As described by Dr. Peter Angood, “All physicians are considered leaders…at some level,”(1) and “routinely face adversity.”(2) Going further, although physicians do face such situations, they also share attributes of the heroic figure.(3) Some of these traits include the notions of self-sacrifice, protection, honesty, selflessness, determination, and saving others.(4) And yet, strangely enough, despite these attributions, physicians sometimes fall short of becoming the best leader that they can possibly be. Whereas heroes protect the weak at enormous personal sacrifice, this is not synonymous with leadership. With nearly 1 million licensed physicians in the United States and 80% of those still practicing clinical medicine, the number of formal physician leaders is still relatively small given the grand pool of talent.
The Hero’s Journey Begins
Early in the education of young physicians a great deal of attention is paid to the basic principles of the biomedical sciences, such as anatomy, physiology, disease, and the like. This is followed by time spent absorbing and honing the basic skills of history taking, physical examination, and disease management during their rotations and clerkships. Finally, upon graduation, these young physicians are ready to proceed to the long years of training ahead. Along that journey, the young physician is seeking to establish his or her competencies and to absorb all the requirements of the profession. It is not unreasonable, therefore, to find that so few physicians find themselves ready to jump into an overt role of physician leader upon conclusion of their post graduate work. Rather, most physicians go about displaying their acquired leadership quietly. For example, a surgeon in an operating room is naturally the default leader of the surgical team, regardless of whether he or she is a department chair or head of surgical services. The emergency room physician is the leader in the exam room when a patient arrives in extremis requiring immediate attention and resuscitation, whether or not he or she is the CMO of the physician group providing the very same ED services. These physicians may display hero-like attributes (saving lives without displaying personal suffering)(5) but will certainly have to rely on their professional training and experience in order to navigate the myriad complexities of the human condition.
Mentorship harkens back to the apprentice style of learning.
Much of the journey after admission to medical school is a series of apprenticeships in order to obtain the highest possible competency and skill set to practice the art of medicine. These well-trained souls follow in the footsteps of those who went before them in all of their experiences, discoveries, and awareness of the human condition. One after another for the better part of the 20th century, and now in the early parts of the 21st century, physicians are taking their hero’s journey into the mysteries of human health and disease.
Stretching Beyond the Journey into Uncharted Territory
What has happened in healthcare recently has tested even the most learned and most experienced physicians. The quantity and amplitude of rules, regulations, requirements, electronic record keeping, financial pressures, resource limits, third parties, and ever-increasing amount of medical knowledge, to name just a few (not to mention the haphazard and frustrating responses to the COVID-19 pandemic) have risen to such heights that even the most battle-tested physicians are finding themselves in uncharted territory and searching for novel ways of managing so many competing priorities. Where does a physician leader turn when his or her compass is swirling and there is a whirlpool just ahead? Or, better yet, to whom does he or she turn? Classic medical education places the responsibility on the learned physician to act and to lead in such a way as to be the single pilot in an airplane, charting course, direction, and speed in order to arrive safely at the intended destination.
Setting Course
Physician leaders often are appointed into formal roles either by default or through a proxy. In the former (i.e., default), a seasoned, well-regarded physician who has earned the respect of peers is asked to take on some sort of directorship role in addition to their clinical practice. Although this may seem reasonable from a clinical perspective, if that individual lacks any formal training in administration, management, much less leadership, the results of such an appointment may be suboptimal. In the latter (i.e., proxy), a physician may bring some additional credentials or certificates (e.g., MHA, MBA, MPH) that serve as a proxy to gain entrance into leadership or the requisite Director experience. That physician is then asked to step into a role such as Vice President of Medical Affairs, Chief Medical Information Officer, or Chief Medical Officer, to name a few. If the health system supports leadership development programming, either externally or internally, such Directors or Chiefs may be asked to participate in leader development—appropriately so, given the limited leadership teaching and instruction provided during medical training.
