Two years ago, our department chair asked me who I thought could lead my division as chief. The prior division chief, one of the most senior people in the department, had resigned a few months ago. I mentioned a seasoned, esteemed colleague I thought would lead the division well.
“Anyone else?” She looked at me expectantly.
“Well, you don’t mean me, do you?” I blurted out, indecision ripe in my voice.
“Of course not,” she scoffed as I sank into the chair, mortification weighing on me like a wet blanket. Of course I couldn’t lead my division; I was only eight years out from finishing residency, had just been promoted to assistant professor, and had the biggest leadership role I’d ever had as the associate program director of our residency program. What possessed me to think I would be capable of leading the biggest division in the department?
I internalized that dismissal and stayed in my lane. It seemed, however, that the division chief job was akin to the defense against the dark arts job at Hogwarts that Voldemort had cursed. The next division chief the chair appointed resigned after less than six months, and the person who took on the role after her indicated that she had no desire to continue for much longer. This transience (or maybe intransigence) of this leadership role forced the chair to conduct a formal national search.
By this point, I had witnessed over a year’s worth of triumphs and debacles in departmental and divisional leadership, and I intuited that you didn’t suddenly get to the point where you were now ready for a leadership role. In some ways, you jumped into the role, and it molded you, with all of your very human imperfections, into a leader. The right substrate just had to be there. That substrate incorporated compassion, integrity, the willingness to work hard, a desire to serve others, and a growth mindset.
MY ROAD TO LEADERSHIP
As the child of immigrant parents, I was raised on the mantra of “work hard, and you will achieve.” Over the last nine years, the bonds I developed with many of my colleagues made them feel as close as family. We supported each other, understood our profession’s challenges and frustrations, and celebrated each other’s successes.
The call to apply tempted me, but my conversation with the chair, when she suggested that I was incapable of being the leader the division needed, echoed in my mind. I spoke to two of the prior four division chiefs from the last nine years, who subtly dissuaded me. The job was operations-focused, and there were always too many fires to put out. One mentor worried that I would lose the joy of my academic work because the role would suck away all my time. I considered their concerns and understood objectively that this job had somewhat crushed four extremely capable women.
The one advantage I had over the prior division chiefs was that I harbored no illusions about the job’s difficulty; it was all guts and no glory. I knew that I might not be able to fix anything, much less everything, but armed with resilience and perseverance, I might be able to break Voldemort’s curse.
So, I applied. The department chair did not offer me an interview and, in fact, did not interview any applicants for the job. I realized I might never be considered a serious candidate for the position. I was ready for career growth and promotion by this point in my career, so I applied for other leadership roles at several institutions.
Nearly a year after my initial conversation with the chair about the division chief role, the office sat empty. My division reeled from rapid transitions and attrition, and I expressed my renewed interest in the role. A month later, I was formally announced as the next division chief.
A year after taking this role, two truths present themselves with great clarity:
I have felt extremely fulfilled professionally as I have grown and faced challenges.
I have never worked harder in my life.
I have made many mistakes, floundered through meetings, and hastened to clarify my intent when I have offended someone through a careless phrase (nota bene: telling an administrator that she slaps patients onto doctors’ schedules will never, ever buy you goodwill).
I have been imperfect and impatient, but I have also held together a division that was fraying at the seams, consistently expressed my appreciation and gratitude for my amazing colleagues, and done every task that I have asked others to do.
ON REFLECTION
As I considered what I could have done better in the last year, I reflected on the lessons that I learned from every situation:
Ask for help.
Attrition had created a dearth of senior physicians within my department. In my new role, I needed mentorship, but I felt as though I couldn’t burden the few people left with my struggles, even as they were facing similar challenges. While working through our problems together could be helpful, without clear leadership from the departmental level, we risked airing complaints without building a framework for solutions.
