“Without a strong leader, the whole machine’s out of whack.”

This pithy quote about leadership actually comes from one of the best-known doctors at one of the world’s most famous academic medical centers: Meredith Grey of Seattle Grace (slash Grey Sloan Memorial) Hospital.

Okay, so perhaps television shouldn’t be the primary source for guiding executive principles. But this particular line calls to attention the often-overlooked importance of true leadership in the medical field. After all, academic medical centers (AMCs) are complex systems whose structure, function, impact, and politics can rival that of any Fortune 500 company.

AMCs are comprised of a university, hospital, individual clinical practices, and, ultimately, a business that needs to make money. Culturally, AMCs are filled with highly educated, naturally competitive professionals for whom a “command and control” approach to leading and getting things done is the norm. While there is the common overarching mission for all to deliver exceptional patient care, siloes can easily develop, with physicians focusing on their own practice and specialty. This diminishes the opportunity for great, diverse minds to come together and collaborate in an industry where making daily life-or-death decisions and being on the front lines of global health crises is the norm. Sound leadership is paramount to achieving not only a unified goal of excellent patient outcomes, but also ensuring the organization is meeting its business objectives (e.g., adding services, financial growth, and becoming the AMC for patient care, research, and innovation).

Leadership training is not part of most medical school curriculums, yet for most physicians, leadership inherently becomes part of their duties as they rise through the ranks of their education and career: residents managing interns, chief residents managing other residents, and attending physicians managing fellows and residents. Physicians quickly transition from individual contributor to team leader with little to no training on influencing, conflict management, communication, making difficult non-clinical decisions, or providing feedback. Moreover, at the division or department chair level, and certainly as CEO, physicians need to pivot in their thinking to consider how they will run the department or AMC as a successful business.

Leadership During Critical Times

The COVID-19 pandemic, in many ways, shone a spotlight on the necessity of having strong leaders in AMCs. The idea of formal leadership training in AMCs is rather new, and we are still learning the most important leadership qualities that strong physician leaders leveraged during the initial COVID crisis. Generally, leading through change should focus on people and process – e.g., anticipating challenges around the corner, creating a shared purpose, focusing on fundamentals, and creating a psychologically safe and empowering environment for one’s team. Researchers at the University of Michigan interviewed physician leaders on the front lines of COVID to determine the attributes and tools that were most effective during this time. The following themes emerged:

  • Bringing together a diverse team with clear, shared goals
  • Using a range of strategies to tend to both their teams’ well-being and their own (e.g., being present and visible, and fostering an environment of open communication and trust)
  • Engaging in “leadership reasoning” (introspecting and gathering feedback about their approach) as a way of learning from others and reflecting on their own actions to inform future practices. Leading through change and crises pressure-test a physician’s leadership skills in ways that begs the question: how can AMCs not afford to integrate leadership training into the curriculum of their medical schools?

Developing Physician Leaders

Creating a strong leadership pipeline in AMCs will require a shift in priorities and expectations – not an easy undertaking with most current medical school frameworks excluding leadership education. Recognizing the ROI of training from patient care and business perspectives will be an important first step for laying the groundwork.

Aside from adding formal leadership courses, providing level-specific training could aid in bolstering leadership acumen in a more relevant, step-wise progression. Perry et al. adapted Ram Charan’s Leadership Pipeline model to focus on specific skillsets at each level. This provides a framework for up-and-coming leaders in the medical world to focus on different areas of strategy, business, relational, and clinical skills.

  • Individual Practitioner: Practicing physician, as an individual contributor, where technical expertise is valued most
  • MD Leader: Involves running a medical group, division, or department
  • Market MD Leader: Responsible for a business segment or region, and oversees other MD leaders and a broader scope of clinical staff
  • Group MD Leader: Oversees a group of businesses (e.g., group president or Chief Medical Officer). Responsible for clinical and business outcomes
  • Enterprise MD Leader: A top leadership position (e.g., CEO), responsible for the entire enterprise

We would also propose that coaching be part of a physician’s “onboarding” into leadership roles. Our firm is a part of a cadre of coaches for a large academic medical center that models this exact approach.  What we often see are gaps that reflect Marshall Goldsmith’s idea of “what got you here won’t get you there.” Developing exceptional clinical skills does not automatically position one well to lead others in more junior positions. On top of this, there are often coaching discussions around navigating the unique and complex politics of AMCs that new MD leaders are ill-equipped to manage.

It is all the more surprising that the focus on leadership development in the field of medicine is so nascent given that the Hippocratic Oath itself touches on many qualities of servant leadership: humility, inquiry, authenticity, and respect for all. Cultivating these qualities will be crucial to the future performance of not only AMCs, but all corners of the medical field. Pairing deep – life-saving! – technical expertise with the ability to coach and develop the next generation of doctors means better medical care for everyone.

After all, in real life, the goal is to minimize the drama.