lack of leadership training in most residency programs. Others are practically invisible and part of the subconscious conditioning we all receive during our medical education. Here are two that jump out of your article for me.

    1) The default Top-Down leadership style of the patient care team.
    Doctors “give orders” and everyone else follows suite. Outside of a “code” situation, this style is not nearly as effective as involving the whole team in the design and delivery of care. In order to be this type of collaborative leader, doctors must learn to quit always
    Giving orders
    Feeling like they must have the answers
    And Learn to ask questions, accept other’s input and build a true TEAM.
    As a bonus … bringing the team in like this makes it so the doc doesn’t have to work so hard.

    2) Doctors attitude toward leadership.
    In order for healthcare leaders to emerge, physicians have to be willing to be lead. Most of the time doctors within organizations are more part of the problems that the solutions because of an ingrained “lone ranger/superhero/workaholic” coping mechanism we all learn in residency.

    This is especially true if the Leader is a Physician. It is common for other physicians to see that MD as someone who has gone over to the “dark side” and vilify them. It is even more common for doctors to slide into victim mode and simply opt out of decision making to sit on the sidelines and complain.

    Those are my two cents
    To be more effective, doctors must learn how to ask questions and become a collaborative team leader. And inside organizations doctors would benefit greatly from either playing a role in crafting the solutions or being better followers.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • http://twitter.com/Coachpatrickv Patrick C. Veroneau

      I would suggest that all physicians are “by nature” managers but not necessarily leaders. To lead requires the ability to inspire people to want to follow. Management is about directing people, which can often accomplished through coercion, threats or intimidation. An understanding and application of emotionally intelligent behaviors would go along way to creating an effective organization for both practitioners and patients.

  • voitokas

    I think that formalized leadership training is the wrong place to look – especially in medical school. Looking at the four important aspects of leadership you identified:

    1. Integrity, trust, and respect
    While you can create a culture within a school, residency program, or hospital that emphasizes these, they cannot be formally taught. And creating such a culture is very difficult even in the best of workplaces, let alone in the very hierarchical and culturally divided world of healthcare. Perhaps medical schools could be a little better at selecting students, but they would have to sacrifice GPA for integrity, and no one wants to do that. We certainly can’t look to business for ways to teach integrity!

    2. Skillful communication and effective conflict management
    This is one area where I agree that formalized training would be good. It would be difficult to make room for it in M3, M4, or residency, but that’s probably where it should be taught. In fact, it should probably continue to be taught in hospitals, because these are skills that everyone on a team needs, not just leaders.

    3. Clear and compelling vision
    This definitely cannot be taught, and probably can’t even be selected for (though I suppose you could select for people who are verbally articulate)

    4. Judgement and accountability
    I would argue that these are already inherent in clinical training. Indeed, much of what we learn in clinical rotations (in the U.S.; unfortunately the clinical years of many foreign schools are comprised mostly of shadowing, though many FMG’s have done residencies in their home countries before entering residency here) and certainly during residency training. We could probably select more for this just by taking older applicants into medical school…

    I agree with Dr Drummond that the subconscious conditioning we get is to some degree responsible for reinforcing the non-collaborative patterns that inhibit teamwork, and with Patrick and Lucy that emotional intelligence and inclusivity are intrinsic to good leadership within a team.

  • http://www.facebook.com/roberta.himebaugh Roberta Page Himebaugh

    Good posting. I actually attended a webinar today sponsored by the Society of Hospital Medicine. It was cleverly titled “Physicians are from Mars; Administrators are from Venus – How to Improve Communication at your Facility.” Dr. Chris Frost from HCA Healthcare effectively presented the importance of communication styles and highlighted the difference in training received by physician leaders and business leaders. The need for skillful communication by clinical and nonclinical leaders in healthcare cannot be emphasized enough.

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