Leadership Skills for the Non-Leader

H. Clifton "Clif" Knight, MD, CPE, FAAFP; Vu Kiet Tran, MD, MBA, MHSc, CHE; Melissa Hemphill, MD, FAAFP


December 15, 2017

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H. Clifton "Clif" Knight, MD, CPE, FAAFP: Hi. My name is Clif Knight and I'm senior vice president for education at the American Academy of Family Physicians (AAFP). I am here in San Antonio at the Family Medicine Experience and am joined by a couple of my family physician colleagues.

Melissa Hemphill, MD, FAAFP: I'm Melissa Hemphill. I'm a faculty member at Providence Oregon Family Medicine Residency in Portland, Oregon.

Vu Kiet Tran, MD, MBA, MHSc, CHE: Hi. I'm Vu Kiet Tran. I'm a family doctor in a community practice in Ontario, Canada, and also on faculty at the University of Toronto for emergency medicine.

Experiences in Leadership From Two Different Perspectives

Dr Knight: Thank you so much for joining me here today. This is going to be an interesting discussion about leadership for non-leaders. All physicians are leaders in some way or another, but many have not been directly involved in leadership roles and may not feel very confident in their leadership skills. We know that some physicians feel a lack of control in their practice environment. In this important discussion we will talk about how physicians who are not necessarily leaders, or have not been in leadership roles, can begin to develop their leadership skills and feel empowered through leadership.

I really appreciate you both being here to share your perspectives and experiences. Melissa, what leadership experiences have you had at this point and how have they been helpful?

Dr Hemphill: I'm only 4 years out of residency, so I have not had a long time to get involved with leadership. My experience with leadership started when I was a medical student. My state academy reached out to me and asked if I wanted to be involved as our student board member. I was nervous and normally would have said no to things like that, but against my natural inclination I said yes. It segued into a student board role, a resident board role, and now I'm our state's vice speaker. This year I was able to come to the AAFP Congress of Delegates as our elected new physician delegate.

You can find leadership in yourself if you look.

Dr Knight: Vu, how about you? What has been your leadership experience?

Dr Tran: My leadership experience started quite late. After my MBA, I took on several jobs and eventually became medical director of a few private enterprises. I own and operate four family group practices in Canada. A lot of my managerial and leadership skills have been acquired that way. Very recently, I joined governance as well. I'm on the board of a major retirement home and long-term care organization operating in Ontario for culturally sensitive patients, mainly in the Chinese community.

Dr. Knight: Quite a bit of different types of experience here. Vu, I know you are doing some teaching on leadership for non-leaders. How did you get involved in that? Why is leadership important for non-leaders?

Developing Leadership Skills

Dr Tran: Leadership is important on many aspects. During my MBA training and other leadership development courses, I realized that leadership skills are important not only at the system and organizational level, but also at the one-to-one encounter level with our patients. That is how the title "Leadership Skills for the Non-Leader" came about. We all have these skills as physicians, because we are asked to be a leader the moment we become a physician. Some of the skills may not be obvious to us right from the get-go. They are taught to us, and we may not realize that we are being taught. Some of us need to recycle and relearn them, but we definitely learned them in our training.

Dr Knight: Sometimes people think leaders were born leaders. Do you think people are born with leadership skills or can leadership skills be learned? Melissa, what do you think?

Dr. Hemphill: In my case they were definitely learned. I do not feel like I was born a leader, but I think that you can find leadership in yourself if you look. I learned that physicians could be leaders in any role when I was in my residency.

During my residency experience, we underwent a medical home transformation that involved co-locating our teams. All of the doctors changed from sitting together in the back room to sitting with medical assistants and staff in a pod. There was a lot of resistance from both the doctors and the staff to this change until one third-year resident went out and did it first. As a resident, not faculty, she inspired every other doctor to go out and sit with the rest of their staff and their team. Our team then felt that they could do it too. It has been that way for 6 years now, and I would not want to go back. Someone who was not a leader and was not thinking of herself as a leader showed true leadership that changed the way my whole clinic functions.

[W]e are asked to be a leader the moment we become a physician.

Dr Knight: Vu, you talked about in your experience that you were not a leader early in your career but you learned leadership skills. Is that right?

Dr Tran: Exactly. I agree with Melissa. Some of us have more leadership potential than others. Although some of us were born leaders, we all have the potential to be one. I learned it throughout the years. I did not really think I had the potential, but I have slowly developed leadership. The nice thing about leadership is that it is a skill that is continuously being learned. I cannot say that I have perfected the skills of a leader. I am constantly learning and that is the fun of it. You learn, you fall, you get back up, and you learn again. The entire journey makes it fun.

Advice for Those Facing Burnout

Dr Knight: Unfortunately, burnout among family physicians is at an all-time high. About two thirds of family physicians report at least one element of burnout. When we hear about the causes of that, certainly the big system is an issue. People feel that there are too many documentation and quality-reporting requirements, and too much emphasis on volume of patients instead of quality of care. There is this deluge from the big-system viewpoint. Other folks feel like the organizations or practices they are in are problematic for them, and this leads to their stress and burnout.

Think about a physician who might be watching this who is feeling trapped in their practice, does not feel like they have control over their situation, and who might be thinking about leaving medicine. What advice would you have for physicians who are faced with that right now? Advice especially around developing a better sense of control. How do they start their leadership journey within their practices and organizations? Vu, what would you say?

If you say yes to something you are actually saying no to something else.

Dr Tran: That is a great question. I started my leadership journey and my understanding of what I wanted to do by learning about myself. The first step was understanding who I was, my likes and dislikes, and my strengths and weaknesses. I am obviously trying to work on my weaknesses, but a lot of the fun is also trying to perfect what I do well.

In a stressful environment with lots of demand on my personal and professional life, I really needed to make choices. Someone told me, "If you say yes to something you are actually saying no to something else." I really needed to know what that yes was and what the no's were, and when to say yes and when to say no. It was a journey about searching for myself first, and once I did, I was much happier.

Dr Knight: Thank you. Melissa, how about from your perspective? What advice would you give?

Dr Hemphill: I would say, hang in there, which I know can be hard if you are feeling like you are burning out. Even just 4 years into practice I have already experienced some of those elements of burnout and many of my peers have too. Every family doctor I know went into family medicine with a passion for taking care of whole families and whole communities. Sometimes it can feel like you are losing that passion, but if you can reconnect with it, it can drive you to be engaged again. Figure out what your yes's and your no's are and what you need to do to stay in the field of medicine.

As a new physician, I went into leadership because I had this dream of what medicine would look like, and when I got into real practice it was not what I thought it would look like. Leadership for me is a way to enact change, and to bring my reality into alignment with my dreams. If I want to practice medicine the way I want to, the only way I can do that is through leadership. If someone is burning out, a wonderful way for them to try to solve that situation is by getting involved and seeing what they can change.

Dr Knight: Thank you both so much for sharing your experiences and your perspectives with us as we try to help improve our system and help empower physicians to help make the system better. Not just for themselves so that they are more professionally satisfied, but most important, on behalf of the patients, families, and communities that we serve. Thanks for sharing your experiences and best of luck to you both.

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