In medicine, there are many buzzwords that are thrown around so frequently and loosely as to lose meaning or purpose. I’m looking at you, ‘patient-centered.’ And you, ‘disruptive innovation.’
Now that it’s August–the season of medical school orientations and white coat ceremonies–there’s another that, as if on cue, is making the rounds: leadership. This time of year, medical students are treated to speech after speech by deans who wax poetic about the physician-leader.
“We brought you here not to be 9-to-5 employees, but leaders in medicine.”
“We’re not just in the business of training doctors; we’re developing leaders.”
At the time, I was a fresh-faced, doe-eyed disciple in my first days of a lifetime in medicine, and I hung onto every word of the sermon–enchanted, captivated, inspired.
In the coming months, though, that inspiration turned to curious inquisition. Inquisition turned over to weary skepticism. One year in, I’ve started to deconstruct and critically evaluate the ambiguous aspiration that is ‘physician-leadership,’ a process that’s led me to these questions.
What’s a physician-leader? A year ago, we were challenged to be more than “9-to-5 employees”–to go beyond the ‘ordinary’ work of doctoring and patient care to advance the frontiers in scholarship, administration, and healthcare delivery.
Since then, though, I’ve seen some sparks of inspiration among the seemingly mundane that reveal a broader sense of leadership. There’s the country family doctor who, as a lone knight, stewards the health and wellness of an entire community. There’s the intensivist who speaks up to oppose medically futile care and guide patients to ‘a good death.’ Does one have to be an Ezekiel Emanuel or an Atul Gawande to be a physician-leader, or can we find and appreciate glimmers of leadership in the day-to-day labors of being ‘just a doctor?’
What’s it mean to train physician-leaders? As orientation became an ever-faint blip in the rear-view mirror, so became the relevance of leadership and transformative thinking in our day-to-day coursework. If we were being trained as physician-leaders, how was our training any different from that of physician not-leaders? I think we learned anatomy the same way. Same for physical diagnosis and pathology, too. A year in, I’m not sure how exactly one trains as a physician-leader, as opposed to a not-leader.
To train physician-leaders is an admirable aspiration, but it would be a little more admirable if there were a little more substance to it.
What’s with the love of leaders? As the old adage goes, if everyone’s special, then nobody really is. Likewise, if everyone’s a leader and trained from the start to think only as a leader, is there anyone left to be led? Students are selected into medical school by leading in the classroom, leading in activities and organizations, and leading in the community. When students who have only ever led arrive at medical school and are instructed to lead, does it compromise the profession’s ability to form hierarchies or collaborate?
I wonder if medical schools ought to teach, along with leadership, the principles of good followership–active listening, influencing from below, knowing when (and how) to challenge a leader. Perhaps then, we’d see stronger cohesion and collegiality, both within our profession and among the health professions.
Don’t get me wrong, now–the importance of effective leadership in medicine by physicians, for physicians is hard to overstate, especially at a time when doctors are facing increasing pressures from changing practice models, shifting payment structures, and growing information technology demands. For now, though, leadership as it’s preached and praised in medical education is a notion without clarity, an ambition without substance.
Speeches and sermons at orientations and white coat ceremonies are good. If we want to do better, though, maybe we should recognize and teach the brand of leadership that happens not only at the highest levels, but in “9-to-5 medicine.” Maybe we should actually think critically about what it means to train physician-leaders as a functional practice, rather than a buzzword not reflected in the curriculum. And maybe, just maybe, we should understand that there are limits and complements to a singular emphasis on leadership that are worth instilling, too.