Engaged Physician Leadership: Current State of Affairs

As a part of the American College of Healthcare Executives’ 2021 annual conference, AAPL CEO Peter B. Angood, MD, FRCS(C), FACS, MCCM, FAAPL(Hon), sat down with a panel of AAPL board members to talk about engaged physician leadership and the current state of affairs.

Angood spent several years as a trauma surgeon and has been in a variety of nonclinical roles, primarily within organized medicine and organized healthcare. Joining him were AAPL board chair Mark Lester, MD, MBA, CPE, FAANS, FACS, FAAPL, a neurosurgeon who has held several different types of leadership roles in a variety of institutions; past board chair Greg Jolissaint, MD, MS, CPE, FAAPL, a family medicine physician who spent many years in the military, in the VA system, and is currently part of the Trinity Healthcare System; and board member Byron Scott, MD, MBA, CPE, FACEP, FAAPL, an emergency medicine physician who has enjoyed a variety of roles in leadership and has been in the nonclinical arena for several years.

This transcript of their discussion has been edited for clarity and length.

PETER ANGOOD: The American Association for Physician Leadership has the philosophy that at some level, “all physicians are leaders.” With that responsibility, physicians of all types, whether they have informal title roles or regular clinical roles, or even those who are outside the clinical delivery system, can be and should be effective leaders.

Given this, we thought it quite appropriate and reasonable for us to consider this current state of affairs and describe what it takes to have an engaged physician leadership. This is a dialogue. It’s a conversation among four folks who have been in the trenches and have experienced lots of leadership roles.

I’m going to ask Mark Lester to kick us off.

Mark, I think you have some opinions on what engagement means, so perhaps you’ll reflect on that for us.

MARK LESTER: Thanks, Peter. The title of this session is “Engaged Physician Leadership — Current State of Affairs,” and I started to say to myself, “Show me a leader who is not engaged.” Where else, when we talk about leadership, do we talk about the leader not being engaged? Certainly not in the political arena, certainly not in the corporate arena, certainly not in the academic world, and certainly not in healthcare.

Our leaders in healthcare are all engaged, so what are we talking about when we say we need engaged physician leadership? And what does it mean when we say that we want physician leadership engaged in the organizational improvement performance? Aren’t all leaders engaged in that?

I fear that part of the issue when we discuss physician leadership is that we’re kind of locked into closed-compartment thinking. In healthcare today, as it has been for over a century, the physicians in hospitals, at least, live in this animal called the “organized medical staff,” and it’s a relatively independent entity. It has its own bylaws, its own rules. And there are legal rules about the kinds of agreements that can be made with physicians. So already, physicians are compartmentalized at the hospital level into this medical staff organization.

When we expand broadly outside the hospital, physicians are compartmentalized into clinical thinking. Many leaders who are nonclinical think physicians only lead in a clinical space. The challenge today is that these compartments don’t work as well for us because if we think about it, the biggest challenge today is to take what was classically clinical and what was classically operational and bring them together.

Isn’t that why the idea of physician leadership has become so current? It’s because we can’t bring them together without physicians in a full organizationally leadership role. So, I think the challenge for us is not how do we engage leaders, but what’s the proper model and how should we be thinking of physician leadership in healthcare today.

We are moving to pay for value. We’re moving to accountable care. We’re moving to real clinical integration. How does all of this work if physicians can’t lead in an organizational context? I think that these questions can help us frame our conversation here.

ANGOOD: Thanks, Mark. Whenever I look at the lists of pressing issues for CEOs in healthcare delivery systems, engaging physicians is often within the top three. As the healthcare delivery system has moved along over the last couple of decades, that engagement of physicians in general is quite tricky. Is there a differentiation, then, between the regular medical staff and the physician leaders, per se?

LESTER: I would think so in terms of influence because leadership, as distinguished from management, is all about influence. So the question is really, how do physician leaders influence their organizations and influence their nonclinical and clinical colleagues?

Remember, clinical colleagues include physicians and nurses and other healthcare staff members, so physicians who don’t view themselves in an organizational leadership role may be influenced by organizational leaders, whether clinical or nonclinical. I think that can help separate what looks like a dichotomy.

ANGOOD: Right. As we know, it’s that formal and informal set of relationships that often drives the culture of an organization, and that efficiency and productivity are reflected in those cultures.

Byron, the nonclinical arena has physicians in many different sectors of the industry now. How is it that physicians are engaged in some of these nonclinical sectors, and how are they viewed? Are they engaged? Are they just business people?

