Some Reflections on Training Physicians, both as Caregivers and Leaders:

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I initially trained as an obstetrician and then as a high-risk maternal fetal medicine specialist. I did that for a number of years and really got a lot of satisfaction out of improving the lives of patients. But early in my career I got an opportunity to also take a leadership role in not only providing direct patient care, but creating systems and policies and procedures and cultures that provided the best possible care for hundreds, if not thousands, of patients.  It was a a career changing opportunity for which I will always be grateful.  What I learned in the process is that I’m just as happy to be one step removed and in the background making it all work seamlessly and improving the lives of many without necessarily being front and center and being the one who receives the thanks from the patient individually. So, I found that this can make an even bigger impact by putting some of the analytic skills and problem solving skills that I developed over time to really improving the lives of not only patients but also faculty and staff. I think that if I had to describe myself, it would be as somebody who makes sure things get done and things get done properly for the benefit of everybody, including the patient, but also the team because you have to take care of the team that provides the care so that they can provide the best care.
Most of us in academic medicine take great joy in sharing our "wisdom" with medical students.  I like to think the advice I give to those who have chosen to work with  the sick is a bit unusual, but extremely practical (click the link for video):




So, what to I tell physicians contemplating a leadership role?   First off, is that you’re never prepared for any job. At most, if you are really making a career leap, you will have about 65% of the skills required to be successful.  What you need  to do is  A) have confidence to rise to the challenge and  B) be willing to say “I don’t know” and be able to learn in real-time. That’s been the case every time that I’ve had a leadership role, from being the chief operating officer of the five hospital system to the chief operating officer of USF Health. You learn the role by  keeping your mouth closed and ears open, enforce upon yourself a period of observation, and  then you work to improve the environment you find yourself in. (click the link for video)


Finally, no discussion on training leaders would be complete without a mention of change and change management.  Here, I absorbed  quite a bit during my training in Six Sigma while at Yale, and the main thing I realized is that physicians usually just focus on half of the equation:



ge-change-managementcap-6-638     As scientists at heart, most physician leaders spend an awful lot of energy on the technical side of the equation.  They work hard until they have a Eureka! moment and the best  solution. They look at it from every angle to make sure it is as perfect as it can be.  Then what do they do next?  Younger leaders, yet to be burned, start rolling it out immediately.  What happen as a result--usually not what was expected--sometimes things even get worse.  Why is that?  We tend not to focus enough on the acceptance or engagement of the solution.  For physicians especially, if they don't have a voice in the change and hadn't had a hand in crafting it, the solution becomes something done to them rather than something accomplished with them. It is therefore essential to have a deliberative and collaborative process mapped out all along, and don't be afraid to have some nay-sayers on the team---you may be surprised at how quickly they come around when you meaningfully ask their opinion.  Once this is done, approach your implementation with care.  Socialize it well.  Change is scary for people, and for those firmly entrenched in a way of life or a way of doing things, change can be terrifying.   Though rare, some may go to great lengths to subvert your efforts, and personal attacks may be one of the weapons you will need to fend off.  Keep in mind though, that if you aspire to be a physician leader, this is the life you have chosen.  The road with be filled with some triumph, but surely with some bumps along the way,  But the people training  and mentoring you, and especially the patients, are counting on you to persevere.

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