How physicians can be better medical leaders [PODCAST]

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“A sad truth is this: Most everywhere, health care is a low-margin industry that lacks resources to invest in leadership development. Although our business’s central, sacred function is caring for our fellow human beings, many who move up in the health care hierarchy do so without possessing the so-called ‘soft skills’ that facilitate one’s ability to lead groups and motivate others.

‘Soft skills,’ a military term that arose in the 1960s, refers to the interpersonal savvy that it takes for organizational stakeholders to succeed. Soft skills are about more than the weaponry and the machinery; they’re about the people. Whether it’s academic medicine, corporate medicine, or public sector medicine, we are simply not taking enough time to focus our leaders’ attention on the interpersonal dimension of their work. Excellent training and supervision enhance essential managerial skills, but most health care organizations choose not to invest in that which is ‘soft.'”

Steve Adelman is a psychiatrist and can be reached at his self-titled site, AdelMED.

He shares his story and discusses his KevinMD article, “The joylessness of harried medical leaders.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Steve Adelman. He’s a coaching and consulting psychiatrist, and he wrote the KevinMD article “The joylessness of harried medical leaders.” Steve, welcome to the show.

Steve Adelman: It’s great to be here, Kevin. Thanks for having me.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Steve Adelman: Sure. I’ll do so, and I’ll keep the lens on the medical leadership piece. I went to medical school at the University of Pennsylvania. I learned very little about medical leadership there, and the medical leaders there tended to be top-down general types. I then trained at McLean Hospital in Boston, trained in psychiatry. I learned very little about medical leadership there. When I was a PG-3, I was told, “You’re the chief resident now,” and I learned to wing it, which is what medical leaders tend to do.

After McLean, I went into an academic position at UMass Medical School. It was an entry-level staff position in year one. In year two, I was told, “We’d like you to be the director of outpatient psychiatry here.” I said, “What do I know? I’m just a young 30-year-old.” They said, “You’ll figure it out.” So I went and I winged it again as a medical leader.

After about seven years at the medical school, I relocated to the Boston area, to a large multispecialty group practice. I was there for 20 years, and after the first six or seven years, I became the chair of the department of behavioral health and addiction medicine. I had 14 sites, I had 125 clinicians, I had a large budget, and I was winging it big time. And not only was I winging it big time as a leader, I was also practicing. So it was a half-time leadership role, and it was a half-time role as a clinician. It was actually two full-time jobs. I started to experience some amount of personal stress and burnout.

The burnout thing was growing around the profession, and I decided around 2012 to take a position as the director of the physician health program here in Massachusetts, Physician Health Services. I had a great eight-year run at PHS, where I was helping medical leaders and the physicians who they were referring to the physician health program to get back on track in a variety of ways. And about a year ago, right before the pandemic, I gave a year’s notice, and for the last three months or so, last six months, since the beginning of March, I’ve been running my own business, adelmed.com, and I work for myself now.

Kevin Pho: So when you made that transition from being a clinical physician to a physician leader, what would you say are the biggest traits that you had to proverbially wing when you were in your leadership positions?

Steve Adelman: It’s assumed that because you’re intelligent and you happen to get along reasonably well with other people, you can lead. Not much is explained about managing. Very little is explained or taught about the financials. You learn a lot about employment law. You’re sort of left to figure it out and to connect the dots for yourself. And I think many, if not most, medical leaders are more managers, especially at the more entry-level leadership positions. Many of us kind of learn through the medical leadership school of hard knocks.

Kevin Pho: And while you were in these leadership positions, were there any mentors or any resources that you could turn to for guidance?

Steve Adelman: I think mentors are often available, but as we know, in medicine and health care today, everybody is super busy. Everybody is doing way too much. You are rewarded for solving problems on your own, and you can’t take up too much of your mentor’s time, your department chair’s time, because they’ve got so much going on for themselves. So you sort of get the message that “You can figure this out, and I’d like it if you weren’t one of the problem children.” And I’m not talking about being a difficult physician. I’m talking about being a needy leader. We’re very self-reliant as physicians, and I think excessive self-reliance is probably one of the core values that sometimes does us in.

