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Monday
Dec062010

Medical Leadership: You Can't Win the Iditarod With A Team Of Pit Bulls

Medicine is no longer a single doc in a silo.

I, as well as most of my colleagues in medical leadership, trained in the era of the medical pit bull. The most desirable medical schools and training programs were the ones where only the strongest were admitted and the toughest survived (and we're not talking just about the patients!).

We loved the Professor and Attendings who put the most unrealistic demands on us. We mocked colleagues who complained. Being on call every other night meant missing half the patients. Leaving the hospital before 9 PM on your "night off" showed a lack of commitment. Asking for help showed weakness and incompetence. Sensitivity was seen as a barrier to optimal performance.

We pit bulls did well in an era when medical practice and care delivery were performed in silos. Trained for autonomy, we ruled in an environment that encouraged and rewarded such. You can't beat a pit bull one on one.

Imagine now a "team" of pit bulls. Imagine them harnessed together and expected to pull a sled laden with enormous weight over the most difficult of terrrain with minimal resources. Not a pretty piucture. Maybe we need to train more huskies and less pit bulls.

But wait, you say, medical schools have changed since the days of purges and leaches. They are investing in diversity, sensitivity training, and communication. Perhaps, but there are still a lot of us pit bulls on the faculties and, more importantly, in positions of leadership and authority in healthcare delivery systems.

While we're training future sled dogs, we need physician leaders today who can get the pit bulls to pull the sled together. this is our challenge now and for the foreseeable future.

Effective physician leadership requires a combination of traits and skills. Fortunately many physicians already possess leadership traits: passion, self-confidence, and knowledge. Unfortunately, however, most need to learn leadership skills: mastery of emotional intelligence and crucial conversations, relationship management, and team building. With proper training, motivation and commitment, these skills can be acquired.

The era of medical autonomy, silos and fragmentation is over. The fantasy of the pit bull cannot be sustained by our financial and demographic reality. The only way to maintain healthcare quality, reduce its cost and increase its distribution is to integrate its delivery along the broadest of continuums. Unexplained variance must be eliminated, outcomes must be tracked and performance metrics must be measured. All of these challenges will require cooperative rather than autonomous behavior. This is our Iditarod sled. We need trained physician leaders who can help us drag this sled together to the finish line.

Reader Comments (2)

Never hurts to have more leaders. However, I think the solution might also be to create more followers...too many chefs, and all that.

Also, fyi, Denver banned pit bulls in 1989.

I hate to muddy up this nice animal metaphor but I will do so by giving the full disclosure that I am a dinosaur.

That's right, I am old enough to remember when physician leaders ruled the world, and did so accomplishing much good while being respected if not loved and made their accomplishments through great personal sacrifice. There may have been some financial reward but the personal sacrifice was so great that the physician himself/herself didn't enjoy a lot of it.

Where are the leaders today--this penful of pit bulls whose traits you so decry? I see only a few groups of toy poodle puppies trying to please their administrator overlords.

Elimination of unexplained variance, performance metrics, cooperation, making sure the sled dogs all pull equally in the traces--is worthless. It has given rise to the medical field muddle that we have today and it has not benefitted patient care at all--actually the converse is true.

Give me some pit bull leaders that will snarl and snap at our administrative, governmental, and insurance overlords and send them scurrying from the field. Those pit bulls will defend their patients, and ignore those deleterious "qualities" that you so admire.

"Go along to get along" has always been a perjorative phrase. We need some leaders who will push back.

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