BYRON SCOTT: I’ve worked in a couple of different areas, one being technology. I also work for a consulting group, and when there’s an annual employee engagement survey, everyone is lumped together, so they don’t break out responses based on whether you are a physician, a nurse, or a nonclinical person. Everyone is essentially measured the same.

With that being said, when people are evaluated in the organization, especially the clinical people, [physicians] are probably viewed as engaged. This is likely based on their value to the organization and their willingness to support and help people above and beyond what their job description describes.

It’s interesting when we talk about engagement. It’s not necessarily separated in those types of environments. Are you just a member? Are you participating?

ANGOOD: Do you think, though, that physicians in the nonclinical sectors are held to a different standard or expectation of behavior? Or is it truly as you described: you’re just like everybody else?

SCOTT: I wouldn’t say you’re held to a different expectation. I think everyone is held to a very high professional standard, but I think when you’re a clinical person, you are probably wearing two hats, meaning you have your employee of the organization hat, and you’re expected to do certain things. But if you’re a clinical person, a physician, you have another skillset, so you’re wearing a different hat. I wouldn’t say it’s a different expectation. You’re probably just doing two things at the same time, and you’re being measured and evaluated on both.

ANGOOD: Interesting. Greg, this might not reflect my true understanding of the military and a physician in the military, but doesn’t everybody in the military just follow orders? Is it easy to be engaged?

GREG JOLISSAINT: That’s a great question. In combat, you follow orders. Everything outside of combat turns into using soft skills — soft skills that we want to develop in physician leaders. You can’t emphasize enough the importance of communication, influence, emotional intelligence, conflict resolution, negotiation.

In the military, there is some sort of expectation that you are going to follow orders, but because at every meeting you attend, you have to convince someone that what you are trying to do for the department is good for the organization, those skills are important, even in the military.

I bounced through several federal organizations before I ended up in Trinity Health. The VA is very different in that there’s no expectation that you’re going to follow orders. Everything is a suggestion. And until you have said it three or four times, nobody believes you really mean it. It really does turn into a negotiation.

When it comes to the teaching hospitals, you have very few employed staff. Your staff comes from the university across the street. It’s an even bigger negotiation — for example, trying to run a quality program and trying to convince the staff to be engaged in the quality program. The first goal is to negotiate to get their participation, and then they will realize the value in participating.

ANGOOD: Absolutely. If you have a healthy culture, then folks in general, whether they’re physicians or other clinicians, want to help that organization move initiatives forward. Having heard all this, Mark, does that change the flavor of your comments about the generic and medical staff model or clinical delivery leaders or physicians?

LESTER: It shows that we have to move beyond just thinking about hospital structures, which were set in place in 1919 by the American College of Surgeons. That’s when the organized medical staff and its bylaws were decreed in American hospitals. Nothing in healthcare is the same as it was 100 years ago, except maybe that we’re in a similar pandemic now.

So, when we move beyond the strict hospital environment and we talk about physician leadership in industry, with startups, in private equity, in pharma, out in the community, and in accountable care, what we are talking about is clinical integration.

We need to be thinking about physician leadership in a generalized way. One of the things that Byron emphasized and Greg emphasized when he was talking about the military is that organizational context is vital because leadership occurs within an organizational context.

When I was with one of my organizations, I began a physician leadership development program for the entire system. It’s important to teach organizational literacy because physicians tend to lack the skills. Clinical training has a different focus, and when you realize that leadership is in an organizational context and leaders have to commit themselves to that organizational context, that’s when you start to think of physician leadership differently.

And you’re not just thinking, “Well, they’re a clinician. Maybe they can get other clinicians to do what we in the organization think is right.” That really isn’t the model that’s going to help us moving forward.

I think what Greg and Byron said helps us generalize the idea of physician leadership and think of it in an organizational context. Then we can realize where the deficiencies in clinical training are since organizational literacy is not taught there.

ANGOOD: Absolutely. And you can go back to the old Donabedian model, where structure and process drive your outcomes. In the clinical delivery system, regardless if you have a predominantly employed physician model or you have the traditional volunteer medical staff model, one of the coveted roles that physicians often aspire to is to be on the board of that organization, thereby creating their own influence. Should physicians be on these boards? And if so, what kind of skillsets should they carry into those boards?

