A Good Doctor, but Not Such a Good Leader

As an executive coach working with physician leaders over the past 25 years across several medical specialties, I’ve noticed a pattern that differentiates physicians who thrive as leaders from those who don’t. Hint: A lack of intelligence is never the problem.

One must understand that physicians, by virtue of their training to become “good doctors,” undergo a multiyear shaping process called medical education. (Some would argue that this shaping begins long before medical school.) Very smart individuals are rewarded for being competitive, certain, and decisive; for standing alone; for knowing the answer; and for asserting their opinions. They take on a heroic identity that is all consuming—one that society typically has held in godlike awe. This is what we have traditionally asked of our doctors here in the United States, and in many ways we still do.

But when these “good doctors” move from clinical roles to leadership roles, they find themselves needing to learn a whole new set of skills and, more importantly, a whole new way of thinking, being, and relating. If they don’t, they are apt to struggle as leaders, typically causing waves of dysfunction all around them.

What is the differentiator between the terrible physician leader and the phenomenal one?

There are many versions of how a “terrible physician leader” presents, as anyone who has worked in healthcare can describe. There also are many versions of “phenomenal physician leadership” that equally come to mind.

What is the differentiator between the terrible physician leader and the phenomenal one? I’ve noticed that there are eight traps that otherwise “good doctors” fall into, preventing them from developing into the phenomenal leaders they could be.

Trap #1: Ignore the importance of building self-awareness.

Self-awareness is a critical foundation for great leadership. When leaders don’t care or don’t realize the impact that their words, behaviors, and actions have on others, they look either ignorant, arrogant, or just plain mean. Physicians who have learned to rely solely on their intellect and clinical skills do so at the expense of developing the finer skills of self-awareness and emotional intelligence. The fact is, being the world’s best surgeon, dermatologist, or pediatrician by itself adds nothing to you as a leader. Self-awareness will.

Self-awareness requires two points of focus:

• A curiosity about your impact on others, and a willingness to be vulnerable enough to seek and take in feedback from others to shore up your blind spots; and

• An appetite to inquire deeply about and explore your inner landscape—how you are wired, what makes you tick, your innermost assumptions and beliefs, what your hot buttons are and why.

Truly phenomenal physician leaders know that, much like ongoing exercise builds aerobic capacity, ongoing exploration in both realms of self-awareness builds leadership capacity and effectiveness.

Trap #2: Reject the role of novice, learner, or less than “expert.”

For many physicians, embedded in their sense of identity is the idea that they are smart, competent, in control, and expert. It’s a comfortable place for their egos to rest. This makes it especially uncomfortable to be in situations where you fumble, don’t know, feel out of control, and are uncertain. For some, this state is so psychologically painful that they can’t embrace being a novice, a learner, or someone who who’s experimenting with new unknown things that lie outside their zone of comfort and competence.

The problem is, we grow from stepping outside our comfort zones and into the realm of the uncertain and unpredictable. Leadership proficiency is built and evolves through practice and reflection, along with inevitable failures, struggles, feedback, and learning. It can’t be learned just from reading a book. When you can embrace the discomfort of publicly being a novice, you’re able to be vulnerable enough to take risks, challenge your own assumptions, ask for feedback, try new behaviors, and, as a result, grow as an authentic, relatable leader.

Trap #3: Rely on behaviors/attitudes that made you a good doctor.

Behaviors, attitudes, and ways of approaching issues that you honed in medical training may in fact derail you as a leader. As I’ve mentioned earlier, that which makes you successful as a doctor is very different from that which makes you successful as a leader.

What are some of the shifts that phenomenal physician leaders are able to make? These shifts include:

• From knowing to wondering;

• From competing to collaborating,

• From standing alone to standing together;

• From directing to empowering;

• From telling to asking; and

• From operating from a place of advocating for one’s own point of view to one of genuinely inquiring about another’s point of view.

Perhaps the most essential skill shift is being able to listen deeply to others with the intent of understanding their perspectives, instead of hearing others only so that you might prove your own point. And the most essential mindset shift is moving from a place of fear (e.g., of losing control, of losing power, of being marginalized, of not having a voice) to a place of creativity, trust, and willingness to optimistically co-create the future alongside nonphysicians.

Trap #4: Assume you know what’s expected of you as a leader.

Some physicians have the idea that leadership is about being “the go-to guy” with the decision power to solve problems. Period. They accept leadership roles assuming this is true, and never probe further to understand what is really being asked of them. The problem is that this is an outdated caricature of what it means to be a leader, and it sets you up for having a tail-chasing, distracted, and chaotic impact on your organization, with a high likelihood of failure.

Highly effective physician leaders get clear on the scope, demands, expectations, and priorities of a leadership role before they take it. They know that if they don’t understand that, everything will seem equally important, and it will be easy to get distracted by the many pressing problems that will come their way. They are not enchanted by the myopic allure of being “a powerful problem solver” within their own fiefdom, but, rather, see that they are part of a larger whole to which they contribute collectively with others. To that end, they recognize the importance of understanding who their stakeholders are (e.g., Dean, CEO, EVP, Chairman, practice executives) and what they care about and find important. As with lining up GPS coordinates for an ongoing journey, highly effective physician leaders continue to take in data from multiple key sources as they move forward toward collective goals and the greater good.

