Review the many personal attributes − from professionalism to manners to self-awareness − that shape leaders and allow them to shine.
No one would argue that to be an effective manager, a physician needs a keen eye for details and numbers. Knowledge of accounting, finance and quantitative-based decision sciences are considered prerequisite for managing health care systems.1
But don't be fooled into thinking that "hard skills" alone are sufficient for job success. Today's competitive job market means that minimum acceptable skills are being replaced with higher standards. Among the higher standards are what many call "soft skills" − the cluster of personality traits, social graces, facility with language and personal habits that mark each of us to varying degrees. A review of the careers of executives who have failed to acquire appropriate soft skills reveals they have been tripped up by everything from business meal blunders to lapses in judgment. Maybe they had one too many at the previous evening's cocktail reception, or perhaps they thought their idea was so brilliant they didn't have to tell their boss − instead they took independent action or went right to the CEO or board chair. Those individuals may have been business savvy, but they probably lacked the soft skills essential for leading and managing people.
Health care leaders are placing equal or greater emphasis on soft skills over more traditional clinical, technical and business skills. It's a given that high-ranking physician leaders are usually experts in their specialty and have business talent. Soft skills, on the other hand, may be conspicuously absent. They are difficult to teach − some would argue they're innate − and they're even harder to measure. Contrary to popular belief, the number of connections you have on LinkedIn is not a true measure of your soft skills.
The ability to develop and use soft skills can help land outstanding job offers and lead to job success. Let's examine what I consider to be the five most critical soft skills for physician leaders:
In medical school, many of us learned procedures by the classic "see one, do one, teach one" method. And they called that leadership.
Although there is no universally accepted definition of leadership, or even general consensus on what constitutes the most effective style of leadership, it is widely recognized that great leaders possess traits in common such as wisdom, compassion and a high level of energy.
In the aftermath of 9/11, then-New York City Mayor Rudy Giuliani was named Time magazine's Person of the Year. The tribute read: "for having more faith in us than we had in ourselves, for being brave when required and rude where appropriate and tender without being trite, for not sleeping and not quitting and not shrinking from the pain all around him."
This is about as good a definition of leadership as I have come across. It describes someone who is capable of rescuing people from the brink of personal tragedy and crisis, and creating a life-affirming vision of the future. In detailing his own principles of leadership, Giuliani observed that leadership is a privilege, but it carries responsibilities − organizing around a purpose, hiring the best people for the job and ensuring they work as a team, taking calculated risks, and articulating and acting on strong beliefs and being held accountable for the results. Giuliani also weighed in on the nature/nurture controversy. He commented, "Leadership does not simply happen. It can be taught, learned, developed."2
Today's physician leaders work in Fortune 500 companies, health insurance companies, investment banking firms, integrated health systems, hospitals, software firms, medical schools, pharmaceutical companies, medical research organizations, all branches of government and the military. It is important to learn from them by examining the leadership challenges they have faced and by evaluating how they have dealt with those challenges at different points in their careers.
Unfortunately, for physicians who are early in their careers and interested in medical management, exposure to bona fide leaders in medicine may never occur, or it may occur serendipitously. Obtaining advice from female physician leaders may be especially difficult, because in many organizations the "glass ceiling" still thwarts the careers of many women leaders in medicine.3 Therefore, early career physicians may require a professional coach to help them develop personal strategies that allow them to assume positions of authority and influence in the future.
It is essential for managers to communicate their thoughts effectively to others. That is why so many job postings for physician leaders ask for candidates with strong written and verbal communication skills. As a group, however, physicians operate with considerable autonomy and have a unique style of perception and communication based on their psychological disposition − for example, as measured by the Myers-Briggs Type Indicator (MBTI), a personality assessment based on Jungian psychology.
