Challenges We Face As Physician Leaders

As a practitioner and writer about physician leadership, I’m sometimes asked to recount leadership challenges I’ve faced in my own career. There have been many, and they’ve been wide-ranging in nature. As I think back on how I handled those challenges, though, one consistent theme emerges. Successful solutions almost invariably began with a look in the mirror. Rather than simply pointing fingers at others, I try to take ownership of the problem.

I’ll offer two short examples from different points in my career. The first occurred when I was a practicing physician without a designated leadership role, and the second occurred when I was in a formal leadership position.

As you know, if you follow my writing, I believe all physicians are leaders, and this first leadership challenge occurred when I was leading as a young neurosurgery resident. In the hospital where I worked—true of many hospitals at the time—there was antagonism between the surgeons and the administrators, as well as between the surgeons and the nurses, and sometimes between the surgeons and other doctors. By contrast, I had a prior tour as an infantry officer in the 82^nd Airborne Division, where we were accustomed to working cooperatively with folks of many different ranks, disciplines, and backgrounds to accomplish our missions.

As a very junior doctor, I walked into this conflict-rich healthcare environment and said to myself, “Well, this is interesting. Folks can cooperate in training for the battlefield, but less so in a healthcare system where healing is our mission.”

It was clear that historical norms in neurosurgery were, in many ways, facilitators of the antagonism. But I was one of the most junior people on the team. Speaking up would likely be ignored or frowned upon.

I realized one thing I could do, however, was—to borrow a phrase associated with Gandhi—be the change I wanted to see. And so, I decided not to feed into the antagonism. In my interactions with other physicians, with nurses, and with administrators, I consciously strove to avoid that “us versus them” mentality and to treat everyone appreciatively. Over time, this approach played out in a positive way. I noticed changes happening, and even some of the senior folks began to soften their attitudes. I had no real power in that setting. My influence came simply from embodying the change I wanted to see.

A different kind of leadership challenge, which I’ve faced from time to time in my organizational leadership roles, involves the promotion of team members. I tend to like and trust people and see their best sides first. But no one is ever truly ready for their next job, and so, choosing someone for a higher role in an organization always involves a certain amount of faith and guesswork. I’ve erred in this choice more times than I would have liked, selecting someone I thought would be a great fit for a role and later discovering they were not.

What do you do, as a leader, in this situation? You’ve tried mentoring and coaching to no avail, and now you’re faced with the challenge of telling someone they’re not right for the job, which might include letting them go or “demoting” them. The easy temptation, and the course some “leaders” choose, is to place the blame on the person who is not measuring up. “You disappointed me, and you’re failing at x, y, and z.”

But that approach is simplistic and can be destructive to the morale of the individual and the greater team. I try to remind myself that I played a major role in the failure. After all, this person was performing admirably in their previous job. I selected them for this promotion based on my judgment. I encouraged them to accept the new role. And so, when I sit down with the person, I might say something like, “Hey, we pulled you out of your comfort zone because we thought you would be good at this next level, but you know what? You’re a great clinical doctor, and it’s clear you don’t enjoy this extra administrative burden. Let’s get you back to doing what you do exceptionally well, which is taking care of patients. I think we’ll all be happier that way.” Of course, the conversation takes longer and is more compassionate than this, but you get the concept.

This approach softens the blow and appropriately distributes the responsibility for the mismatch.

I believe most leadership challenges can be resolved more favorably, and with less conflict and pain, when the leader looks in the mirror before taking action.