SCOTT: It’s an interesting question, Peter, because if you go back 20–25 years ago, you probably didn’t see many physicians on hospital boards and on other organization boards besides maybe a medical group. Today, there are physicians on most boards in healthcare.

But I think that like leadership development, there probably needs to be a certain skillset. Again, it’s about investing in your development as a board member, because the duties of practicing clinically, having a leadership role in an organization, and being a board member are different skill sets.

That said, I think physicians have a responsibility when they’re on these healthcare boards, especially when they’re with nonclinical people, because they can be a big influence. They can be the individual who can help educate nonclinical people about certain nuances. I’m a big fan of having nurses and other clinical people on boards. Either way, there needs to be the proper development and training to be involved in those roles on boards.

ANGOOD: Greg, historically oftentimes physicians who sought out those kinds of roles would get tagged with a certain negative stigma. That may not be as prevalent these days, but given what Byron just said, as they aspire to more administrative influential roles, how do they manage that stigma?

JOLISSAINT: I think one of the things that we owe to healthcare in general is the idea of building the bench: figuring out who the next set of leaders is going to be and having those kinds of crucial conversations with them so that they understand this is not about becoming an administrator. This is not about giving orders to your peers. This is about making a difference for more than just the one patient who is sitting in front of you. This is about developing the skills that are required so that you can step back, and in a big-picture kind of format, understand where you fit into the organization, understand how to get things done in the organization, and understand how to lead in that organization.

The question is: Where is the person now in their career? Where are they regarding their leadership education? Sometimes it’s just a matter of giving them the confidence by sending them to a weekend conference to develop some of these soft skills. Some of them already have it, so it’s a matter of coaching them and meeting with them on a regular basis while they take over that job.

Some of them may have learned how to do spreadsheets in their formal training, but then they need to master how spreadsheets are completed in their own healthcare system or learn how to manage a budget. Filling in the gaps, from a professional basis, is going to help them be leaders.

ANGOOD: Absolutely. Mark, one of the most common questions I hear is, “Do I have to stay clinically active in order to be an effective leader inside of my healthcare delivery system?”

Personally, I’ve been out of clinical care now for a number of years, so perhaps my answer is a little bit artificial, but part of my message is to pay attention to your own local culture, especially around expectations. You should have the same focus and dedication to leadership expertise that you did for your clinical training and evolution. Be prepared to really invest in yourself and invest your time to be an effective, successful leader.

LESTER: If we think of leadership among physicians as strictly in the clinical space and as trying to influence other doctors to a clinical performance metric decided by an organization, that’s a limited view of physician leadership.

Early in my career, I was a leader in a clinical space. Neurosurgery was a division in a department of surgery in a big tertiary medical center with a strong academic affiliation. I was able to lead both at the section level and at the department level as vice chair for operations in the department.

I don’t think you need to be clinically active for many leadership roles. I’m guided by Mike Useem, who has a quote in his The Leader’s Checklists book that says leadership is learned by practice and becomes refined and improved with practice.

By practicing leadership extensively and by devoting yourself to it, you become better at it. You continually look back, but you also look forward. When you are in a leadership role and trying to influence clinical colleagues, it’s important that they see you as a credible physician. I found that the key to do this is to always relate physician-to-physician. You can do this even if you are not presently clinically active.

I think it’s important for the role of physician leader or physician executive that at some point in your career, you were in the trenches clinically. With this, you understand the clinical perspective. To lead at the level that we’re talking about and what’s required today when we talk about accountable care, clinical integration, organizational transformation, all of these features — well, that’s a full-time job. And if you’re going to lead at a high level, you’ll be giving clinical practice short shrift. So, I don’t think it’s necessary to practice clinically.

ANGOOD: I would agree with that. As I said, I’ve been out of clinical care a number of years, and yet I’ve maintained my professional association in my relevant specialties. I continue to get a variety of clinically oriented journals, and I do so because I want to be able to maintain my integrity.

Our constituency within this association is physicians of all types or multiple disciplines, a whole variety of institutional sizes and ranges. Whenever you engage with any individuals or even with some of these organizations directly, it is important to demonstrate that you’re cognizant of what’s going on in the healthcare industry, and to some degree what’s going on in the clinical arena. Not that you need to practice, but it’s maintaining that demeanor and sense of integrity as you know what it’s like to be a physician. You need to be aware of the current stressors of being a physician if you are a physician leader.

