If doctors were trained in leadership, the entire health care system would benefit

Leon E. Moores: ©Leon E. Moores

If we can agree that leadership means influencing behavior to achieve a desired result, then it becomes obvious that all doctors are acting as leaders in many different health care environments.

But as I see it doctors aren’t formerly trained as leaders or even taught about the importance of leadership — i.e., Influencing behavior to achieve a desired result— in their daily work. Leadership training is not a standard part of medical school curricula.

This gives us an opportunity to change that paradigm. Medical education can absolutely prepare doctors for the challenges of being a leader — starting on the first day of medical school. Additionally, leadership development can be a cornerstone of each physician’s professional development throughout their career. In a future state where every physician is educated and trained in fundamental leadership skills, the entire health care system would reap the benefits — nurses, technicians, administrators, finance departments, HR professionals, and doctors themselves. But the chief beneficiary would be patients.

Leadership is a core competency – and should be taught as such

As a core competency for physicians, leadership is just as critical as clinical skills. Influencing thought and behavior is essential to achieving desired results in patient care. Leadership connects directly with the Accreditation Council for Graduate Medical Education’s (ACGME) six core competencies, encompassing all of them, either directly or indirectly​.

Therefore, we have an opportunity to teach leadership as a core competency for all physicians. Leadership involves a complex interplay of professionalism, communication skills (especially listening skills), cultural sensitivities, etc. And we are not necessarily born knowing these things. Fortunately, leadership is a learned skill. It can be improved through study of the theory and practice of leadership and through practical exercises and feedback.

We owe it to our medical students and residents to: 1) be explicit that they have a role as leaders in the healthcare environment, and 2) prepare them to lead in various environments as members of multidisciplinary teams under high levels of stress, including the responsibility for people’s lives and well-being.

But medical students and residents typically acquire leadership skills only in an ad hoc, inconsistent way. Students may gain some leadership experience through observation and even extracurricular activities, but this is largely unstructured and varies widely between institutions and individuals. The lack of intentional, cohesive, progressive leadership development leads to gaps in physicians' ability to lead effectively within health care systems.

Setting standards and getting oversight bodies on board

In visualizing how leadership should be taught in medical school, consider presenting it as foundational, much in the same way we teach physiology, pharmacology, or how to tie a surgical knot. I believe we should recognize that influencing thought and behavior to achieve desired results is a critical enabler of physician success numerous times each day, and we should build a foundation in how to accomplish that.

A physician who is a less effective leader is a less effective doctor. If you don’t start thinking about leadership until you’re 50, you’ve lost a huge opportunity to gain that mastery.

My personal vision is that we develop a set of standards for the leadership aspects of a physician’s training. Eventually, this set of standards would be adopted and refined by the oversight bodies that guide physicians’ careers, such as the Liaison Committee on Medical Education (LCME), the American Council on Graduate Medical Education (ACGME), and the American Board of Medical Specialties (ABMS).

These bodies have prescriptive authority. They can say to medical schools and training programs, “This is what you need to be teaching and practicing,” and can work with these entities over time to ensure that all doctors have a common training in a fundamental leadership skillset.

Standardization would benefit healthcare system leaders, as they would know that newly hired doctors possess a base level of leadership competency, much as they now know that all doctors possess a base level of clinical competency. Every physician will have been thinking about leadership, doing self-assessments, undergoing 360-degree assessments, and refining his or her leadership skills for years. The organization can then build on that base set of competencies to further develop the physician leader.

Advancing the leadership conversation

That is the vision. But we are a long way from seeing that as a reality. I have no illusions that such a change will happen overnight. The medical establishment changes slowly. Incorporating structured leadership training into every medical school and GME program can take decades.

Implementation should aim at codifying a set of base-level skills that can be generally agreed upon as a good leadership foundation for all doctors. In the meantime, let’s advance the conversation. Let’s start addressing leadership topics at conferences and symposia. Let’s get to work within our own organizations to develop in-house standards for physician leadership. Let’s start creating leadership curricula and sharing it with other institutions and organizations. Let’s start developing courses, implementing them, and measuring results. Let’s start assigning leadership coaches and mentors to doctors in our system.

Doctors should be trained in how to lead themselves, other individuals, and teams. Those who show interest and potential should be further trained in organizational leadership. Medical schools can lead the way in establishing the conviction in young physicians that they are leaders — that they have influence and impact every day — and igniting the desire to be trained as such. By linking leadership skills to the improved performance of health care teams and better patient outcomes, schools can change the current culture in which student doctors relegate “soft skills” to the back burner as they focus on clinical training.

Realistically, we can’t take hours of instruction away from core clinical courses. Nor would we want to. So, the trick is to find places in the curriculum where we’re already teaching “leadership-like” topics and to organize and revamp that material in a more cohesive and powerful way.

Once medical schools are doing this, residency training programs, physician practices, and healthcare systems can build from there. The leadership curriculum should never end. Everyone in medicine should ideally continue to seek and receive leadership training and feedback throughout their careers.

Doctors who know how to truly lead make a difference

Doctors are leaders, whether we recognize it or not. Our only real choice is whether to embrace our leadership role and commit to doing it to the very best of our ability. Or not.

Great physician leaders exude a presence. They bear themselves with confidence, but not cockiness. They look people in the eye. They listen to their patients, absorbing everything they’re saying — and not saying. They treat colleagues warmly and respectfully. They speak with directness but also with compassion and sensitivity. They welcome questions, invite feedback, and are always trying to improve. They address doubts and uncertainties. They strive for consensus.

That kind of leadership presence has a direct bearing on the way patients commit to treatment and the way colleagues rally together as a team. Don’t doubt for a second that it affects patient outcomes. It does.

If you are a physician, you should want to be the kind of leader who inspires people through your words, your actions, and your presence. And if you are in health care management, you should want to have a staff full of physicians who possess this kind of leadership ability.

My hope is that medical school deans, residency and fellowship program directors, health care administrators, and leaders of physicians’ societies feel inspired to work together and take up the cause of teaching better leadership skills to physicians. In doing this, we will enrich the future of medicine, create higher-performing health care teams, and improve patient outcomes.

Dr. Leon Moores (allphysicianslead.com), author of All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes, is a West Point graduate who was commissioned as an infantry officer in the 82nd Airborne Division. Moores earned his MD from the Uniformed Services University (USU) School of Medicine and his Doctor of Science in healthcare leadership from the University of Alabama, Birmingham. He has served as Chief of the Department of Surgery at Walter Reed Army Medical Center, Deputy Commander (SVP) of the National Naval Medical Center Bethesda, Commander (CEO) in Fort Meade Medical System, and CEO of Pediatric Specialists of Virginia. A practicing professor of pediatric neurosurgery, he most recently served as the president of the largest medical group in northern Virginia. A sought-after speaker and consultant in physician leadership, Moores was twice the Army Surgeon General physician leader of the year, has been designated “Top Doctor” by Washingtonian and several Virginia magazines, and has been awarded citations from the governors of Maryland and Virginia.