Kevin Pho: Now, can you tell me a story or share an example of one of these leadership traits that you had to learn on the fly over the past years of your leadership roles?

Steve Adelman: So I’ll link this to my work in the physician health program in Massachusetts. The physician health program is a great, great resource for medical leaders who are contending with physicians who report to them who have one sort of behavioral challenge or another. Often it’s not clear what the challenge is. It could be a mental illness, an addictive disorder. It could just be, you know, kind of a difficult personality and difficulty getting along with other people.

So when I was leading in my last job, I had one of these doctors with rough edges who was a little bit difficult. This physician also happened to be incredibly productive. He did a lot for the bottom line of my department and the organization, and I sort of left well enough alone until the whole thing blew up. Little did I know that there was this resource, the state physician health program here in Massachusetts, where I could have called. I could have gotten input. I could have gotten advice. And it really blew up for me, the organization, and in particular for this particular physician and all of their patients. It blew up spectacularly, because we really had the mentality of “If it isn’t broken, why try to fix it?” And it was a little bit broken, but it wasn’t so broken that we did anything about it.

Kevin Pho: All right, let’s transition now into that article that you wrote. I’m certainly interested in hearing more about that transition and journey into physician leadership. It’s titled “The joylessness of harried medical leaders.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Steve Adelman: Well, it was really to exhort the profession to do more in the domain of teaching leaders in particular, but all health professionals, teaching them what we call the soft skills. So to be effective health professionals, there’s a lot of knowledge to acquire. There’s a lot of skill that’s mostly technical, in applying that knowledge to the patient. But then there’s this squishy stuff, as it’s referred to, the so-called soft skills. How do I manage myself when I’m feeling really stressed out by all that’s coming at me? How do I manage other people when I don’t have enough time to even eat lunch or go to the bathroom? How do I stay calm when something very, very stressful hits me?

It reminds me of a story that came up in our MedPEP podcast, where the doctor was having a great day until she got a fax that indicated that one of her patients had died, and she had no idea that this person was so ill that he was about to die. And she kind of lost her bearings during that session, and there was nothing for her to do to kind of regain her bearings, and she had another 15 patients scheduled. She didn’t know what to do. She didn’t have a leader who said, “Come to me if you have a problem like that.”

So, sort of managing yourself, managing up and down the hierarchy, those are the soft skills, the soft management, self-management, and other-management skills that we don’t learn about. And there ought to be a leadership training program, a leadership academy of sorts, for rising medical leaders. Some well-heeled organizations have such entities, but I think more often than not, the young medical leader is sort of left to figure it out on his or her own.

Kevin Pho: Now, can you give some tips on how these emerging medical leaders can deal with some of the situations that you mentioned? What are some ways that they can deal with the stresses of leadership, and what are some tips you can give to help them manage themselves?

Steve Adelman: First of all, I would say you really should work on yourself throughout this profession. This is a high-stress profession. It’s like being in the military. It’s like being in the police. And if you don’t take really good care of yourself, you can’t help other people. That’s what I learned over and over again from the state physician health program here in Massachusetts. And in fact, that’s why currently, in my work as a coach, I’m working with individual physicians and leaders one-on-one, to help each individual figure out the secret sauce for their own growth and development in this profession.

If I was to install a few apps, if you will, metaphoric apps, in each physician, each health professional, and each medical leader, I would say regular exercise, critically important; learning some mindfulness skills, critically important; minimal use of psychoactive substances such as alcohol; no illegal drug use. I think cannabis is threatening a lot of physicians’ careers in various ways. I’d stay away from that altogether. So there’s a lot of self-care stuff you need to internalize and learn: stress management, stress reduction. Managing that work-life balance interface involves a lot of fancy footwork in this high-stress profession. Those are the ones that come to mind off the top of my head.

Kevin Pho: Can you give a case study, perhaps, of what you’d say are the more common scenarios that you see, either from your past or from your coaching practice, that you see these physician leaders fall into?