Greg, with the pandemic’s onset we’ve seen from our federal government, through the state level, and in a variety of clinical delivery systems, so-called incident crisis management assigned to teams. More often than not, it’s the physicians who are in charge of those teams. And yet there are also nonclinical folks represented. The nursing perspective and pharmacist perspective are there, plus other clinical disciplines. Whether it’s the hurricane, the earthquake, or the pandemic, what is the importance of incident management, and how do physicians slip into that leadership role?

JOLISSAINT: It ties back to Mark’s comments about organizational literacy. When a crisis occurs, the first thing you have to decide is who’s going to be most impacted by the crisis. With the pandemic, healthcare was going to be most impacted, so early on, many organizations decided to make the senior physician in the organization the incident commander. This made sense because they understood the nuances of the organization and they could step back and use the training they received (sometimes as far back as medical school) and be able to answer the public health questions that need to be addressed during a pandemic.

The physician has the ability to look across the organization and understand the impact on beds, on the nurses, the PPE, and the medical logistics. Also, transitions — what it means to transition to 12-hour shifts six days a week and the impact that that’s going to have on things like resilience.

ANGOOD: Byron, you’re an old emergency department sage. What’s your view in terms of crisis incident management and the role of physicians as leaders in these kinds of situations?

SCOTT: I agree with Greg: You need to have senior people involved in those roles, and I can’t think of anyone better than one of your organization’s senior physicians. But the larger issue is the strategic plan and disaster plan. If everyone goes back and reviews their disaster plans, they’re going to find that some of the basics have worked, but much of the plan didn’t work. Most organizations did not expect the extent of the pandemic, even though we’ve been talking about a pandemic for a long time. I remind people that yes, we have COVID, but we’re still due for a major influenza pandemic one day. Hopefully, we learned some good lessons.

ANGOOD: In my world of trauma surgery, I couldn’t agree with you more. Without the practice and at least the tabletop exercises of scenario planning you are ill-prepared. There is this concept of swarm intelligence, that somehow the swarm will figure it all out in the heat of the battle. But you shouldn’t rely on that because you still need your structure. You still need your processes.

Mark, what are some of your reflections on what we’re talking about here in terms of physician leadership and command central?

LESTER: We all have a tendency to think in a very linear way. You’ve heard over and over again during this pandemic: “Well, what’s the plan? We need a plan.”

I’m guided by the words of this great sage about complex adaptive systems, Mike Tyson, who famously said that everybody has a plan until they get punched in the face. You can have a plan that’s set up linearly and you think you have dealt with everything and then suddenly something happens, and it’s not at all like what you predicted. We see this all the time; therefore, we have to be able to adapt and reframe our thinking.

We have to remember that we live in a fishbowl. The entire world is watching us 24/7, especially in urgent situations. You have to factor in that you are onstage continually, and your actions could be misconstrued. Communication becomes even more important in leadership in critical situations.

If we think of leadership in terms of engaging physicians so they’ll do clinical things, then we’re not really thinking about our world as complex adaptive systems that require physician leadership and nonclinical leadership. In the broadest sense, we need to be able to train our leaders, physicians, and otherwise to think and act in these ways.

ANGOOD: What we haven’t touched on is the presence of social media in these situations. Not that the physician or the physician leader needs to engage in social media, but to your point, Mark, the healthcare delivery system is always being watched. And unfortunately, there is a section of our population that wants to engage on social media in a negative way, whether they’ve got the right details, the right facts, or whether they’ve developed misperceptions, or they’re purposefully trying to create a little bit of a vicious behavior.

Should a physician leader engage with social media? Should they deflect it? Should they just let it go away? This could be a separate discussion, but I bring it up here because it is just managing the communication. Greg, what do you think?

JOLISSAINT: Hopefully, you belong to an organization that’s large enough that you have people who do your marketing and communications, and you’re not sitting there with your phone doing social media yourself. But social media is a powerful tool to get the information out to the public that you serve.

Whether it is messaging surrounding wearing a mask, washing your hands, and using hand sanitizer, or doing your best when your priority group comes up to be vaccinated, you can use social media to get the word out. Since everyone is being bombarded with disinformation, hopefully you and your organization have developed the rapport and integrity, so the community wants to hear what you have to say. Hopefully, they are going to listen to you; they’re going to act on what you say, and that’s going to overcome the disinformation that’s being spread in social media channels.

