A Call for Leadership

The modern physician is called to provide twenty-first century health care upon the foundation of a twentieth-century training. Long gone are the days of home house calls and the autonomy of the solo practitioner with an isolated patient population. Today's physician trainees enter a world of teamwork and collaboration in health care delivery. Evidence-based medicine and quality initiatives reinforce the fact that better outcomes and lower costs are driven by such a team-oriented approach. Complimenting these internal health care initiatives has been the strong response of policy reform and regulation. Together, new models for health delivery facilitate patient care under the joint banner of teamwork and communication. At every step of the journey, physicians accept the role of team leader, facilitator, and communicator.

The ability for future physician leaders to embrace the role of team leader can be best cultivated and enhanced through the response of medical educators. This next generation of physicians must be equipped to deal with an expanded skill set that goes beyond the approach to developing the traditional clinician. It must also relinquish the outdated belief that physician administrators are the only group in need of leadership training. Rather, all physicians must be prepared to be active leaders. The academic medical community can go a long way to develop this sort of physician leader, one that is prepared for the challenges and successes of twenty-first century health care.

This call for a new model of leadership development in the medical academic community was most recently emphasized in the November, 2011 issue of Academic Medicine,

“The full benefits of such a model will not be apparent for years. Early benefits, however, include reduced costs of care, increased availability of health care, improved quality, and a focus on wellness rather than disease management. Long-term benefits include increased involvement of physicians in all aspects of health care administration, with younger physicians leading changes in health care delivery.”(1)

Research suggests that there is a link between the engagement of doctors in leadership and quality improvement – with correlative improvements in patient care.(2) It has become evident that trained physician leaders are better able to both initiate positive change as well as respond to negative or unexpected diversions. This flexibility to interact with change is crucial to the maintenance of equitable and sustainable high quality patient care. With the continued mantra of placing the patient first in health care, investment in such leadership development should be a priority.

Meanwhile, contemporary legislative and regulatory output continues to interplay with systems development to drive the evolution of patient care around the foundation of team-based approaches. Health care systems continue to grow, and to further integrate the various levels of providers and practitioners, in an effort to find a cost-saving blend of quality care. The constant in all of these regulatory models remains that the physician is placed at the center of delivery and as the leader of a team. If the academic community does not strive to meet the demands of these evolving health care systems, perhaps other licensed providers will be offered the chance to step into the void. Physician leaders must be prepared to both interact with, as well as facilitate and lead, these future health care teams.

Finally, perhaps the most systemic influence on leadership development will be driven by financial incentives. Bundled reimbursements, value-based purchasing of health care resources, and pay-for-performance all indicate that providers will be rewarded in concert with team-based care. To complement this, several national societies, think-tanks and government bodies have suggested stratified incentives to academic institutions that engage medical core competencies to differing degrees. All of this is indicative of a likelihood that institutions and residency programs that address necessary competencies, such as leadership development, will likely see greater direct funding.

Some would argue that the movement towards leadership development in medicine is already upon us. To be fair, much discussion has taken place and early adoption has followed in, mostly, isolated settings. But, as a profession, we must still be doing something wrong. Physician burnout is at an all time high, with studies demonstrating that 1 in 3 physicians is experiencing such burnout at any given time. (3) Further studies show that 90% of professionals, who leave their profession, either voluntarily or involuntarily, leave not because of technical incompetence, but because of a non-technical shortcoming or difficulty. Meanwhile, the most commonly raised issues in both medical student and physician performance continue to be within the domain of the non-technical competencies. These areas of concern include professionalism, ethics, and perhaps most important - interpersonal skills. (4)

The time for leadership development in medicine is at our doorstep. It is quite clear that the business community tapped into the importance of recognizing and advancing these principles over three decades ago. In review of the literature on leadership development, it is evident that these topics have only just begun at earnest within the past five to ten years in the medical community. As a profession, physicians have likewise lagged behind – with only recent mutterings and support for the importance of structured and focused leadership in academic medicine. The necessity for developing a new generation of physician leaders is without question. The call for such leadership development is now loud and clear. However, the response of the academic community must be considered. As a profession, we cannot miss the opportunity to answer the door.

1. Snyderman, Carl. Eibling, David. (2011). The Physician as Team Leader: New Job Skills are Required”. Academic Medicine. 86(11): p 1348.

2. Ferlie, Ewan B.Shortell. Stephen M.(2001). Improving the Quality of Health Care in the United Kingdom and the United States: A Framework for Change. The Milbank Quarterly: A Journal of Public Health and Healthcare Policy. 79(2): p 281-315.

3. Shanafelt, Tait D. (2009). “Enhancing Meaning in Work: A Prescription for Preventing Physician Burnout and Promoting Patient-Centered Care.” Journal of the American Medical Association. 302(12). p 1338-1340.

4. Eva KW, Rosenfeld J. (2004). “An Admissions OSCE: the Multiple-Mini Interview.” Medical Education. 38 p. 31-326