Physician Hat Tricks

Elyas Bakhtiari, for HealthLeaders Media, May 15, 2008

What distinguishes a physician leader from other doctors? The AMA puts the number of physicians in the United States at roughly 940,000, which includes both active and inactive doctors in virtually all practice settings and represents many top-notch clinicians, researchers, and residents. But how many of them can be considered leaders?

I posed the first question to Richard Schwartz, MD, a professor of surgery at the University of Kentucky College of Medicine who has researched and written about physician leadership development. His answer, in short: A physician leader is someone who is able to deliberately put on a different hat—clinical or managerial—depending on the task at hand.

It sounds simple enough, and the hat analogy certainly isn't new to discussions of leadership. But for hospital administrators and executives, putting on a different hat typically means shifting their focus to a specific area of management—patient safety, finance, or human resources, for example.

For physicians, it isn't so easy. The skills that make physicians excellent clinicians are in many cases "diametrically opposed" to the qualities needed in a manger or organizational leader, Schwartz says. Physicians are trained to interact one-on-one; leaders must deal with multiple constituencies at once. Physicians, particularly surgeons, are accustomed to making life-or-death decisions on the spot; leaders incorporate feedback and work on long-term projects. Physicians are trained to think of the patient first; leaders must consider all stakeholders. To throw another analogy into the mix: Physicians play solo sports, like tennis; leaders play team sports, like soccer.

So for a physician to step out of an operating room and into a board room requires not just a shift in focus, but an entirely new skill set. Successful physician leaders are aware of the distinct skills needed in each situation and are able to switch hats at will. They are able to put a foot in both worlds, and that's precisely what makes them such an asset. "The goal of the physician leader is educate the administrative hierarchy about clinical issues and physicians about administrative issues," Schwartz says. No one else has the perspective and skills to pull off both of those tasks.

Where many physicians go wrong is assuming that the quick thinking that makes them successful in the emergency room will translate at an organizational meeting. And where many organizations go wrong is in promoting physicians to leadership positions based on their clinical expertise. Just because a cardiologist is the rock star by every clinical measure doesn't mean he or she has what it takes to be a department head.

In fact, sometimes the physicians with the most influence in an organization don't hold traditional leadership positions. These "opinion leaders" are able to bridge the administrative-clinical gap without official titles.

So is physician leadership development simply a matter of identifying physicians who already have hat-switching abilities? That's part of it, but physician leadership can also be developed. "A lot of the popular literature would say leaders are born, not made. But there's no data to support that, whether you're talking about running GM or a healthcare system," Schwartz says. "You can groom yourself to be a good leader if you put in the time and the effort."

It's just a matter of learning a few new tricks.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at

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