With or without a formal leadership development program, healthcare organizations will have physician leaders in place to manage and drive particular goals of importance to administration, such as within a service line (e.g., quality outcomes, growth and adoption of new services, supply chain efficiencies, and vendor device management) or within a clinic (e.g., patient/customer experience, schedule management, behavioral concerns). Those same desired results are undoubtedly equally important to the dyadic administrative leaders in those areas. When physician leaders are struggling to manage all of those added non-clinical responsibilities on top of their already busy patient care duties, who else might they turn to beyond their collaboration with administrative partners? This is equally true of the roles (beyond typical medical directorships) that encompass even broader scope and responsibilities, such as Chief Medical Officer, Chief Quality Officer, and Chief Clinical Officer, many of whom are required to develop new initiatives that bring value to the organization. When such responsibilities seem to stretch those leaders, to whom do they turn to for insight or guidance? In traditional medical education, physicians are used to learning directly from a seasoned attending physician, so it would seem only natural that in healthcare management, that role could be filled by a physician mentor who has previously served in such positions.
Beyond Leadership Development
Most physician leadership programs are built to enhance the traditional management skills of individuals, especially with regard to traditional models of finance, negotiation, influence, and so on. Some programs focus more on elevating a leader’s abilities of self-awareness and the awareness of others (i.e., emotional intelligence, empathy, psychological safety), with fewer directing energy toward the ability to lead entire organizations. A quick Google search of “physician leadership program” will allow any executive a chance to explore multiple offerings in order to tailor a program to the system’s immediate needs. However, given the ever-increasing forces of nature that are swirling in front of physician leaders, these traditional models of physician leadership programming may be inadequate in getting the physician leader to full potential. Additionally, newly minted physician leaders are being stretched and run the risk of burning out, threatening the sustainability of the advances made by the programs that generate nascent physician leaders. One response to these concerns may be the development of a mentorship program, specifically one directed at physician leaders. Whereas broad leadership programs try to set forward the principles of leadership and the tools by which to perform its responsibilities, a mentorship harkens back to the apprentice style of learning that is so familiar to the physician trainee. A physician leader mentor serves as someone who teaches or gives help and advice to the less experienced person. More specifically, a mentor can bring real-life experiences and contextual history into a relationship with an aspiring leader in order to frame the principles and tools by which the physician leader can effect substantive change in his or her scope of work.
Why Go Beyond?
Healthcare today is undergoing significant change and faces many disruptions. Organizations routinely set forth short- and long-term strategic initiatives in order to succeed in their mission to deliver care. Much of that strategy work is done at the level of senior management, whereas administrative leaders are required to operate within their structures and available resources in order to reach the strategic goals. When new physician leaders are informed of goal setting, metrics, and other measures of success, they often face challenges when asked to participate in the organizational strategy, because they may still be on the learning curve. Leading teams in the OR or ED does not necessarily equate to leadership in the executive conference room when attempting to align multiple physicians, administrators, and support teams in order to achieve a desired result.
When leadership development alone falls short, are there other ways to bring value back into the organization via investment in the physician leader?
It is incumbent upon administrative leaders, such as practice managers or business development directors, to support their physician dyad partners and provide them with the needed tools and resources to be successful. Because most of the physician leadership roles described in this article are paid, as either part-time or full-time, therefore representing a cost to the organization, administrative leaders should be asking those same physician partners to help facilitate ways to offset their stipends, either through reducing inefficiencies and undesired costs or by increasing revenue. But when leadership development alone falls short, are there other ways to bring value back into the organization via investment in the physician leader?
Mentorship as Leverage to Lift All Boats
Unlike a dedicated physician leadership development program, a mentorship program is a smaller, more focused program designed to enable new or seasoned leaders to develop their abilities even further and to reach new levels of competence. This, in turn, can lead to higher value for the organization, because the mentored leader can now foster stronger growth, more focused initiatives, or any other key priorities. Mentorship can be tailored even more to individual leaders in order to help them grow into future roles or to determine if such a leader has reached a plateau in his or her contributions to the organization. Unlike executive coaching, which tends to focus on the metaphorical “tools in the toolbox,” mentoring provides a different development pathway. According to Johnson and Ridley, “mentoring relationships are dynamic, reciprocal, personal relationships in which a more experienced person acts as a guide, role model, teacher, and sponsor of a less experienced person.”(6) Unlike coaching which can incur significant cost, mentoring typically is either free of expense, or costs very little compared to hiring an executive coach, and does not require a significant drain on the mentee’s time, which is a valuable commodity. These features are particularly attractive because administrators may find that resources are scarce for such additional programming.
