Editor's note: This popular story from the Daily Briefing's archives was republished on March 16, 2020.
While doctors are typically thought of as "scientists, caregivers, or educators, … we must also understand [them] as leaders," Dhruv Khullar, a physician and assistant professor of medicine and health care policy at Weill Cornell, writes for the New York Times' "Well," noting that both doctors and patients stand to benefit from more physician leadership in U.S. health care.
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"Physician leadership is critical for better patient outcomes, clinical performance, and professional satisfaction," Khullar contends.
To make his case, Khullar points to a recent initiative to reduce heart attack deaths by changing a hospital's culture. Under the Leadership Saves initiative, clinical leaders from 10 hospitals received training focused on "changing hospital culture and promoting proven practices." The participants learned about leadership through annual meetings, semi-annual workshops, and remote support throughout the initiative.
The results of the initiative showed "large reductions in heart attack death[s]" at "[h]ospitals where leaders were able to transform culture—through engaging staff, better managing conflict, and communicating more effectively about new care processes," Khullar writes. He notes that the American College of Cardiology promotes the toolkit.
"Strong leaders are not only good for patients, but also for doctors," Khullar asserts, pointing to Mayo Clinic as an example. Mayo physicians every year assess their supervisors on a 12-question survey. The survey covers five leadership domains, which include truthfulness, transparency, character, capability, and partnership, Khullar explains. "The results have been impressive," he writes, noting that every point in a leader's score is tied to a 9% improvement in professional satisfaction and a 4% reduction in frontline physician burnout. Further, Khullar writes, "Across departments, nearly half of the variation in satisfaction can be explained by the Leader Index score of the chairperson."
Khullar continues, "More broadly, developing physicians as leaders may be good for the medical profession as a whole." He notes there has been a "skyrocket[ing]" increase in non-physician administrators over the last few decades" and that "many physicians feel frustrated by policies imposed by those they perceive as disconnected from the realities of clinical care." He points to data that shows "[p]hysicians are happier when their bosses are also physicians."
Leadership training should start early
To ensure adequate physician leadership, Khullar says "it's probably good to start the process early." While medical schools typically emphasize "test scores and GPAs" when determining whether to admit someone, "assessing leadership skills may be just as, if not more, important for selecting students who will become good doctors," Khullar writes. He notes that some medical schools "have recognized the need to formalize leadership education and have introduced business school-inspired courses on management and emotional intelligence."
Medical groups are creating leadership pathways as well, Khullar notes, pointing to Sound Physicians, a company with more than 3,000 physicians. The company "has a pipeline for doctors to advance through structured rungs of leadership—emphasizing a different mix of clinical, strategic, and business skills at each stage," Khullar explains.
"As our health system continues to struggle to devise ways to improve quality and reduce costs, it's increasingly clear that a healthy culture can lead to better medical care," Khular writes. "For their patients and their colleagues, doctors must be leaders" (Khullar, "Well," New York Times, 11/21).