Leadership skills are not formally taught in medical school. The best opportunity to lead during the training process is during residency, when the young physician leads teams of medical students, interns, and junior residents. Many residency programs are now recognizing the need to address the gap in leadership training as medical care is transforming into “care team models” comprised of attendings, nurse practitioners, physician assistants, and a variety of other support positions.
Corporate culture matters. How management chooses to treat its people impacts everything—for better or for worse. — Simon SinekBefore you are a leader, success is all about growing yourself. When you become a leader, success is all about growing others.— Jack Welch
Leadership skills are not formally taught in medical school. Getting into medical school is an individual effort, and academic success, scores on the MCAT, and further testing through the USMLE Step exams largely determine whether a student can successfully navigate the process of becoming a physician. It is mostly an academic exercise. It remains a solid truth that the hardest part of becoming a physician is simply getting into medical school. Once in, the system is designed for students to succeed.
The best opportunity to lead during the training process is during residency, when the young physician leads teams of medical students, interns, and junior residents. I vividly recall senior residents who did a great job and, conversely, those who did not. Many residency programs are now recognizing the need to address the gap in leadership training as medical care is transforming into “care team models” comprised of attendings, nurse practitioners, physician assistants, and a variety of other support positions.
Because medical training mirrors military leadership and training, authority and leadership are based on individuals’ training status as they progress. Academic success and excellent clinical skills are not necessarily strong foundations for leadership and effective team management. This does not mean physicians in general are not good leaders, but most young physicians lack the experience and training to lead because that is not the focus of medical training. With no formal program, young physicians who are motivated to learn how to lead more effectively often have to carve out this path on their own through mentors, formal coursework, workshops, or self-study.
Many physician leaders recognize the glaring gap in our training; we are more effective leaders through formal training and education. Over the last two decades, physicians have been obtaining MBAs, MHAs, MMMs, and a variety of other degrees and formal leadership certificates, including the CPE through the American Association for Physician Leadership and the FACHE through the American College of Healthcare Executives.
In 2019, for the first time, the number of employed physicians has exceeded those in private or solo practices. Many physicians, unfamiliar with corporate business structures and processes, are frustrated as their autonomy and practice environment have changed. I highly recommend graduate degrees, courses, and certificates for all physician leaders. The opportunity to network, share ideas, and learn the business side of medicine sets leaders up for success and the opportunity to discuss difficult scenarios and situations with other physician leaders.
How is effective leadership defined? I don’t believe it is possible to truly define leadership with a single sentence or word, but we know good leadership when we see it or read about effective leaders within a historical context. From a purely corporate perspective, effective leadership leads to increased productivity, profitability, market share, or business growth. Physician leaders are in the business of governing and managing others who provide a service within an organization. Good physician leadership includes these characteristics and behaviors:
Strong ethics and high moral standards.
Effective, timely communication.
Outstanding self-organizational skills.
Lifelong learning and development.
Commitment to nurturing growth in others.
Connections and positive inclusive relationships.
Effective team building.
In healthcare, effective leadership leads to financially strong organizations with excellent patient safety records, growth, and capacity to adapt to change through agile, flexible responses to ongoing stresses, both external and internal.
There are many leadership styles; each one has advantages and disadvantages.
Democratic leaders empower others and involve all stakeholders, including frontline staff, in many of the decision-making processes. They seek input and value individual opinion. A disadvantage of this style is the time necessary to seek input and analyze the qualitative and quantitative data.
Ultimately, the decision for an action plan is the responsibility of the leader, but “paralysis by analysis” is a potential stumbling block. The time constraints put pressure on performance and potentially slow progress. Effective democratic leaders are able to switch gears and use different styles, depending on circumstances.
This is one of the least-effective leadership styles. These leaders often make unilateral decisions without seeking input from staff or colleagues. A path to disaster, this leadership style disempowers employees and can lead to high turnover, low morale, and decreased productivity. It is impossible to maintain a hegemonic culture using this style.
This leadership style is exactly what the name implies: a “hands-off” style that empowers nearly every employee. A major advantage of this style is the degree of empowerment that allows for individualistic style and input; however, without reasonable deadlines and frequent “check ins” on progress, one team member can delay a project, and the leader is ultimately responsible. For this style to be effective, the leader must hold employees accountable.
