Leaders as Physicians: Back to Basics
Article Outline
EDITOR’S NOTE: Leadership development and the related issue of leadership behaviors are major priorities for our departments, medical schools, and affiliated institutions. This article is a departure from our usual format by offering the very personal reflections of a highly respected, experienced, successful senior leader from our field. Our reviewers acknowledged the value of this unique perspective for both current and future leaders.
—Paul H. Dworkin, MD
Much has been written about physicians as leaders in academic medical centers. The proliferation of physician leadership positions has resulted largely from the demands of increasingly complex health care systems. Many articles on physicians as leaders focus on preparing physicians to become interdisciplinary team members, to understand shared leadership with other professionals, and to master skills to manage major fiscal responsibilities with multimillion dollar and, sometimes, even multibillion dollar budgets.1, 2 The literature may be quiet on the many other skills that physician leaders possess from years of medical training and experience that will aid them in leading not only the clinical domain, but also educational and research programs and fundraising.
Two experiences that I had as Chair of a medium-size department of pediatrics and, subsequently, as acting Dean of our medical school catalyzed my thinking about leaders as physicians and why physicians (pediatricians in particular) are well-prepared to lead when they use the familiar medical model with its well-honed values, skills, and traditions.
During my time as Chair, a colleague referred to the position as “administration.” However, most of us who perform major administrative responsibilities identify more closely with the role of physician-pediatrician than with that of administrator. When I was acting Dean of our medical school, a faculty member asked why I wore a white coat. He assumed that Deans did not see patients and were acting only as “administration.” We discussed that one of the major responsibilities of the Dean was training and mentoring young people in all the medical school’s training programs. Further, in taking on this role, I believed that the Dean must be a physician-role model for our young doctors-in-training and, for me, that meant wearing a white coat for all my duties within the medical center. These two short conversations, although taking place when I was in different positions in the medical school, crystallized my thoughts about leaders as physicians.
What are some of the unique values, skills, and traditions that physicians, particularly pediatricians, possess that will strengthen our ability to be leaders? We have only to review the Hippocratic Oath to consider the professional values we promised to honor, no matter what our professional role.3 Our profession’s core values of dignity, integrity, and respect for each person with whom we interact are the same values that outstanding leaders possess. When leader physicians are grounded in those principles throughout their careers, then their moral compasses will not waver, no matter what immediate pressures they face.
As leader physicians, we are trained to interview, to observe behavior, to communicate with others, to seek further information, to honor confidentiality, and to be a presence for those for whom we are responsible. In addition, pediatricians are well aware of family dynamics, including sibling rivalry, which comes in handy in academic medical center administration, and the impact of the environment on outcome, particularly the effects of stress on well being.
As much as we do in clinical settings, as administrators we listen to our colleagues’ concerns, observe nonverbal behavior, provide feedback, speak with others to gain more insight of issues, and secure additional information as needed. We do this with utmost confidentiality and discretion. As doctors are known to their patients and available to them, so are the best leader physicians known to their colleagues and available to them.
The well being of each individual is central to our mission. We will best serve the greater good by trying to become familiar with the individuals in our constituency, which is not limited to the physicians to whom we may have specific responsibilities, but also includes the nurses, the staff, and the families and children of our colleagues. Taking a sincere interest in their well being and that of their families (and sometimes even their pets) is often appreciated by colleagues.
Another tradition from our medical model that I found useful in both administrative roles was “rounding throughout the department or the medical school” twice a week—a modification of rounding at the bedside or ambulatory-side. These “cruise-and-schmooze rounds” included unplanned visits to departmental faculty/staff members’ offices when doors were open, occasionally to the senior faculty in other departments, to the pediatric inpatient floors to talk with patients, families, house staff, students, and staff, to the laboratories to visit investigators, and to discuss issues with the faculty and colleagues. We quickly learn what works and what doesn’t within the area of our responsibility. Albeit time-consuming, this professional-personal, spontaneous interaction can be satisfying to both the leader and the colleagues. Leaders learn first-hand what their colleagues are thinking. Additionally, our colleagues are in their own settings where they feel most comfortable, much in the way a house call accomplished the same objective in days gone by. This process can keep the leader physician grounded.
Today’s leader physicians need many skills to manage their changing and complex areas of responsibility (eg, departments, medical schools, medical centers). This article focuses on the personal attributes of leader physicians that may facilitate the enjoyment of being a pediatric Chair. Other skills that are important to the success of modern academic medical leaders include the ability to develop financial strategies to keep their departments solvent, an understanding of human behavior, especially the complex behavior of stressed or depressed adults, and insight into how one’s behavior as a leader physician affects one’s colleagues. Courses on management of departmental finances, medical school finances, or both, courses on adult behavior and its effects on others, particularly the larger group, and faculty development courses/experiences help some leader physicians become more facile with the practical skills demanded in complex administrative positions.
When leader physicians stay close to their medical roots, however, then leading can be very satisfying. When one views oneself as purely an administrator, as was implied by my conversations with my colleagues, then there may be less enjoyment of the leader physician role. As a Chair, one can easily be overwhelmed by trying to achieve excellent care of every child, to keep laboratories funded, to keep faculty progressing without getting discouraged, to garner enough resources such as space and dollars, and to plan for the future.
We should not forget that we are pediatricians, first and foremost, and our training as physicians and pediatricians can be applied to major leadership roles.
References
- . Developing physician-leaders: a call to action. J Gen Intern Med. 2009;24:876–878
- Training the next generation of physician-executives: an innovative residency pathway in management and leadership. Acad Med. 2011;86:575–579
- . Hippocratic Oath: text, translation, and interpretation. Baltimore: Johns Hopkins Press; 1943;
PII: S0022-3476(11)00666-4
doi:10.1016/j.jpeds.2011.06.039
© 2011 Published by Elsevier Inc.