Steve Adelman: One of the problems that many physician leaders encounter is a sense of, I would almost call it existential desperation: “This is unmanageable. I can’t possibly do this all. How in the world can I manage my leadership responsibilities, my patient responsibilities, and be there for my family and my other loved ones?” It just seems unmanageable.

Our field, our profession, has gone back and forth around this a little bit: How much of what we need to do involves improving our own tools, and how much of it has to do with improving the system, the clunky system that we’re all embedded in? And frankly, it actually involves both, but it’s really impossible, or very difficult, to fix the clunky system if we don’t have a sense of vitality and effectiveness and well-being ourselves. So I do think we need to establish a basic sense of “I know what I’m doing. I know how to manage myself and my environment and other people effectively.” And then I can bring that to bear as I deal with tinkering with the system, which is far from perfect.

Kevin Pho: We’re talking to Steve Adelman. He’s a coaching and consulting psychiatrist, and he wrote the KevinMD article “The joylessness of harried medical leaders.” Steve, not every physician is built to be a physician leader. Some are actually happy not being in that leadership role. What are some of the character traits that physicians should have that would make them suited for leadership positions going forward?

Steve Adelman: That’s a great question. I do think that the ability to tolerate ambiguity is extremely important, the ability to think dialectically, to understand that there’s no perfect right answer to every problem. Part of what’s tricky about being a physician leader is that some of the very things we learn about being a good physician don’t apply to being a good physician leader. You can’t solve every problem as a leader the way you might make a diagnosis and solve the patient’s problem. Having the ability to think about the larger picture, to think about the system, and to communicate effectively, these are really, really important leadership characteristics.

And then I think last but not least is understanding the corporate financial gears in the large machine that we find ourselves part of. Medicine is not just a calling and a profession, although it is very much a calling and a profession. It’s also the largest sector of the U.S. economy, and if you don’t understand how all that fits together, you’ll have a hard time leading others who also don’t understand it.

Kevin Pho: Now, when you’re telling your story, you clearly have been involved in a variety of physician leadership roles, and you’ve had time to reflect. If you were to start this journey all over again from the beginning, what are some things that you would do differently?

Steve Adelman: So I thought about that long and hard, because I know you often ask your guests that question, and I actually have thoroughly enjoyed everything I’ve done in my career. I will say that something came to me midway through, in the ’90s, that I wish had come to me earlier, because it’s been part of the secret sauce for me. And this might surprise you, I don’t know, but I became a person of faith in the mid-’90s. And quite specifically, I was on a sabbatical in Israel, and I saw people observing the Jewish Sabbath traditionally and really unplugging themselves one day out of seven. I said, “That looks really good to me. I’m going to start doing that.” And I started doing that in the ’90s and never stopped, and unplugging one day a week has really been my salvation. I’m surrounded by a community of people who also do this, and that’s part of that salvation, but it’s really about having a day of downtime, a day of reflection, a day to think about the larger picture in this world. So that, to me, I wish had come to me a decade sooner.

Kevin Pho: And for those emerging physician leaders, what kind of resources could you recommend they turn to?

Steve Adelman: There is a Physician Leadership Institute, I think it’s called now. It used to be the Association of Physician Executives. They have a lot of educational materials that are out there. I would certainly consider taking a look at their website and partaking in some of those materials, those educational programs. I do think that one-on-one work of one sort or another, depending on what your needs are. This could be working with a mentor, working with a supervisor, working with a business consultant, working with a therapist, or working with a coach, one or more of the above. I would say most leaders, especially the ones in the highest echelons of corporate and medical leadership, make use of those kinds of resources rather freely.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the clinician audience?

Steve Adelman: It’s a glorious profession that we’re in. It’s a difficult one and a perilous road. Stay in touch with what’s inside of yourself, and work on it as best you can along the way, because you can’t take excellent care of patients if you don’t really fine-tune yourself.

Kevin Pho: And how can people reach you?

Steve Adelman: They can reach me through my website, which is adelmed.com, A-D-E-L-M-E-D dot com.

Kevin Pho: Steve, thank you so much for sharing your time and insight, and thanks again for being on the show.

Steve Adelman: You’re welcome, Kevin.

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