“Nearly all physicians take on significant leadership responsibilities over the course of their career, but unlike any other occupation where management skills are important, physicians are neither taught how to lead nor are they typically rewarded for good leadership.” (1)
Leadership and management are intrinsic to medical practice, and necessary not only to those who seek management positions.
Medical paradoxes include individual responsibility decision-making versus teamwork; high-cost activity versus financial and operational constraints; high patient and societal expectations versus unpredictable events. Physicians are at the intersection of all these and act on them, sometimes with conflict between these. But choices must be made with clinical and financial consequences.
Medical practice is increasingly multidisciplinary, complex, and sometimes unpredictable with simultaneous planned and emergent decision-making needs. Also, patients are increasingly aware of their options, want to be part of the decision-making process, built in trustful relations.
A necessary part of the learning curve and responsibility to patients involves the disclosure of errors, discrepancies and communicating bad news to patients and families, such as death. Although advocating a patient centered approach, the doctor-patient relation is asymmetric, regarding the control of the information and personal versus professional involvement of each. This can be emotionally stressful, and sometimes conflict arises, with patients and other health professionals. As I write, I remember a colleague treating a cardiac arrest patient and a desperate family member threatening him if something went wrong. A common experience is the discussion of whether and when a procedure should be done, such as an urgent MRI or a patient transfer, with no vacancy available, so a “gymnastics of agendas, patient and physical spaces swaps” must be done, with clinical and financial decision changes imposed on others. Other example is a radiology staging decision-making that will impact the choice of high-cost cancer therapy.
“Financial literacy will always be an important skill for a physician leader. But now, because of the ongoing challenges of COVID-19 and the unique demands it imposes on budgets, the skill set is even more critical.” (2)
Almost every medical decision has a financial impact. Understanding how resources are allocated and how to negotiate during financial discussions has never been more important (2), affecting clinical decision-making.
Leadership skills curricula should include both interpersonal literacy and systems literacy (1). Interpersonal literacy includes coordination of teams, coaching, feedback, communications, and other soft skills. Negotiation and decision-making in stressful and conflict environments should be a part of the curricula. Systems literacy is necessary to know the healthcare landscape, in which physicians act. Since the healthcare organization, operations management, and cost structure impacts physicians’ actions, but also facilitates physicians’ contribution to these. To better communicate and to build teamwork, we need a common language with managers.
The need for leadership training has been recognized. Previous assessments (3) of leadership expectations among medical residents revealed important skills to be trained including “leading a team”, “confronting problem employees”, “coaching” and “resolving interpersonal conflict”.
“Conflict comes from things we care about, and we both care about patients, so that’s a nice place to start.” (2)
Because it is intrinsic to medical practice, leadership and management curricula should be incorporated both in medical graduate and postgraduate education (1,4).
How can we do this? Understanding that both managers and physicians care about patients, from different perspectives. We need to understand how to foster communication and understanding. To do that, we need the same language to be spoken; paradoxes to be accepted, and that each side has different doubts, expectations, and practice guidelines. Partnership with business schools is fundamental for this training. Not only it is where most expertise of management and leadership lies, but also that leadership knowledge needs clinical input.
First, an assessment of the needs can be made. Following, a tailored blended format of formal lectures and case-based approach (ex. Using simulation learning centers) can be developed. Training should increasingly incorporate soft skills and leadership needs in clinical scenarios based on real-world experiences. This approach intends to reduce the potential gap between learned lessons and their applicability. Apart from medical and business faculty, contributions from other expertise are useful, such as teams who operate in sensitive environments.
This education should target students and faculty alike, to gain support on the importance leadership training (1). An idea would be to share (either in class or through publications) a case-based archive of good practices and a mentorship program depicted from the usual organization of residency programs.
In conclusion, leadership and management skills are necessary to all physicians, because of the nature of their practice, the reality of financial constraints and the necessity of cooperation with managers in a patient centered way. In this point of view, we advocate that cooperation is a necessary step to efficient use of resources, to better respond to societal and individual patient expectations and with these improve clinical results.
1-Harvard Business Review. (2018). Why Doctors Need Leadership Training. [online] Available at: https://hbr.org/2018/10/why-doctors-need-leadership-training.
2- www.hsph.harvard.edu. (n.d.). It’s More Important Than Ever for Physician Leaders to Develop Financial Literacy—Here’s How to Start | Executive and Continuing Professional Education | Harvard T.H. Chan School of Public Health. [online] Available at: https://www.hsph.harvard.edu/ecpe/its-more-important-than-ever-for-physician-leaders-to-develop-financial-literacy-heres-how-to-start/ [Accessed 29 Jan. 2022].
3- Fraser TN, Blumenthal DM, Bernard K, Iyasere C. Assessment of leadership training needs of internal medicine residents at the Massachusetts General Hospital. Proc (Bayl Univ Med Cent). 2015 Jul;28(3):317-20. doi: 10.1080/08998280.2015.11929260. PMID: 26130876; PMCID: PMC4462209.
4- Blumenthal DM, Bernard K, Fraser TN, Bohnen J, Zeidman J, Stone VE. Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions, and lessons learned. BMC Med Educ. 2014 Nov 30;14:257. doi: 10.1186/s12909-014-0257-2. PMID: 25433680; PMCID: PMC4261637.
MD (Radiologist) Hese-EPE, Evora; Affidea Portugal | Affiliate Member at Nova SBE Health Economics & Management KCWebsite
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