Physician Leadership? The experts tell us how Part 2

Thoughts and ideas from The Physician Executive
Physician Leadership? The experts tell us how Part 2
November 28, 2017 at 12:00 AM
by The Physician Executive
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I continued my conversation about physician leadership with Jennifer Perry, a principal at FMG Leading and Dr. Matt Brubaker, CEO at FMG Leading, in Part 2. [here is Part 1 if you missed it]

Philippa: You’re making a pretty compelling case for why physicians need to be in these leadership roles and perhaps even need to be leading organizations. What’s in the way of developing effective physician leadership?

Jennifer: There are many factors. For most physicians, their career path hasn’t given them the level of experience or exposure to take on the role of leader and look at all the dimensions that are required to robustly lead a business, not just deliver medicine. That’s one piece. And the schooling that physicians have had doesn’t lend itself to a longer strategic perspective and/or a broader team collaboration. Having an inquiry perspective is critical for leaders, as opposed to knowing and having the answers which is how physicians are trained to function. The mindset is very different for business business leaders, and this lack has made it difficult for physicians to navigate those experiences and be highly effective.

What would you add, Matt?

Matt: It’s a long view and a long process, and so it’s a hard thing to fix with a class or a course or a coach. By the way, we certainly enjoy and appreciate the opportunity to do all of those things. But the reality is this is a strategic development opportunity along the career path and entire life cycle of a being a physician. We’ve seen no organization doing it excellently across the entire enterprise. Those who are making headway or are ahead of their peers tend to be thinking about focusing on physician leadership relatively early on, rather than as a remedy saying, “Hey, we’ve got a doc and we’ve just given she or he a really huge business responsibility. Can you help them learn everything they need to know about that?” That’s obviously a Band-aid approach. We’re really advocating for a more strategic, intentional career path development model.

Philippa: Can you elaborate on that? How do you believe that this deficit of physician leadership should be addressed?

Jennifer: There are several ways to address the gap. In our article, we refer to building a physician leadership pipeline, as Matt said, with the intention of identifying what roles different physicians can have throughout their careers that prepare them for increasing responsibility as leaders. This would include different experienceswith gradually increasing responsibilities. In our article, we have looked at that from a physician leader perspective — what are those different roles, and what’s that ladder, in terms of how physicians can take on responsibility and gain experience as leaders? How can they successfully build capacity to lead ever larger organizations or groups?

Matt: The process of preparing for a medical career is so exhausting, and in most cases, being a doctor is linked to either a sense of identity or sense of purpose. There’s a sense of calling. “This is what I do AND it’s who I am.”And the thought of giving that identity up, giving up clinical work to take on a leadership role at some point, whether now or in the future, can be an existential crisis for many of the physicians we worked with. There are, however, many development opportunities where physicians don’t need to give up their identity. The perception that “I’ve become a corporate person or I’ve become an executive rather than doing what I care about and believe in”can be interrupted — sort of have your cake and eat it too, because, in our experience, it’s a relatively small number of physicians for whom their work is 100% administrative.

Philippa: I agree heartily with what you’ve said, Matt. In my own experience as a coach, the identity piece is critical. I can even speak to having had that personal experience, transitioning from a clinical position to something else that was originally hospital administrator, and then yet again to a coach. I struggled with my own identity shift. This is a deep and personal piece to work through with physicians as they step into new roles.

What would you say physicians are typically good at when they step into their leadership roles?

Matt: The first is giving feedback. It’s funny, for many of the folks we work with in other sectors and other industry verticals, giving direct constructive developmental feedback is a challenge. And they either beat around the bush or do it in a way that’s not direct enough to be valuable. My experience with physician leaders is that, in general, they’re good at delivering feedback. This habit is built in to a doctor’s daily life of exchanging information at a very tactical level.

Jennifer: I would add that physicians are learners by nature, and so they have that sense of inquiry and a desire for knowledge. Often, when physicians take on leadership roles, they have a thirst to understand and do it well — most physicians are very driven and goal-oriented. Their drive for excellence and continuous improvement is also a real strength that plays out positively in their physician leadership roles as well.