Instead, I contacted a division chief from another department with whom I had collaborated on a paper. That meeting influenced the trajectory of my fledgling foray into leadership. The division chief suggested I apply for a physician leadership program at the institution. I cobbled together an application in four days and was accepted into the program based on the strength of her recommendation.
Through the program, I received coaching; training on delegation, negotiation, and conflict management; and support for the operational projects I embarked on. By surrounding me with supportive scaffolding, the leadership program enabled me to experiment, focus on building my leadership skills, and reflect on my mistakes and challenges among other new leaders without fear of judgment. None of this would have been possible had I not asked for help.
Allow people to challenge you.
A colleague texted me recently that she didn’t understand my recruitment strategy. My top priority since I started this role has been recruitment to replace the faculty we had lost. I had been talking to potential candidates, updating our job descriptions, and interviewing up to four candidates a month to fill our many vacancies. Hiring stuttered along without a permanent chair or an increase in compensation.
As I scrambled to arrange coverage on labor and delivery nearly weekly, I was acutely reminded of the lack of success in my recruitment efforts. This very visible failure gnawed at me, and so when I received that text message, I could immediately feel the blood rush to my head. My first thought was: Doesn’t she see how hard I am working to recruit people? Doesn’t she see that I know exactly where the holes are and that I’m trying to fill them?
I responded to her text with justifications for my efforts, and we continued to volley back and forth. I could feel my heart racing as I typed back evidence of all the work that I’d been doing: I’ve put out 11 offers! I’m interviewing three more candidates this month! I can’t control if people decline the job!
This exchange raised my hackles (and probably my blood pressure), and a few days later, I reflected with my coach on how this text exchange made me feel. She paused and asked me why my first instinct had been to defend myself. “Against what accusations?” she probed. My coach pointed out that my colleague had said that she didn’t understand the strategy for recruitment. Yet, I had made multiple inferences from that comment, which ultimately led to one conclusion: I was a failure.
My coach asked me what I could have done to manage this situation differently. First, perhaps I shouldn’t have had this conversation via text in the middle of a busy clinic day. Second, I should have approached the conversation with curiosity: “What makes you say that?” or “Tell me more,” rather than immediately constructing a castle of words in self-defense. I should have invited my colleague to speak with me at a mutually convenient time so I could grant her my undivided attention and practice being curious about her perspective.
To approach from a place of curiosity, I had to stop hearing and feeling that I was a failure. I had to realize that whenever anyone questioned my decisions, it was not reflective of a failure on my part but rather originated from a place of genuine desire to support the division. It is a constant battle, not feeling that I could have done something better or been better somehow.
I don’t have the solutions to dampen that inner critic, but recognizing my achievements and learning from my failures is the only way forward. Discarding the defensiveness and landing at a place of curiosity by flexing my growth mindset will allow people to ask questions that could lead to engagement among the faculty, discussions that could lead to potential solutions, and a shared sense of responsibility and solidarity.
Question assumptions.
When I transitioned to part-time clinical work after having my second child, the division chief at the time told me that I couldn’t continue to do major surgery, take call on labor and delivery, and build a robust patient panel.
Practicing general obstetrics and gynecology is unique because we are somewhat a jack of all trades, but maintaining that skill set requires a significant time investment. The assumption was that I couldn’t keep the breadth of expertise working clinically only part-time, yet I put in the effort to maintain that skill set. Somehow, though, I had internalized this assumption.
When a faculty member in the division decreased her clinical footprint significantly, I found myself parroting the very words that had been said to me some years ago. I had to pause to identify where this assumption came from and whether it was even accurate. I followed up my meeting with the faculty member with an apology. I reiterated my support of her clinical career, which was particularly important for this early career faculty member as she balanced an academic career with clinical work.
Assumptions enable us to make faster decisions and navigate challenges efficiently. By relying on past experiences to inform our response to current conundrums, we eliminate the need to rethink our response to every predicament. We know what worked before and can implement that. Yet assumptions can profoundly limit our understanding of the world. They can make us forget that each person is unique, and while situations may be similar, the human element constantly changes as we each bring our own strengths and foibles to the context.