Because it leads to rapid innovation, start-up companies often benefit from this approach, but as the company or organization matures, this style can be less effective as processes require standardization and uniformity in service or product delivery. In healthcare, this style is especially beneficial because physicians, for the most part, value their independence and autonomy.
Strategic leaders sit at the interface between maintenance of operations and growth opportunities. This style is highly effective in healthcare when organizations seek to improve quality of care while growing through service-line development.
Strategic leaders seek opportunities and are keenly aware of internal and external circumstances that affect organizational performance. These leaders can incorporate characteristics from other leadership styles and quickly adapt to new situations. Those with charisma are often seen as visionary or future-oriented.
Transformational leaders identify goals and tasks for employees and set expectations for organizational performance. Transformational leaders are change agents, seeking to improve existing processes through increased efficiency.
A distinct advantage of this leadership style is pushing employees to go beyond their personal limits and learn new skills for a growth mindset. Employees who are not self-directed can be frustrated by this leadership style.
Transactional leaders reward employees for their work. Traditionally, these leaders may offer performance bonuses for meeting production or safety goals, which is somewhat effective; however, a major disadvantage is that the “bonus” structure can encourage employees to do the minimum amount of work required to reach predetermined metrics.
Physician performance or quality bonus payments, for example, are commonly used “carrots” to encourage increased productivity. Once physicians have reached a metric, however, such as volume expectation, they may not have an incentive to work above and beyond this “floor of performance” unless they are rewarded.
Daniel Goleman’s book Primal Leadership suggests that a coaching style of leadership may best describe the qualities of the quiet leader. “The coaching style is the least-used tool in the leader’s toolkit,” Goleman says, “probably because it doesn’t look like leadership.”(1) Quiet leaders achieve breakthroughs by asking guided questions rather than by giving orders or advice. What better way to empower your team?
In 1947, Max Weber first described the bureaucratic leadership style, in which an organization is highly regulated and controlled through a top-down approach, with the leader strictly enforcing rules and an established hierarchy. It is an ineffective way to lead a healthcare organization. By focusing on rules and regulations, these leaders lack the flexibility and agility to adapt to rapid changes, both internal and external.
Servant leadership is perhaps the oldest style of leadership, and it encompasses a broad range of positive attributes, attitudes, and behaviors. Literally, this leadership style means to serve others, which fosters and encourages growth in subordinates; creates a positive, inclusive team atmosphere; and contains a baked-in ethical philosophy of selflessness, honesty, and integrity. Servant leaders possess the following traits:
Strong decision-making skills. The servant leadership philosophy emphasizes people’s needs. Good leaders use their knowledge and experience to make a conscious choice to benefit the business or company, and it may not always be an easy choice; however, a strong servant leader isn’t afraid to make an unpopular decision or offer critical feedback when necessary.
Emotional intelligence and self-awareness. A high degree of emotional intelligence gives servant leaders the capacity to take perspectives and experiences of others into account in the decision-making process. They listen to understand. They understand the impact of their decisions, both good and bad.
Sense of Community. Building community is important for colleagues and coworkers, especially in a shared team environment. Creating a sense of community requires a foundation of cultural trust and a sense of belonging.
Foresight. Servant leaders use their past experiences to inform their expectations about the future. They think and plan ahead and predict the likely outcomes or consequences of potential actions. Servant leaders also know when to follow their instincts based on the knowledge they’ve gained over the years.
Ownership. Servant leaders take ownership and acknowledge errors or poor decisions.
Of the many leadership styles, the servant leadership style is best-suited for physicians because it incorporates attributes good physicians already possess: the capacity to listen and empathize with others.
Your leadership style will have an impact on your performance, others’ perception of your leadership capabilities, and most importantly, your relationships. Effective leaders are capable of switching gears and using the best traits from each style, depending on the context or situation.
Several tools are available to help you assess your leadership style, and I encourage you to use them. The AAPL has an online assessment tool you can complete; the results provide an analysis of your strengths and weaknesses. I also recommend hiring a leadership coach who can formally assess your style and recommend strategies and exercises to overcome your weaknesses and maximize the potential of your strengths.
Goleman D, Boyatzis R, McKee A. Primal Leadership: Unleashing the Power of Emotional Intelligence. Boston: Harvard Business Review Press; 2013.
Excerpted from Physicians and Professional Behavior Management Strategies: A Leadership Roadmap and Guide with Case Studies by Matthew J. Mazurek, MD, MHA, CPE, FASA.