The challenges of becoming a physician leader

It isn’t easy to become a physician. There is the need for good grades in high school and college which often means foregoing social activities. There is medical school which requires mastering a huge amount of information, skills, and procedures. There is the need to find a suitable area of specialization and consequently finding employment in a small practice or integrative care environment that suits the needs of each physician.

Along the way physicians learn that their success rests totally in their hands. If they want to make something happen, they have to do it themselves. They are consummate problem solvers. Each patient brings a set of issues upon which a diagnosis of cause must be determined. Patients expect their clinicians to give them the right, accurate, and latest information. Physicians often deal with life/death emergency situations. They have little time for the frivolous. Over the last few years, their performance is closely monitored in terms of quality and quantity.

When physicians are asked to step up to the leadership plate they find a set of circumstances that is substantially different from their past experience. Physician leaders have to learn

• It is no longer about their own performance, but that of the group
• The issues they face are often thorny and have no simple solutions
• Those who were once peer physicians no longer trust them because they have management responsibilities
• Building workplace community is far more challenging than they ever imagined

A true life example

Dr. Smith was a great surgeon, renowned in his field. He set up a specialized medical center and staffed it with the most capable personnel he could find. At first the newly formed organization thrived. It was highly successful. It had huge market potential. As the organization grew, Dr. Smith’s ability to manage the Center with his existing strengths created significant animosities between the staff. What were his issues?

• Dr. Smith expected loyalty from his crew. They respected him for his medical expertise. But lack of interpersonal skills and inability to build a leadership team limited what the organization could become
• Though he had an excellent vision for his Center, he was unable to build the necessary relationships and trust to get the critical support he needed
• Dr. Smith did not know how to lead an effective meeting. He failed to understand how to create the necessary sharing of information and decision-making with his staff. The opportunity for internal communication was lost
• He struggled to create the forums in which people could positively and effectively address the issues. As a result, personality/interpersonal issues took far too much air time and impacted morale
• Dr. Smith had little patience for what he thought were petty issues. He couldn’t understand why people didn’t follow through with expectations. He struggled to relate particularly on those days in which he performed long and complicated surgeries.

Dr. Smith’s inability to establish leadership trust with internal and external stakeholders limited his effectiveness. Yet, it was Dr. Smith’s fine reputation as a surgeon…the impact he had as a clinician that enabled the center to exist in the first was insufficient for him to fully realize the potential of his ideas.

Dr. Smith became tired, frustrated, and angry. The final chapter of his career remains to be written.

It is one of the ironies of life that often what we have often had to give up to achieve a successful outcome may in turn prevent us from reaching a higher goal later in life.

Dr. Smith’s script is true of many physician leaders. I know many physicians who report to a Dr. Smith who desperately seek additional support and leadership and are frustrated in not being able to find it. Yet, physician leadership remains a critical ingredient for the delivery of quality healthcare. We have to find more effective ways to help physicians who have a vision develop the capacities to handle the complexities of operating and growing vibrant and effective healthcare organizations.

What advice and thoughts do you have for improving physician leadership? Your comments are welcome.