Let me share with you why I chose to move away from clinical care, how I did it and what I have learned.

Several events in particular nudged me out of my gratifying life as a practicing physician.

As fellows, we were told one day that the time we had to see our continuity clinic patients would be reduced to 15 minutes.

A few years later, as attending physician, we were told by our Department Chair that in an effort to improve access, backlogs and wait lists had to be eliminated within a few weeks, even if that meant staying late for  no extra pay. While the rationale seemed reasonable and necessary, how had this momentous decision been made?

Then came the sub-optimal implementation of the electronic medical record and medication reconciliation. These events made me question whether those who had made the decisions were clinicians, understood the significance and the consequences of these actions, whether they had at least consulted with clinicians, and why there was no explanation to those who were supposed to implement those changes.

It occurred to me that maybe the best person to understand and to tackle these issues that directly affect clinician work and their patients, would be a clinician. It was only years later that Harvard Business Review commented on how physicians made superior leaders in healthcare.

After having been asked to serve as Residency Director, my first leadership role, I realized that while I had learned the skills of being a physician and subspecialist, I didn’t know anything about management and leadership. Oftentimes, eager or talented physicians are “promoted” into leadership positions without any training, and struggle. Being the leader of a team in a clinical specialty that you are expert in is very different from leading change in an area that affects more and diverse people,  people you don’t  know, and in areas you are not familiar with (improving safety in the OR if you are an internist for example). There are several degrees to give you the leadership knowledge and tools, including the most popular Master in Business Administration (MBA). After some thought, I got a Master’s degree in Medical Management (MMM) because the emphasis was specifically on healthcare and less on finance.

During my MMM studies, that I conducted online and in person during normal clinical duties and call (yes it is very possible!), I discovered a whole new side of healthcare I hadn’t known existed: the policies, politics, governance, leadership skills, impact on community, legislation, marketing, legal, system quality and finance. I was very excited and felt liberated being able to think creatively, outside of protocols and standards of care, about these topics that so directly impacted the health of the people I was seeing in my practice and directly affect the lives and work of my fellow physicians.

I decided to give a career in leadership a try and have never looked back.

You might believe that a physician is best suited to lead in healthcare, shape the way healthcare is provided, you might want to grow professionally, you might want a change, or you might want to make an impact on more people’s lives. There are many reasons to take this step, and this decision is not irreversible!

It is important to note that I gave up clinical practice completely. Depending on your specialty and the leadership position you are considering, this might not be necessary. In my case, I felt that as an oncologist, I needed to be available to see my patients and couldn’t accept practicing just a day a week. Also, I was interested in higher level leadership roles that required a fulltime commitment.

What I learned for Physicians in Leadership:

• The hardest lesson for me personally was the realization that in a healthcare leadership role, I didn’t have the knowledge to successfully address all the issues. As physicians, we pride ourselves (and it is obviously essential!) on having all the answers, and if we don’t have them, we quickly find them. I realized that once I left my specialty, I wasn’t the expert anymore. For quite a while, I felt uncomfortable with not having all the answers! As a leader, you can’t and don’t know all the answers and indeed, you shouldn’t. You ask the experts, you delegate.
• Delegating is a critically important skill that also doesn’t come naturally to many physicians. We strongly feel that the responsibility for the outcome of a patient’s condition rests with us. We tend to get quite “possessive” of our patients. Delegating requires trust, something many physicians have trouble with. We have been trained in an environment that typically requires us to be self-reliant and independent. And while this has changed with the new emphasis on teamwork in medical school and residency, we physicians still mostly operate rather independently.
• Don’t jump to problem solving too quickly! As physicians, problems (symptoms, findings, concerns) are brought to us and our job is to promptly solve them (“diagnose, treat, next patient please!”). The problems that will be brought to you are complex, outside of your scope of expertise and likely have already failed resolution attempts by others. It is important to make sure the problem is clearly defined and thoroughly analyzed prior to attempting resolution. It is incredibly helpful to know who is an expert (and willing) in which areas in your organization, so that you can turn to them for their knowledge. It is equally essential to know who is accountable for what, so that you can appropriately delegate.
• I sorely missed patient interaction, the deep fulfilment of building rapport with them and working with them towards stabilization, improvement or cure. I missed seeing the impact I directly had on a life: life after life, in the office and at the hospital. It took me about four years to overcome this longing. I would literally get nostalgic walking past hospital rooms and the procedure room.
• It took me a few more years to convince myself that I was making a difference in people’s lives as a non-clinician. If you went into medicine to make a difference in people’s lives, you too might wrestle with this. I ultimately understood and believed that being removed from the clinical frontline didn’t mean I didn’t have an effect on patients. Indeed, as a leader I affect patients, their families, clinical teams and staff by shaping the environment of care and the processes of efficiently and effectively being able to provide that care.

There are many options for a physician to be a leader: the more clinically oriented Division Chief and Department Chair, Director or Vice-President for Patient Quality and Safety, the education and research oriented Chief Academic Officer, the Chief Medical Officer who is responsible for physician performance, Chief Operations Officer, Chief Executive Officer and more.

Our clinical insight positions us to make meaningful improvements to a culture of safety, adoption of innovation and technology as well as the path towards value-based care.

Over the years, I have seen a growing number of physicians pursue leadership roles in healthcare and believe there is more to come.

After having spent 10 years in clinical practice, going into leadership was a wonderful decision. I have been and continue to be very happy! Leadership has allowed me to grow as a person, to develop a vision, to listen deeply, to do some big-level thinking, to balance risk with benefit, to have a broad scope of activities, to express appreciation, to lead and grow teams, to create a work environment where all can provide care and safely and more efficiently, but mostly leadership has gifted me with a tremendous diversity of intellectual and human challenges, and enabled me to make a difference in many people’s lives.

As a physician in leadership, our clinical experience gives us the unique capability to bridge the gap between the human dimension of medicine and the financial aspect of the business of healthcare. We can lead from a position of humanity and science.