When my division chief warned me that I wouldn’t be able to do it all, I’m sure that warning emerged from her past experiences with others who had floundered, so she wanted to spare me disappointment and failure. I, too, wanted to set my faculty member up for success, which is why I passed along the same warning I had received. Yet both of us had different priorities and experiences from our predecessors, and applying the same solution to similar problems for other people generated only discontent and frustration.
We must question our assumptions and examine our own biases. In doing so, we can engage more fully in the challenges that inevitably arise in leadership. While seeking advice from others who have been in similar situations provides an invaluable resource, using that as an opportunity to reflect on the individual before you and brainstorm solutions that incorporate that individual’s unique skills rather than copying what was done before you enables you to be nimble and thoughtful in your approach rather than rigid and stringent.
Listen and learn.
When I started my role, the division faced a seven-figure deficit, we had an attrition rate of 30%, and nearly half of our shifts on labor and delivery remained unfilled. Significant changes were needed to close the financial and coverage gap.
The urgency of the situation called for rapid, decisive action, and I made several substantial adjustments to clinical schedules, productivity, and compensation to stabilize the division and our clinical spaces. Given the quick turnaround demanded however, I could not build consensus on the necessary changes.
I presented the division’s financial and clinical troubles to the faculty to provide the rationale for the changes that I had simply informed them about. Understandably, people grumbled about the changes, which I maintain were necessary, although many of them were also quite drastic. Even though some changes improved people’s quality of life (like increases in compensation and decreases in overnight calls), faculty primarily remembered the negatives: that they were asked to add more clinical sessions and reduce administrative time.
I struggled with balancing the negative sentiments and the criticism subtly directed at me for the rapid-fire implementation of these changes. A few months later, a mentor told me to slow down, hinting that people were still reeling from the pace of progress. Progress had to happen in a department that had been in limbo for more than five years, but stagnation had led to a sense of complacency that had lulled people into thinking that nothing would ever change or that it needed to change. When I started the role and entered very much like Miley Cyrus’s wrecking ball, it left people feeling unsettled and unheard.
We hired two additional faculty members, and the first quarter’s financial results were significantly better than last year’s. Finally, I felt reassured that my division would not fall apart or cease to exist. Having stabilized us, I paused to take a breath and reassess how to navigate the next few months. I realized that while people would begrudgingly accept action undertaken in a time of urgency, I needed to slow down and listen now that we were through the most stressful time.
As a division, we were going to be okay. Our patient access had expanded and our revenue had increased. Now, I needed to focus on physician satisfaction within the division. Still, to do that, I needed to know their points of frustration in the current clinical and operational systems.
After speaking with a project management expert (offered through my leadership program), I decided to convene a meeting where the faculty could talk freely about the issues that they wanted to prioritize in the coming months. I also prepared with my coach, creating strategies for focusing the meeting and leaned on a quality improvement expert within the department to help me run the meeting.
We framed the meeting as an opportunity to identify areas for improvement without focusing blame on anyone. I simply listened and took notes while the quality improvement expert organized people’s thoughts into a priority matrix that everyone reviewed after the meeting. This discussion proved rich and informative, providing me with a significant amount of information about what our faculty valued and what they felt could be improved, and gave me a substrate with which to work. All this happened simply because I listened.
KEYS TO SUCCESS
Leadership in a time of instability engenders a unique set of challenges, but accepting a new leadership role in a vacuum of support can create a miasma ripe for failure. Regardless of how much experience they bring to the role, any new leader will struggle, but to struggle alone leads to burnout and discontent.
Yet, even in turbulent times, a new leader can succeed. Ultimately, we as leaders are representatives and advocates for our faculty and our team, and consistently remembering and broadcasting this message creates an environment of trust, mutual respect, and collaboration that can elevate our team and foster success.