Clinical Practice: Leadership Practice

Greetings from San Francisco, where I am meeting with fellow California Academy of Family Physicians #FMRevolution-aries!

Lately, I have been awash in thoughts about family medicine and leadership (blame it in part on my participation in the California HealthCare Foundation Health Care Leadership Program). We are, after all, at a historic juncture in redefining how to deliver health care to more people given that health care reform is now law. Because health care delivery is still mostly a local enterprise, we physicians face tremendous opportunity and we face tremendous fear (my resident physician colleagues might call this a “fearpportunity”).

We cannot afford to fear. We must choose courage.


Historically speaking, physicians have largely abdicated their responsibility for shaping health care delivery because they chose to oppose change (often vociferously) or worse, remained silent believing that business and politics were best left to the business people and politicians. The development of physician leadership in many ways reflects this passive, even passive-aggressive, thinking. Just look at the walls in the board room of any hospital: our physician leaders historically have been those (graying) (wo)men who have demonstrated excellence in clinical practice over their career.

Another way of saying the same thing is that physicians inherently distrust those physicians leaders who are far-removed from clinical practice. We little regard leadership acumen mostly because we do not deliberately think of leadership practice as distinct from clinical practice. This way of thinking must change. To not change will result in the hugest lost opportunity in the history of medicine (and I do not believe that I am conflating here).

The O’Brien Group writes about physician whiplash and outlines the differences/tensions between clinical practice and leadership practice. Here are a few select examples:

  1. Prescribe and expect compliance versus lead, influence and collaborate
  2. Procedures and episodes versus complex processes over time
  3. Relatively well-defined problems versus ill-defined and messy problems
  4. Consistently effective solutions, protocols, best practices, processes versus frequent environmental shifts requiring complementary changes in solutions, processes, best practices, styles and approaches
  5. Increasing focus on specialization versus increasing need for comprehensive and integrated approach
  6. Being the expert versus being one of many experts
  7. Working solo or with small teams versus working with larger teams and complex networks
  8. Respect and trust of colleagues versus suspicion of being a “suit”

We must embrace the fearpportunity. Not only must we become the physicians that we wrote about in our personal statements, we must become the physician leaders that the health care system needs us to be. Just like it required years of training to become a physician so will it require time to learn the practice of leadership except we cannot afford to wait passively to be trained. Now is our time. Fear not. Rise up and speak up. Become a leader.

This post originally appeared on FAMILYDOCWONK, Dr. Jay Lee’s personal blog.

Author: Jay Lee, MD, MPH

Jay W. Lee, MD, MPH, FAAFP, is Associate Medical Director of Practice Transformation at MemorialCare Medical Group and Assistant Program Director/Director of Health Policy at the Long Beach Memorial Family Medicine Residency Program. He is also Speaker on the California Academy of Family Physicians' Board of Directors.

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