Trap #5: Don’t make time for “leadership.”

Being part of “leadership” is more than attending a routine leadership meeting or holding a title, although some physicians approach their leadership role as only that. Perhaps distracted by more familiar roles of researcher and clinician or lured by the belief that “I must be clinically productive to be credible,” many ineffective physician leaders fail to set sufficient time aside for actual leadership.

Highly effective physician leaders continue to take in data from multiple key sources as they move forward toward collective goals and the greater good.

Effective physician leaders know that leadership takes time—to reflect, plan, meet with people, gather perspectives, and focus on their own development. And to attend, prepare for, and contribute to leadership meetings in meaningful ways. They schedule time to engage in these activities, considering leadership time to be as important as their clinical time.

Trap #6: Cling to a narrow physician identity.

The multilayered “doctor identity” is very strong for most physicians and is, in fact, a core essence of their being that remains long after retirement from clinical work. (I’m reminded of my father-in-law, a former surgeon, who wanted his medical degree hung alongside family pictures in his tiny assisted living quarters. During his final weeks, in and out of consciousness, he was frequently seen working his hands as if conducting a complex and careful surgery. In the end, to most of those who surrounded him, he was always “Doc.”) Perhaps more than any other profession, the sense that “I am what I do, I am my profession” prevails for physicians, and along with that comes a myriad of nested beliefs, assumptions, and sense of self and others that can be firmly fixed and difficult to shift.

How does a narrow physician identity potentially impact one’s leadership? First, it constrains the array of behaviors one might exhibit because you tend to fall into Trap #3, relying on the behaviors that make you a good doctor. Second, it constrains you into typical physician worldviews, such as seeing the world as “scrubs vs. suits,” “doctors vs. administrators,” or “us vs. them,” which undermines leadership team effectiveness, and the way systemic problems are framed and solved. And finally, the belief that I am credible only if I do clinical work sometimes drives medical executives to spend an inordinate amount of time seeing patients, at the expense of making time for leadership (see Trap #5) or focusing on more strategic issues.

When leadership is approached as a team sport, an environment of high trust is created.

Do physicians need to abandon their physician identity to be effective leaders? Not at all. They need to learn to expand their identity beyond that of a traditional physician to include a larger identity—as an organizational leader, a person driving broader objectives and viewpoints, a curious and compassionate actor in a larger play with multiple differently talented actors. In this expanded world, there is no “us vs. them.” There is just the larger and more complex whole, the greater good, the more complex view of the world within which being “right” or “all-knowing” is a dangerous stance to take. Being able to see (and hold) multiple perspectives is essential to make this shift, as is the ability to see the systems (and systems within systems) that are at play in any given dilemma.

Trap #7: Fail to recognize that leadership is a team sport.

Physicians who approach leadership as an individual sport are rarely effective for long, if at all. This stance may have gotten them through medical training with great success, but when serving as a leader, it creates a toxic and highly political environment. When one takes a competitive stance towards others, and focuses on short-term self-interest and personal gains, an atmosphere of collective mistrust and interpersonal dysfunction sets in. Time and energy are wasted on petty conflicts, political positioning, and second-guessing “what’s really going on.” Results, if achieved, typically are mediocre and short lived.

On the other hand, when leadership is approached as a team sport, an environment of high trust is created, because energy is directed toward collaboration, understanding, tapping collective wisdom, and going for the greater good. Such leaders pay attention to where others are coming from, where others are headed, and how they, as leaders, might help their team members succeed.

Feedback, both positive and negative, is highly valued to keep improving both individual and team performance. Team members don’t gossip, complain, or second guess team decisions with outside audiences. When decisions are made in the team, although not all may agree, all unreservedly support the decision publicly.

Trap #8: Pursue a leadership role for the wrong reason.

There are many wrong reasons for pursuing a leadership role, all of which act as a drag on effective leadership. When physicians are questioned about why they aspired to a particular leadership role, those who are less effective typically offer reasons such as, I wanted to have the power. I wanted to be in the know. I wanted control. I didn’t want anyone else to have the role or be the leader of me. I didn’t want that guy to get the role, so I pursued it. The most popular “wrong reason” among physicians? I wanted the title, as a mark of my achievement. And that’s all.

What are the right reasons to pursue a leadership role? I am passionate about this organization and want to do all I can to help it succeed. I want the challenge of working together with these colleagues to help move this organization forward. I really love getting people aligned around a big idea and inspiring them to achieve more than any of us ever thought possible.

Conclusion

Those who avoid all eight of these common traps are physician leaders who:

1. Pursue leadership for noble reasons, not selfish ones.

2. Practice leadership as a team sport.

3. Keep building their self-awareness as a lifelong practice.

4. Don’t have to be the best at everything. They allow themselves space to be novices and learners.

5. Expand their skill set and mindset beyond that which made them good doctors.

6. Recognize the pull of their physician identity and consciously work to expand their identity beyond those limits.

7. Get aligned with others on what their leadership role entails and what’s expected of them as an organizational leader. They don’t assume.

8. Set aside time for leadership, beyond time spent attending leadership meetings.