In fact, the personalities of physician leaders may be the polar opposite of nonphysician leaders.4 In addition, over time, as physicians gain experience in management, their personalities may change. I first took the MBTI in 1994. At the time, I had just entered business school, and I had limited management experience. I took the MBTI again in 2012. To my surprise, I had become more "intuitive" and "feeling" in my personal interactions and less "sensing" and "thinking." My MBTI type was representative of someone who helps people see new possibilities and has a clear vision of how best to serve the common good, a vision no doubt shaped by working many years in the industry in diverse medical management positions. Apart from leading to a better understanding of oneself, the MBTI can create awareness of the essential psychological differences between physician leaders and nonphysician executives. This information can be used for devising strategies to optimize clinical communications and strengthen relationships between physicians and administrators. A large part of communication involves collaboration through teamwork. Thus, team skills have become an important part of medical practice and management. Accountable care organizations were predicated, in part, on the assumption that team-based health care delivery will produce consistently high-quality care. A team that is dysfunctional may result in policies and practices that compromise the quality of care.
According to Patrick Lencioni, author of The Five Dysfunctions of a Team,5 team members must also learn to trust each other, resolve conflicts, make commitments, accept accountability and focus on results. There is nothing that an individual can do that an effective team cannot do better.
It is important to act in a professional manner at all times, but it is especially important when there is intense competition for health care positions at the executive level. It seems that recruiters like outgoing, friendly, well-adjusted physicians more than those with great qualifications but less acceptable soft skills. Mary Frances Lyons, a physician and executive search consultant, states, "In search work, we are constantly exposed to differing levels of professionalism. There are professional MDs and there are less professional MDs. High levels of professionalism are strong contributors to career success, as it is the major determinant of how those around a person perceive and work with the person."6
Lyons defines professionalism in many ways; for example, by doing what you say you are going to do, showing up for important functions, keeping sensitive information confidential, speaking well of others and taking responsibility for your mistakes. Admitting mistakes and accepting blame while offering an apology signifies a high level of professional behavior and earns the gratitude of those around you.
Lyons asserts, "If you really want to be professional and perceived as such, there is an easy way to keep track of what to do. Whatever would make you feel the best if you were at the other end of the interaction, do that. In other words, 'Do unto others as you would have them do unto you.' "
Jane Jerrard, a medical writer based in Chicago, Illinois, observed, "Your physical appearance − the image and demeanor you present in your work environment − plays an important role in your career. If you aspire to a leadership position or are looking for a new job, be sure to examine your outward style as carefully as you craft your curriculum vitae."7
Body language, style, attitude and general deportment are an extension of your appearance. Simply put, you must look the part and appear "corporate," even if your employer has adopted a business-casual dress policy or you typically wear surgical scrubs instead of a suit. Physicians, by virtue of their specialty or work environment, may be insulated from traditional office dress attire, but they are not immune to the basic standards of workplace decency and appearance.
It is important to listen and be open to other people's opinions and suggestions. Otherwise, you may appear to be close-minded or, worse yet, a know-it-all. Listening can be a challenge for physicians who tend to be authoritative and dominate conversations. The balance between how much to say and when to stop talking can reveal much about your emotional intelligence and ability to connect with people. A welcoming attitude, sincerity to others and a pleasant demeanor can bolster your career path.
Etiquette codifies behavior by delineating expectations for appropriate social behavior in contemporary society. Physicians are expected to exhibit proper etiquette in all aspects and places of their work, whether the boardroom, the cafeteria or the water cooler.
Basic expectations include:
- Address people by their name using courtesy titles, such as Mr., Mrs. or Ms.
- Establish and maintain eye contact.
- Always be polite and courteous.
- Arrive at appointments on time, or at least giving advance notice of possible lateness.
- Hold the door for others behind you.
The point of etiquette rules is to make people feel comfortable rather than uncomfortable.
Granted, etiquette does not always put people at ease. Dining etiquette typically causes anxiety, because the rules may be complex or unclear. However, table manners play an important part in making a favorable impression. They are visible signals of the state of our manners and therefore are essential to professional success. Jobs and even the careers of physician leaders may unravel at business dinners. Common mistakes include ordering expensive wine, ordering finger food, using incorrect utensils, talking with food in your mouth, eating loudly, slurping and burping, and answering your phone at the table. (Switch your phone to vibrate, and if you must take or make a call, excuse yourself from the table and step outside.)
Network etiquette, or netiquette, pertains to rules for online communication, including social media. Cyberspace has its own culture, and there is something about cyberspace that makes it easy to forget you are interacting with real people. You might offend people without meaning to do so. Or you might misunderstand what others say and take offense when it's not intended.
