All physicians lead, not just those with designated leadership titles, such as Medical Director, Department Chair, or Chief Medical Officer. Leadership is foundational to the doctor’s role.

Fortunately, leadership is a learned skill and improving physicians’ leadership skills can change how well we do our key job of taking care of patients. As physicians improve individual leadership skills the entire health care system will reap the benefits: nurses, technicians, administrators, finance departments, HR professionals, and doctors themselves. But the chief beneficiary will be patients.

Better patient outcomes are always our goal. Improved physician leadership leads to better teamwork, higher morale, and improved decision-making at the “front lines,” where patients are being cared for.

Physicians lead teams, patients, and decision-making processes. However, we are not explicitly told we are leaders unless and until we are promoted to an “official” leadership position. This lack of awareness that we are all leading limits us and blocks much of the reflection and growth that can improve teamwork, the environment of care, and patient health outcomes. The absence of consistent training in fundamental theory and practice of leadership presents us with an opportunity to change.

Leadership is a core competency.

Leadership is more than a buzzword in business books and seminars. Leadership is influencing thought and behavior to achieve desired results, something all doctors do many times daily with teammates, patients, and families. As such, it is every bit as important as clinical knowledge and technical skills. It is a core competency.

This presents us with the opportunity to ensure physicians are trained in leadership as a core competency from the start of medical school. Leadership skills training built into the medical school curriculum in a coherent, progressive fashion can improve physicians’ skills in this domain before they put on the long white coat.

Ideally, this training should continue throughout residencies and entire careers. There is data across industries showing front line leaders (those at the “point of production”) impact team member performance, engagement, retention, error rates, and outcomes. When physicians become better leaders, the health care system works better for everyone.

As we know, competency-based education makes sense. We know how to teach. The goal with leadership training is to bring content-specific education for this competency. The Accreditation Council on Graduate Medical Education (ACGME) lists these:

• Patient care
• Medical knowledge
• Interpersonal and communication skills
• Professionalism
• Practice-based learning and improvement
• System-based practice

Upon review, these six competencies sit nicely within a mental model of leadership. And so, the ACGME is already saying, in a roundabout way, that leadership is an essential aspect of being a physician.

But still, these traits have not been tied together under the construct of leadership, and so it is not necessarily clear why these disparate competencies are important, namely, to be able to effectively and sustainably influence thought and behavior to achieve desired results.

Across institutions leadership concepts such as communication skills, cultural competency, or professionalism are being taught. But because they are presented in a disconnected, piecemeal fashion, students may not connect the dots to better patient care. In the stress of learning basic and clinical sciences, the level of effort put into these “soft skills” (for many reasons a poor descriptor, but you know what I mean) may take a back seat. Because students are not looking at the skills holistically, through a leadership lens, they may miss the bigger picture.

Leadership is the organizing principle under which many of the competencies can be grouped. By viewing leadership as central to good medical practice, physicians-in-training can more clearly see the reasons why they must learn all these seemingly disparate skills. And educational programs can fill in the gaps in their training, providing a longitudinal, progressive, cohesive curriculum in leadership.

Symptoms of lack of leadership emphasis

Because we do not view leadership as a core competency in medical education and fail to teach it as such, the symptoms are felt throughout the health care system:

• Disruptive physician behavior: This can manifest in several ways: yelling, bullying, demeaning or insulting team members, impatience, condescension, etc. We are getting better as a culture at limiting these behaviors, but too often interventions are enacted only in a punitive fashion directed at the more severe outliers.
• There are better ways to lead effective and efficient teams in high-stress, life-and-death environments. Techniques to excel at leading under pressure are taught in many leadership courses but are rarely found in medical education programs at any level. Strange on its face, because leading under pressure is what we do every day.
• Low-performance/high-stress teams: When physicians fail to provide active, skilled leadership, the negative effects on their team can be immense. In general, low-performance teams are marked by decreased alignment with the mission, poor communications, low accountability and transparency, fear of speaking up, absence of role clarity, and lack of positive feedback.
• Low morale and high turnover: When employees are subjected to high-stress, low-performance environments over prolonged periods, they become disengaged or burned out. Disengagement leads to higher absenteeism, lower productivity, and lower profitability. Morale suffers, and staff turnover is inevitable.
• Poor patient outcomes: It stands to reason that teams that are suboptimal have poorer results than their well-led counterparts. When staff members are highly stressed or disengaged, they are more prone to error. Errors in a medical environment can lead directly to worse patient outcomes.

Embedding leadership in medical culture

A culture of leadership starts by stressing, on the first day of training, that a physician is not just a provider of care to patients; a physician is a leader of teams and patients who is influencing behavior to achieve the desired result of better health outcomes for our patients.

Leading is a relational skill; it is not learned in a vacuum, nor is it spontaneously acquired when one is given authority status. From the beginning of medical school, we can build a culture that emphasizes leading high-performing teams. Physicians are members of health care teams, not solo operators.

In addition to leadership being taught as a core competency in medical school, it should then be refined throughout GME training and the physician’s career, through specific training and day-to-day, moment-to-moment interactions. When the latter occurs, not only does the “student” receive helpful feedback on their leadership skills, but the “teacher” refines their own leadership knowledge as well. This creates a virtuous cycle in which leadership improves at every level of an organization.

It will take time to change the culture of medicine so that leadership skills are viewed as integral to being a physician, but we should all be motivated to move in that direction.

Leon Moores is a neurosurgeon and author of All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes.