Physicians have the potential to be great leaders of health-care organizations. Yet, the path from the clinic or hospital to the c-suite or boardroom remains lightly travelled.
In fact, the physicians who do brave that first step into one of those early healthcare leadership roles, say medical director or department chair, often find the leap much tougher than they expected. It can be a tremendous letdown when, after having experienced career success as a clinician, they can find themselves feeling both ineffective and unhappy as a leader.
What I’ve learned in my own sometimes challenging transition from practicing internist to Chief Medical Officer to now CEO, is that there’s great untapped potential for those who choose to make the transition. However, there’s usually not enough support and mentorship to bridge the divide between clinician and leadership roles.
The few doctors who do end up in leadership roles often struggle because they do not know how their own strengths and weaknesses line up with leadership. There is often a fundamental mismatch between the skills and mindset that served them well as clinicians and those demanded by their new role.
That’s a shame, because physicians have many skills and personality traits that can make them among the best, most well-rounded healthcare leaders. They have a true understanding of the intricacies of patient care, which combined with operations and business acumen allows for a potent leadership mix. Indeed, there’s evidence that hospitals run by physicians perform better than those that aren’t. Doctors also tend to possess several personality traits—conscientiousness, emotional stability, and extroversion—that correlate to good leadership.
That said, physicians need to have more self-awareness about the ways in which some of their traits, training, and experience can hinder rather than help their effectiveness as leaders. The following are four challenges of the physician-to-leader transition that I’ve discovered the hard way during my own journey from practicing physician to CEO.
Think of it as the things I wished someone had told me long ago.
Risk aversion. One of the guiding principles for doctors from medical school onwards is “first, do no harm.” As physicians, we’re discouraged from taking risks or practicing outside of clinical standard of care. No patient wants to hear that their doctor is going to try out an experimental new surgery to remove their appendix. In leadership roles, however, strategic planning or change management requires an appetite for risk and an acceptance of the negative consequences that could result. Physician leaders who aren’t able to break out of their ingrained conservatism can end up paralyzed by an unwillingness to take necessary calculated risks.
The checklist mindset. Doctors succeed in patient care by being task-oriented. They often work through checklists for specific scenarios to ensure they don’t omit steps, any of which could make the difference between life and death. In medicine, every detail matters. As a leader, though, it’s an approach that will make you miserable and ineffective. Leaders need to prioritize a small handful of crucial tasks and delegate responsibility for the rest—trying to do too much can often, paradoxically, result in fewer goals actually being met. This aspect of the transition from clinical practice can be shocking, as I discovered firsthand. As a doctor, I was encouraged, rightly, to keep my focus as narrow as possible, so that nothing would come between me and the care I offered each patient. As a leader, I suddenly had to face the prospect of managing thousands of moving parts that defied my prior checklist approach. The expansiveness of my duties was overwhelming, up until the moment I accepted that part of my job was to delegate many tasks and leave even more, lower priority tasks simply undone.
Authority vs. influence. Doctors get results by being authoritative and decisive. The whole clinical system revolves around physicians’ usually unquestioned decision-making. But that approach doesn’t translate to the corporate world. A leader is suddenly AN expert among other experts, instead of THE expert. As a chief medical officer or CEO, being authoritarian will, in the long run, lead to bad decisions and staff departures. Unlike a doctor, a CEO can’t be the owner of the truth. A good leader’s authority instead comes from influence. As a chief medical officer, for example, I had to oversee a controversial change in policy on blood transfusions for anemic patients. The doctors, reflecting their risk-averse instincts, were reluctant to lower the established threshold for fear it would result in bad outcomes. Even though I felt that the change was warranted, my challenge was to avoid any lingering authoritarian instincts that might have caused staff rebellion and instead harness data and rational arguments to influence the shift in protocol, rather than force it.
Short-term mindset. The nature of their job means that doctors are overwhelmingly focused on acute issues, the here and now. This conditioning makes it hard for doctors to take the kind of long-term, telescopic view of the world that is needed in leadership. For an organization, it’s crucial to have a forward-looking strategy with a multi-year vision of where the business is headed. For doctors, that’s not always a default setting. But for those making the transition to leadership, it needs to be.
Four short bullet points won’t totally prepare you for a change as substantial as providing care in a hospital or health system to helping to run one. My hope is only that younger physicians with leadership ambitions, or those already in management roles, can start to see the need to find the right support and advice to rise to the challenges they will face.