Some docs consistently say “no thanks” to formal leadership roles. They prefer not to run for a board position, become department chief, or step into an executive role because their passion and focus is patient care.  This primary interest in the core work shows up in other professions, too.  My brother, a mechanical engineer (I’d say “brilliant mechanical engineer,” but he might read this), eschewed management positions his whole career. He was in demand as a guy who could diagnose and fix malfunctioning turbines in huge power plants around the globe.  He loved it. That was perfect for him.

I admire many physicians with a similar mindset; those passionate clinicians who want nothing more than to care for patients, using exquisite respect and competence in the process.

However.

This does not suggest that:

• someone other than a physician ought to be at the helm of the department, the board, or the system
• physicians in general don’t want to lead, shouldn’t lead, or aren’t prepared to lead

Above all, this in no way suggests that physicians inherently lack leadership capabilities. Oh, contraire. More on that in a sec.

A blogger on KevinMD was moved by artwork depicting a physician during a house call sitting at the bedside of a sick child.  She said, “The business of medicine has overshadowed the nature of care and left those with the calling in their hearts confused and disenchanted.”

Yes. The almost endless frustrations of how health care is organized, reimbursed, delivered, and documented has certainly disillusioned swaths of physicians.  And sadly, medical training offers a dysfunctional launch to physician careers.

So yes, there’s a big pit of despair.

Courageous leadership is needed to pull patients, communities, medical trainees, physicians, and healthcare systems out of this muck.

It was the following sentiment by the “take back the bedside” blogger that veered off the rails:

“Physicians should not fight politicians or economists or insurance companies. Physicians should carry on business as usual having and sharing moments of intimacy to remind society what they truly seek in a doctor.”

I couldn’t disagree more.

Physicians can demonstrate excellent skills in a variety of arenas probably due to selection for smarts, drive, people skills, and resilience. In my work with medical groups, advocacy organizations and healthcare systems I am wowed by the comprehensive command physicians have of operations, strategic quality leadership, IT, PR, finance, government relations, public policy, HR, and legal issues.  The idea that physician terrain starts and stops at the bedside does not serve our profession or our patients.  Care and caring are critical—but they are table stakes.  We mustn’t sit in a well-circumscribed perch at the bedside and defer leadership or simply trust the expertise of administrators, lawyers, accountants, or MBAs.

When a patient requests a doctor at the bedside it is not solely because of an assumption of empathy — though that’s important — it’s because of an assumption of expertise and power.  Patients trust that the doctor will use her knowledge and leadership in order to make sure the patient’s needs are served.

What’s my point? Physicians must lead.

Abdicating leadership allows people who do not share the core values of our profession to take over:

Wait.

What about that oft-repeated “fact” that doctors are lousy leaders?  Most of us are numb to the descriptions of physicians as top-down narcissistic lone wolves who act like autocratic dictators (punctuated with a “herding cats” reference and a conclusion about “leaving leadership to the experts”).

I’ve never bought it. When I led the strategic HR department of a 500+ physician group “physician as leader” was the headline for our physician selection efforts. Selecting for leadership behaviors (and challenging victimized or tyrannical behavior) proved to be the best way to serve patients, honor the high-performing nurses and team members, and improve outcomes. Physicians as a group possess an impressive reservoir of leadership talent. I’d partially ascribe this to the academic equivalent of Navy Seal training followed by the need during residency to influence teams when authority is murky, and accountability is high.

I mentioned that I’ve been wowed by the leadership skill and knowledge of physicians I know. Beyond my anecdotal experience is there any evidence that would support that notion?

A 2011 study analyzed the performance of hospitals in the U.S. based on whether they were led by physician CEOs or by non-physician managers:

Six percent (6%) of the 6,500 hospitals in the U.S. had physician CEOs. Of the highest performing hospitals (based on US News and World Reports Top Hospitals in Cancer, Cardiac and GI disorders) 41% were led by physician CEOs. The study showed that quality scores were 25% higher in physician-led institutions. In addition, USNWR identified an elite subset of the 21 highest ranking institutions. Of these 21 hospitals on the USNWR Honor Roll the majority (76%) had physician CEOs.

The researcher responsibly points out that this dramatic link between physician leadership and organizational performance does not define a cause-and-effect relationship. But it certainly corroborates my experience that physicians are more than capable of wrapping their heads around this leadership thing. And if we want to climb out of the fix we’re in, physician leadership is a good bet.

Patty Fahy is an internal medicine physician and founder, Fahy Consulting. She can be reached on Twitter @pattyfahyMD.

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