ANGOOD: Maybe not the social media side, but underneath all of this is data, right? And it’s the flow of data, whether it’s in the right channels or the wrong channels. Byron, you have experience with data and data management. How can physician leaders influence in a positive way, like Greg was just alluding to?

SCOTT: We are talking about the correct way to handle leadership, management, and communication. You need to learn how to communicate in a professional manner. Along the same lines, as a physician leader, you need to understand data and analytics. You probably need to take courses. Data can be powerful, but again, like communication, it can be misused, manipulated, or misinterpreted, so physicians need to understand where the data’s coming from — can it be trusted and is it reliable? That’s a skill set I think is a basic competency for physician leaders that they need to develop. This is a foundation for any healthcare leader and especially any physician leader in today’s age with the speed of technology.

ANGOOD: Mark, as we think about communication and leadership, it really means we need a strong collaboration, correct? In a clinical delivery system, there’s a lot of collaboration between the clinical and the nonclinical leadership, both as individuals as well as teams.

Let me ask you a two-fold question, Mark, and then we’ll go over to Greg and Byron again. As you try to foster a sense of collaboration, you also encounter competition between clinical and nonclinical leadership. How do you manage that paradox of collaboration versus competition?

LESTER: I think it’s a great point. We’re talking about care. This is the essence of what healthcare is. Whatever we’re doing in healthcare, it’s about caring for people, and it’s about caring for people when they’re most vulnerable and most distressed and most challenged.

Care today has become very complex. Multiple pieces have to be in place and functioning properly, and often the course of a disease or an event may take a turn that wasn’t anticipated. Therefore, we have to be able to rapidly recalibrate and adapt, and we have to be able to use a variety of resources. Earlier I talked about taking what was classically operational, classically clinical, and joining that. You can’t have those running in parallel streams today — it’s too complex.

So by its nature, care mandates collaboration not only among clinicians and among nonclinicians, but also with their teams. That gets to team building. That’s another piece of organizational literacy and competency physician leaders need to master. All care today is team-based, and we have to be able to collaborate and to work together.

For the idea of competition, let’s look at a football team. Our organization has historically been based in Tampa, so let’s look at the Tampa Bay team. You’ve got [Tom] Brady and [Rob Gronkowski] Gronk. They are incredible assets to that team and helped it win a Super Bowl. They may be in competition to see who can be better that day, but they’re highly collaborative, so whatever competition they have is to make the team better and not to make the individuals better.

That’s very important in healthcare today. It’s not about the individual; it really is about the team. And that’s a shift, because as a field, healthcare has always pinpointed the individual. Who could we blame for a problem? Who could we credit for a good thing? Often, when we really look, it’s an entire team that produced. The competition enhances the collaboration and enhances the team’s delivery.

ANGOOD: Good points all around. And yet, Greg, we see a lot of dyad models, triad models, popping up around the country. Some of them are successful, some of them are failing, but under this same stream of collaboration–competition, what’s your view from your perch?

JOLISSAINT: Comparing three different large healthcare systems, the ones that succeed understand that it’s not just the nurse who’s in charge of quality, and it’s not just the chief medical officer who’s in charge of the medical staff. They understand that it is an interdisciplinary team effort. The effort requires interdisciplinary cooperation, collegiality, and leadership. The organizations that can transition the crisis and eliminate the finger pointing are the winners. Everyone understands their role.

Yes, the physician at the end of the day is going to end up making the decision about the patient, but you do that with the input of the nurse who’s taking care of the patient, and you’re doing that with the input of the supply-chain person who tells you what equipment is working and what equipment is not working, what supplies are available and what supplies aren’t available, whether it’s in the ICU or in the operating room. And, by the way, if you are a true team builder, you even make the housekeeping personnel and the transporters understand their role in the care delivery system. They are part of the wellness and improvement of health of the patients in that healthcare system.

So, being able to transition a crisis means you’ve got to be able to have a relationship where it really is four different members of the C-suite operating in their own lanes. It is a dyad, a triad, everybody working together as a team.

ANGOOD: There’s been another significant trend this past year that has caught a lot of attention, and that’s healthcare equity. We tend to think about social determinants as well. It’s a certain socioeconomic part of our social structure, but healthcare is not necessarily always good with equity. What is it that physician leaders and physician leadership can do to address some of these issues around equity?

