Physician Leadership and Physician Culture

Future shock...the shattering stress and disorientation that we induce in individuals by subjecting them to too much change in too short a time.

Alvin Toffler (1928), Future Shock

To say physicians are undergoing cultural change is an understatement.    To say this change represents “future shock” in an overstatement.

Nevertheless, among physicians, the need for cultural change is profound. This change requires adjustments in thinking about clinical, management, and leadership affairs.  It requires changes in thinking about individual physician performance and collaborative physician performance.

Traditionally, physicians have handled complexity by specializing, mastering individual clinical/academic skills, and celebrating this mastering.  Physicians have shown a disinclination for followship and collaboration.   We stand on our own two feet and nobody else’s. 

We have focused on clinic/academic performance rather than organizational leadership.  We have been inattentive to training and preparing for leadership.   Our general attitude has been that every physician puts on his/her pants the same way, and you cannot and indeed, should not, differentiate leaders from followers.  In short, to paraphrase George Orwell, all animals are equal,  and no animal is more equal than the others.

But medical  trends,  they are a ‘changing, as  Tim Norbeck and Walker Ray,  MD,  president and CEO of the Physicians Foundation respectively,  pointed out in a January Forbes  article,  “Four Critical Trends Physicians Must Keep Top of Mind in 2016.”  

These trends are :  1) evidence-based regulation; 2) health insurance market consolidation; 3) value-based care, 4) physician leadership.  We cannot escape them, and we must collaborate to cope with them.

Physician leadership calls for an understanding of leadership skills more than management or technical clinical skills.  It demands  a whole new mindset.   The Physicians’ Foundation knows this, and so do a growing number of physician organizations and MBA programs,  who have set up physician leadership development  programs for addressing and overcoming  cultural and administrative barriers,  for  quality and performance reporting and measurements,  for  adapting to  ICD-10 coding,  and for coping with  the pressures of a rapidly changing health system  requiring collaboration rather than individualism.

Leadership is a vast and amorphous subject.  Most of us know leaders when we see them, but leadership is a slippery subject to pin down. 

Leadership takes personal, organizational, innovation, and teamwork.   

Leadership takes a clarity of purpose,  strategic vision,  building trust and credibility, persistence  when challenged by obstacles, political savvy,  a positive attitude,  praising and recognizing emerging leaders,   self-confidence,  formal education or experience in management and leadership, and that elusive trait known as charisma.   

Leadership  takes disciplined passion,  big ideas of where the future lies,  seizing opportunities,   creating a new organizational bandwagon,  a comprehensible  defined strategy,  and  knowledge of  your limitations  and the strengths of others. 

Leadership takes building an effective team, developing a measurement system to know how one is doing, and knowing what is of value to patients and what they need.

Leadership  takes honesty,  delegating  to others, commitment, communication, a positive attitude, creativity,  intuition,   inspiration,  and a flexible approach when things go wrong.  

None of these things are safe and easy to do, but they are what physician leaders must do.