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Novice leadership


One physician's first "real" job of residency was at a small clinic serving a mostly active-duty Army population.

My first "real" job out of residency was at a small clinic serving a mostly active-duty Army population.

Building on a successful strategy I had mastered in residency, when I first came to my new clinic assignment as just one of the doctors, I tried to establish friendly working relationships with the other clinical staff. This strategy worked well, and I enjoyed the camaraderie of working with a family-like group of medical assistants and administrative staff.

Thinking through the situation, I realized that the problem must be a general lack of morale. The war was gearing up, everyone was stressed, times were uncertain. The clinic staff must be struggling like everyone else on the base, I thought. If I could improve morale, maybe their job performance would improve as well.

I started a weekly all-staff meeting. During these meetings, I listened to the long litany of complaints, from those about the lack of department-level support for our small, outlying clinic to those about the miserable condition of the break room. I took their concerns to my supervisors and even spent a Saturday morning at Target shopping for bright and cheery kitchen- and tableware to brighten up the break room. I came up with a celebration of our clinic's namesake and threw a party, inviting leaders from the hospital to join us for cake. I put pots of flowers around the entrance way (the Army is decidedly toned-down in terms of ambience). I lobbied for new furniture and paint. With an open-door policy, my office was a frequent stop for disgruntled clinic staff.

Things did not substantially improve. Although the clinic staff members thanked me for the break room decorations, commented on the lovely plants, and sighed sympathetically as I explained how hard it was to get new furniture for our clinic, many continued to exhibit poor job performance. Mid-afternoon bowling continued.

Then, I thought, it must be that I am not being a good-enough Army officer. They didn't respect me. So I started doing physical training with my non-commissioned officers. I wrote and distributed more policies and procedures (the Army loves policies and procedures). I spent extra time shaping my beret and shining my boots.

Despite these changes, the complaining continued. Each staff meeting, I was met with frowns and crossed arms as the clinic staff stared back at me with a mixture of defiance and pity.

I was at a loss for what to do next. After one particularly frustrating staff meeting, I was crying tears of anger and frustration in my office. What did I need to do to get through to these people? Why didn't they have any pride in their job? What was I doing wrong? In walked a senior officer who had experience as a clinic officer-in-charge. She heard me out and then offered some advice.

"Listen, you are the officer-in-charge, and you need to establish that. If they don't like the job they are being paid to do, let them go elsewhere and help them get there," she advised.

She was right. I was expected to demonstrate leadership in this position, and all I was doing was trying to be popular and well-liked by the people I was responsible for leading.

Things changed with the very next staff meeting. I started by acknowledging the general unhappiness.

"I realize that over the past several months, many of you have been unhappy with aspects of working at this clinic. It is frustrating to deal with many of the issues we have in front of us," I said. "I have tried my best to advocate for you and fix what I can. Despite all of this, I have failed to motivate you to show up for work on time, do the necessary components of your job, or to have a good attitude at work. Therefore, I am inviting you to transfer to another clinic at the hospital where you think you may be happier. I will do everything in my power to facilitate your transfer."

Silence greeted my carefully rehearsed speech. I continued.

"If you do choose to transfer, please let me know where you are interested in applying, so I can help you make that move. However, if you choose to stay, my expectation is that you will show up on time, not leave before the end of the workday, not abuse your break times, and do your job well," I said.

I next asked for a show of hands of who was interested in making the transfer. No one volunteered. I invited anyone who changed his or her mind over the next few days to let me know.

"Otherwise, I am assuming that you are choosing to stay and work here," I said. "So I am no longer interested in general complaining and discontent. I remain willing to work on specific problems or concerns you have."

I concluded the meeting feeling unburdened and in charge of both myself and my professional responsibilities. No one ever approached me about arranging a transfer.

This situation, the first of many challenges I have experienced as a medical director, served as a valuable lesson to me. I discovered that popularity would rarely be my reward but that I could earn respect. I learned that there is a careful balance between my responsibilities as a leader toward those I lead and their responsibility to me. Additionally, I realized that it is almost never a good idea to court friendship with subordinates; it is difficult to obtain and nearly impossible to maintain.

As I continued in clinic leadership, first at this small clinic and later at a larger, hospital-based clinic, this meeting became an important catalyst in my professional development. I remain committed to effecting necessary and specific change but keep myself (mostly) impervious to the explicit and veiled threats of complaint and discontent by staff members. I like to think that I have grown up enough to prefer being respected to being liked.

The author is an assistant professor of family medicine at the University of Wisconsin (UW) and the medical director of the UW Health Fox Valley Family Medicine Residency Program, Appleton. Send your feedback to medec@advanstar.com

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