SCOTT: It’s been an amazing time this past year because of all the focus on health equity and health disparities in our country. Yet, this is nothing new. The health disparities that we’re suddenly talking about have been there. Go back several years to the six aims of healthcare quality. One of the pillars is equitable healthcare. So, that should be a basic building block for any healthcare organization — no different than balancing the budget every month and making sure your P&L is accurate. What are you doing to measure yourself as an organization in making sure healthcare is equitable?

We all know the challenges with certain communities and social determinants of health, but again, are you doing everything you can as an organization? As a physician, I think that is one of those basic competencies, and it comes into that whole healthcare quality. I teach healthcare quality at two universities, and one of the things we focus on is those aims and making sure that people understand what equitable health means and all the variants of what that means and what you need to do.

Health equity is a critical skill for physicians because if we’re not taking the lead and trying to influence the organization and where it’s going, that organization or others are going to be in a tough bind. While I am happy we are paying so much more attention to health equity now, we should have been doing this a long time ago.

ANGOOD: Very well said. Thank you. We don’t have time to talk about all of the pros and cons of various employment models out there, but it’s clear that there certainly are increased employment trends for the physician workforce. As a part of that, there’s more engagement of physicians in leadership roles. Yet, some of these employment models are starting to falter and more often than not, it does come back to the communication, learning how to work together as a team, how to function in an interprofessional way.

As physicians, the way we’re brought up, the way we’ve been trained, the way our culture pushes us along, many times we have to unlearn a lot of behaviors. Mark and I are guilty. Neurosurgeons, hard, hard egos. Trauma surgeons, probably harder egos. But both of us have had to unlearn an awful lot of behaviors in order to be successful.

That’s going to be critically important in that employment arena. All of society is struggling with related to stress, anxiety, burnout. Suicidality is high in physicians. It’s going to take a lot of systems change over a long period of time and physicians need to be engaged in order to help create these healthier environments for the workforce as a whole. In order to help us get there, Greg, do we really need all these added credentials that we've accrued behind our name? Is it important?

JOLISSAINT: It’s a good question Peter, because similar to what Mark was talking about earlier, you have to bring some credibility to the table. There is a requirement that you have to demonstrate credibility as a leader. We’ve been talking about physician burnout for years, but I think the one thing the pandemic showed us is, it isn’t just physicians who can get burned out. As soon as we as leaders of a team are able to demonstrate for our healthcare systems that we’ve got to worry about burnout in our nurses, we’ve got to worry about burnout in our respiratory therapists, this is a team sport and everybody’s getting tired and everybody’s getting burned out.

We’ve got to build resilience in the entire workforce. So yes, being able to step back as a leader and see the big picture, to see the whole organization, to understand the organization and to understand the impact of anything that the organization is going to have, it’s critically important.

ANGOOD: In a few short words from each of you, and we’ll start with Mark, what do you see as the future trends for increased efficiency and improvement of physician leadership in this country?

LESTER: We need to reimagine what physician leadership means and what it can bring. And then having done that, we need to provide physicians with the competencies they need. Influence, emotional intelligence, team-building, negotiation, strategic thinking, understanding operations, finance, all of these things, and understanding organizational context and what leadership means. And that means we need to work with physicians to develop their leadership for the future needs and the present needs of healthcare.

JOLISSAINT: Building the bench. Like I said earlier, we’ve got to identify those future leaders. We have to help them self-assess as to what their current skills are and where their gaps are. We have to help them develop the skills and tools that they’re going to need in order to lead, and then we have to continue coaching them and mentoring them as they progress into the future.

At the same time, we’ve got to get rid of our pride and be willing to work with nurses, be willing to work with the supply-chain folks, be willing to work with the people who are going to make organizations successful. And we need to rethink the whole leadership model for healthcare systems in the first place.

SCOTT: I think it’s taking all those things together and also trying to re-imagine and create innovative ways to bring joy back to work. Make work fun. I mean, medicine is hard, but all of us have worked times in our organizations clinically, where you work very hard and are very productive, but you were also having fun. And we need to make sure that no matter what, we continue to emphasize that. No matter what, let’s bring that element of joy to work.

ANGOOD: Thank you. Great comments from all of you.

At some level, all physicians are leaders, and our association really strives to help the physician workforce and organizations as a whole embrace that sense of potential for physicians to provide stronger leadership.

Remember, leadership drives the culture in any organization, whether it’s clinical or nonclinical. The culture of your organization knows when the leadership is working well or not. And physician leaders, physicians as a whole, are often closely tied into that culture; they drive the culture indirectly as well as directly. Physician leadership is pivotal.