In medicine, online miscues have had serious consequences, including breaches in patient privacy and violations of company policies governing confidential information. I knew a physician who used the company computer to send salacious emails to facilitate an extramarital affair. In doing so, the physician compromised the integrity of the company, and the physician's employment was abruptly terminated.
Most organizations have policies describing principles for online behavior and other standards of conduct. Make sure you are familiar with them, because companies can and will monitor your email and use of social media.
Inappropriate use of social media can also spur action by U.S. and state medical boards. Nearly three-quarters of state licensing boards have investigated physicians for violations of online professional standards. Among 48 executive directors of state medical and osteopathic boards, there was high consensus that any of the following situations would lead to an investigation: citing misleading information about clinical trial results, using patient images without consent, misrepresenting credentials and inappropriately contacting patients.8
Finally, given that health care is a global concern, it is important to become familiar with international business and dining etiquette. The failure to adjust to foreign etiquettes may result in awkward situations and the loss of existing business or potential business opportunities.
Physician leaders need to master a variety of soft skills as described in Table 1. Here are a few points to consider:
Pay attention to your manner of dress and grooming. You only have one chance to make a good first impression. Make sure you dress appropriately for job interviews and for the job setting.
Learn the basics of public speaking. Take a speech communications course or join a local Toastmasters group. Practice your telephone skills. Make a video recording of yourself giving a presentation.
Engage people. Practice your approach in greeting them. Look people in the eye. Smile and offer a firm handshake, but not one that is painful.
Practice the art of conversation. Become well-versed in current events and topics other than medicine. Attend book clubs and community discussion groups. Join your local ethics society.
Maximize your leadership potential. Clearly communicate your vision and achieve buy-in of your ideas. Motivate people to do their best. Display your ability to multitask.
Enter long-term strategic relationships. Expand your network and increase your sphere of influence. Learn to manage conflict and change. Negotiate issues fairly.
Tackle tough situations head-on. Be a problem solver. Establish stretch goals. Be honest if you fall short. Be upfront with everyone.
Keep taking initiative. Volunteer for projects. Help get things done. Take calculated risks to be noticed and get promoted. Learn how to read people and adapt your style to them.
Be grounded and humble. Don't forget the reason why you're a leader and the purpose of your leadership. Maintain selfawareness at all times. Don't let success inflate your ego. Each day, take time to remember your purpose and roots.
Clearly separate your personal life from your professional life. Do not use company computers and mobile devices for personal matters. Exercise good judgment. Protect confidential and proprietary information. Respect the privacy of yourself and others.
Always be polite and courteous. Respect the opinions of others. Try and develop consensus. Never compromise your ethics. Do the right thing!
Now, ask whether you need to acquire new skills or improve existing ones.
Arthur Lazarus, MD, MBA, CPE, FAAPL, is medical director for Cigna Group Insurance, adjunct professor of psychiatry at Temple University and an editorial board member for the American Association for Physician Leadership. This article was originally published by AAPL in 2015.
- Hillman AL, Nash DB, Kissick WL, Martin SP. Managing the medical-industrial complex. New England Journal of Medicine, 315(8):511-3, Aug. 21, 1986.
- Giuliani RW. Leadership, New York, NY: Hyperion, 2002.
- Lazarus A. Breaking the glass ceiling. Physician Executive Journal, 23(3):8-13, May-June 2007.
- O'Connor SJ, Shewchuk RM. Enhancing administrator-clinician relationships: the role of psychological type. Healthcare Management Review, 1993;18(2):57-65.
- Lencioni PM. The Five Dysfunctions of a Team. San Francisco, CA, Jossey-Bass, 2002.
- Lyons MF. Nine ways to project professionalism. Physician Executive, 30(1):50-51, Jan-Feb. 2004.
- Jerrard J. Appearance counts. The Hospitalist, March 2009.
- Greysen SR, Johnson D, Kind T, Chretien KC, Gross CP, Young A, Chaudhry HJ. Online professionalism investigations by state medical boards: first, do no harm. Annals of Internal Medicine 2013;158(2):124-130, Jan. 15, 2013.