Basic Program Elements
To begin a physician mentoring program, the identification of both a current physician leader (with or without an administrative dyad partner) to act as champion of the program is desired, along with at least one senior physician leader—most often one who is retired or semi-retired—who can begin the program as lead mentor. If selected carefully, the lead mentor is a natural teacher, displays empathy, is someone with the desire to “give back,” and has the time and energy to provide mentoring. The program champion(s) should meet with the lead mentor and ask if that individual will act in a mentor role (with clear intentions set forth and agreed upon) and will generally abide by standard mentor principles, as outlined by Brad Johnson, PhD, professor of psychology at the U.S. Naval Academy (Table 1). If a small stipend is agreed upon, it should be nominal and far below the cost that would be incurred by hiring professional coaches. In preparation for the mentorship program, the champion(s) should deliberate and map out the following: the number of mentees to be involved (no more than six, and preferably just three to four to start), along with operational structure (Table 2) and desired results (Table 3) in order to demonstrate its value to those who authorize such programming. If proven to be successful, the program can be expanded to make physician mentorship available more widely, and to become self-sustaining within the organization—not just for physician leaders, but for other groups as well (Table 4).
Observations Along the Journey
One such mentorship program, that started in late 2021, is still evolving and expanding at the time of this writing, but early observations have yielded some clear findings. Physician mentees involved in the program have been more expressive about their future pathways and more deliberate in their choices, such as whether to pursue areas of expertise (e.g., quality and safety roles, informatics), advancing executive roles, or business degrees, to name a few. This has led to further development of untapped potential talent of the expanding physician leadership corps in order to better lead teams within the organization. Mentees have displayed more satisfaction and engagement with the organization as a whole, in part because the one-on-one attention paid to them by mentors makes them feel more supported and more connected to the organization. The mentees developed a greater knowledge base about their role in the larger matrix of the system, which also contributed to their feelings of being connected. Mentors offered longitudinal perspectives about organizational life that otherwise might not have been appreciated by mentees. Casual conversations with various stakeholders (e.g., clerical staff, ancillary staff, administrators) suggest that the physician mentees are more inclusive and more open-minded (perhaps best stated as “less bossy”) and more pleasant to interact with than they were prior to the program. Several physician participants have remarked that their desire to remain within the organization has increased, which ought to assist in the retention of these physician leaders. It has been observed that the mentees convey a new appreciation of the system to other physicians, both in the physician lounges and on interdisciplinary rounds. This type of connectivity and stability in the physician leadership team may yet translate to the broader physician enterprise, in either greater engagement or greater retention. The former supports the direction of the organization, whereas the latter conveys a highly desired benefit, because attrition and turnover of physicians is very costly for any system. Likewise, executives have shared their own (anecdotal) similar observations that the physician mentees are playing a renewed part in assisting in the larger aims of moving the system toward its intended direction as a result of greater clarity of expectations, roles, cooperation, and, perhaps, trust. All health systems desire to increase the platform of trust between the physicians and the rest of the organizational sphere. Many systems benefited in this regard from the crises of COVID-19, but there also is a cautious optimism that additional trust has developed between the mentored participants and the overall organization in response to the early phases of this particular program. Finally, several physicians have commented to their mentors that the experiences of both leadership development programs and access to mentors have resulted in a greater sense of well-being. Although this has not yet been fully explored, it doesn’t take too much imagination to consider that having a mentor watch, listen, and reflect on life can nourish the intrinsic forces of the evolving physician leader.
References
Angood P. All Physicians are Leaders. Washington, DC: American Association for Physician Leadership, Inc.; 2020: 1.
Angood P. All Physicians are Leaders. Washington, DC: American Association for Physician Leadership, Inc.; 2020: 37.
Terrell GE. Reframing Contemporary Physician Leadership. Washington, DC: American Association for Physician Leadership, Inc.; 2022: 81.
Kinsella E, Ritchie T, Igou E. Zeroing in on heroes: a prototype analysis of hero features. Journal of Personality and Social Psychology. 2015;108(1):114-127.
Terrell GE. Reframing Contemporary Physician Leadership. Washington, DC: American Association for Physician Leadership, Inc.; 2022: 81-82.
Johnson WB, Ridley CR. The Elements of Mentoring. New York: Palgrave Macmillan; 2004: xv.