Physicians as Leaders: What's Missing?

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.

An issue that is not often discussed is that many physicians have personality or character issues due to a prolonged period as a student. Many do not start their careers until their early 30s. They work long hours and study in their off-hours. They have little time to develop social skills. Their social skills often stop developing when they enter medical school. By the time they are asked by the healthcare organization to take a leadership role, they will have bridged some of the social skill gap, but it is very likely that there are still some socialization skills that are significantly lagging.

Conflict management is a skill that the physician leader may have practiced with patients but more often than not, the physician speaks and the patient listens with little opportunity for conflict. However, the need for this skill is unavoidable in any leadership role. The physician leader must be able to deal effectively with diverse personalities and cultural backgrounds. He or she must be able to find the root cause of the disagreements and reach compromises that will be accepted by all. To do so, the physician leader must demonstrate that he or she is impartial, trustworthy, and capable of resolving the conflict.

In today's complicated healthcare environment, physicians need more than clinical and leadership skills—they also need business development skills. Physician leaders must work to gain the trust and referrals of the primary care doctors who are only loosely connected to the hospital and also use business development skills to recruit other physicians.

Finally, the physician leader must be the advocate for the highest quality of patient care for both the individual physician and the medical staff. He or she must be able to critique care with other physicians without being punitive, unless there are chronic problems. There must be an understanding of evidence-based medicine and he or she must be able to evaluate the quality of the measurement statistics that are provided. Improving quality of care and evaluating the need for new technology are probably the most important aspects of the physician leaders' job, especially as pay-for-performance becomes more prevalent.

Physician leadership strengths

Physicians do, on the other hand, possess some very positive characteristics that they bring to the leadership table. They typically have high self-confidence and are accustomed to making tough, even life or death, decisions. These decision-making skills are a great benefit to any leadership role. At Executive Development Associates, working with executives across medium and large organizations, we have found that this is often an area of development for even the most senior members of the leadership ranks.

When the physician is widely respected for clinical skills, he or she will be even more effective with other members of the medical staff. Doctors have a unique respect for other doctors, and no matter how great a leader an administrator becomes, without the clinical credentials there will always be a gap between the administrator and the medical staff.

Regardless of their grandiose mission statements, hospital missions are primarily to care for ill patients and restore them to good health. Physician leaders understand what needs to be done clinically. They are able to prioritize the development of clinical services and requirements for new technology and typically they are also very adept at alerting the management team of the clinical consequences of business decisions.

Physicians also use time efficiently. They are usually more interested in conserving time than in processing ideas. This can be a strength and a weakness for the physician who is operating in a leadership capacity. Maneuvering through political minutia can sometimes take more time than a physician leader is willing to give.

Acquiring the necessary skills

Fortunately, physicians are accustomed to continuing education, so taking classes and working to learn leadership skills is not a barrier. The physician leader will need additional leadership skills to be a contributing member of the management team.

Ultimately, physician leaders must understand the gap in their skills and be willing to invest in their leadership growth and development with such activities as:

• 360-degree surveys feedback to identify skill gaps
• One-on-one coaching
• Conferences
• Development programs
• Formal degrees

Leadership development takes an investment in time and effort with significant trial and error along the way. The physician leader role is rather unique and is best served with a combination of learning and development opportunities that are tailored to meet the individual physician's circumstances, ultimately creating physicians who are excellent leaders as well as excellent clinicians.

Charles Saunders, MD, is vice chair of the St. Luke's Allentown Hospital Board of Governors and serves as a trustee of the St. Luke's Health Network Board in Bethlehem, PA. Bonnie Hagemann is CEO of Executive Development Associates, Inc.