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Physicians as Leaders: What's Missing?

Charles Saunders, MD, and Bonnie Hagemann, April 15, 2009

Physicians as leaders are often like fish out of water. While they are typically regarded highly by society, most physicians have no leadership experience whatsoever. Physicians are among the most highly educated groups in our society, but as they progress from high school to college and from medical school to specialty training, the breadth of their education markedly narrows.

In fact, most physicians are students well into their 30s before they finally go out into the world to practice a specialty. Once they begin to practice, they often work in an environment that allows them to focus on what they do best—practice medicine.

Hospitals, on the other hand, are run mostly by leaders who have either MBAs or degrees in hospital administration. They understand hospital finances and hotel management, but they typically do not understand clinical medicine. Because of this obvious gap, most hospitals delegate clinical quality and physician credentialing to the medical staff. Furthermore, hospital presidents know that physician-generated admissions and utilization of resources by physicians are important to their financial stability. They need and depend upon the physicians.

However, they typically hire physicians and then place them in leadership positions such as department chief, medical director, etc., and this is where the problem begins. Physicians lack the proper training for some of these roles. They do, however, bring both strengths and weaknesses to their leadership positions, and physicians who perform well as leaders are a highly valued treasure for any healthcare organization.

Physicians becoming leaders

For the physician, leadership can be a lonely scenario at times. Upon assuming a position of leadership, there is inevitably the belief among colleagues that he or she is no longer one of them and is now an "administrator."

This shift is not unique to physicians. It is a difficult but necessary move on the leadership pipeline, but for the physician leader, it doesn't stop there. To add to the pain, the hospital's senior management team often does not regard the physician as a true executive, either. This is due to the lack of formal business education or the lack of leadership experience. So the physician lives in a sort of no-man's land.

Healthcare leaders who are not physicians have typically been groomed for leadership for many years, but the physician has been groomed to provide quality healthcare. There are often major gaps between what the physician is and where he or she needs to be to execute the business of healthcare effectively.

The leadership gaps

Physicians in general are used to being totally responsible for their patients' care. They may consult with specialist colleagues, but they alone control the aspects of their patients' care. As leaders, this skill does not serve them well. They often find delegation of duties very difficult and try to do everything themselves. Delegation of responsibilities and allowing the delegate to perform independently without hovering is an art that must be learned and developed.

Physicians are also accustomed to being obeyed, to working independently, and to being the center of attention. A doctor gives orders and expects absolute deference and immediate action. This may work in the operating room where the environment can be urgent and tense. It does not work, however, when leading others outside of the operating room.

As a healthcare leader, influencing becomes a critical skill. The physician leader must learn to effectively state a case and still be able to support the management team if an alternative course of action is chosen. He or she must learn the art of give-and-take, negotiating with other team members. Ultimately, the physician leader must learn to participate in and build effective and cohesive teams.

Another peculiar characteristic is that physicians are often in "transmit" mode. This is a result of their training, which is odd because it doesn't always work that well in the practice of medicine. In fact, many physicians are not even that good at listening to their patients. Developing good listening skills is crucial, as effective communication requires both transmitting and receiving.

The physician leader has to learn that when attending a meeting, it may be better to hear others' opinions around the table before speaking. This gives the physician time to be clear about what he or she wants to say and then to be more flexible in presenting ideas. Communication skills (verbal, writing, and listening) are crucial for effectiveness both as a physician and a leader.

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