Philippa: I endorse that because I find that physicians make wonderful coaching clients when they come to the relationship motivated and wanting to shift things. They engage, and you’re absolutely right, they’re terrific learners and they love it when they’re presented with something that challenges them and also has a framework of learning.

What are they typically not good at as leaders?

Jennifer: Where we see breakdown is when physicians move from the individual contributor role to managing others and making time to coach and mentor others to build their capacity. Often, since many physicians still keep at least a piece of their clinical role, we’ve found them to be challenged to make it a priority to effectively coach and develop others. To build the capacity of those around them, as collaborative team members.

The other challenge is taking the longer strategic perspective. Much of a physician’s training is focused on dealing with the here and now, how to diagnose in the moment. So they are great problem solvers, but taking a strategic or a broader enterprise or systems view can be difficult.

Another struggle we see show up is relationship management skills. Lack of self-awareness and emotional intelligence in terms of reading others, managing their own mindful presence, managing their reactions in the moment when they may be triggered — these can be problematic. That’s something we work on with all leaders, building self-awareness and the ability to pause and reflect on “what is the wake that they’re leaving”. Is it a positive wake or is it a negative wake in terms of impacting others?

Philippa: I’m going to deviate here because we now talk about VUCA environments, VUCA being volatile, uncertain, complex, ambiguous. And I’m just wondering what the extra qualities are that physicians need most to thrive as leaders in VUCA-type environments?

Jennifer: That’s a great question. One of the things we mentioned in our article is resilience. You hear everyday that the challenges and demands of practice and of physician burnout are immense. Developing resilience is a really important mindset. And going back to self-awareness. We’re always amazed at how few physicians and physician leaders have ever received 360 degree feedback. Although as Matt said, they may be great at giving feedback, very often they themselves haven’t received candid 360 degree feedback. Holding up that mirror can be really powerful for physicians in terms not only of self-reflection but also of their understanding of how they’re perceived as a leader and what’s required for them to be most effective.

Matt: My two qualities are derivatives of what Jennifer said and they both happened to be buzzwords, but so is VUCA. So I guess it all fits together. Number one is emotional intelligence (EQ) with self-awareness and other skills like empathy and the ability to intuit how others are hearing, and receiving, and responding to crisp, clear, important direction. So generally speaking EQ needs to be there. In some cases, it’s not. But absolutely worth investing in.

And the second quality is change agility, and that is not only the ability to respond to change, but also the ability to lead through change; the ability to engage followers in a thoughtful change process. By and large, leaders reach a certain level where they can see the next island they’re moving to relatively easily.Engaging people in the journey from here to there and making that both palatable and meaningful is key. Developing clinical leaders who can engage people in that change journey is a big deal in my mind.

Philippa: So in your opinion then, what are the best ways to foster the development of these qualities? Through what kind of developmental techniques, let’s put it that way?

Jennifer: Part of that response depends on where physicians are in their leadership careers. The avenue many take is to go get an MBA, believing they’ll be better business leaders. We haven’t seen that to be a useful answer. It’s more about having a set of experiences and being exposed to many leadership opportunities, whether leading a task force around a strategic initiative, or being involved in presentations within the organization.

Second, we believe that executive coaching can be powerful for physicians in terms of not only building self-awareness, but also providing insight into what their specific strengths are, and skills and developmental gaps exist. With that awareness and focus, physicians can improve their leadership capacity and bring their “whole person” in terms of authentic and sustainable leadership.

The third piece that I would comment on, from an organizational perspective, is to invest in physician leadership development in a more integrated, strategic, “long-view” manner rather than merely sending someone to a course. Tailoring the leadership development program to the organization’s needs to provide a cadre of physician leaders to not only learn from each other but to also focus on those specific issues that their organization and business are facing in a way that reinforces and supports the culture as well as being tailored to their mission, vision, and desired outcomes.

Part 3 will be coming up …