Why Do Some Pursue Roles in Leadership?

The reasons are as varied as the individuals themselves, but one thing is certain: They want to be catalysts for change.

When Mary Klotman, MD, trained as an infectious diseases fellow at Duke University School of Medicine in 1985, human immunodeficiency virus was the raging epidemic, almost surely fatal within a year of diagnosis.

Mary Klotman

Klotman saw some of the first patients afflicted with the virus. Working in a small cadre of specialized scientists, she zeroed in on a particularly cruel manifestation — end-stage kidney disease. This eye-opening experience, which transpired during her collaboration with the National Institutes of Health to rein in complications of the virus, crystallized Klotman’s fervent desire to become a physician scientist.

The first antidote to the HIV/AIDS pandemic, an antiviral medication, arrived less than a decade later, in 1994, more swiftly than an effective treatment for any illness in history. It served as a powerful example of how academic health systems can spark life-altering change. Klotman sought to be at the forefront of that kind of revolution, integrating her talents and interests in science with a passion for leadership.

From the outset, Klotman enjoyed being part of the academic medical culture while engaging others, especially younger professionals, so she sought formal leadership roles. “Either I [do it], or somebody else will,” she says.

Eventually, she became chair of Duke’s Department of Medicine, where she served for seven years. This past July, she rose to the most significant opportunity of her career — ascending to the position of dean at Duke’s medical school and the university’s vice chancellor for health affairs.

It’s a major-league leadership position. At a time when NIH funding has been declining, Duke ranked third-highest ($132 million) last year, after the University of California at San Francisco ($200 million) and Johns Hopkins University ($164 million), according to the Blue Ridge Institute for Medical Research.

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What motivates Klotman and other physicians to become leaders, to stand out from the crowd? What fuels the fire within? To be sure, for some, it’s about ambition, peer recognition or desire for a bigger salary. For others, with the support of nurturing administrators, it’s about diversifying power. And for many — perhaps even most — it’s about altruism on a large scale.

The Driving Force

No two physician leaders are alike, but there are some striking similarities among high achievers aspiring beyond one-on-one patient care. For many, the driving force stems from yearning “to have a greater impact on the delivery of health care and patients’ and families’ lives, by being able to work more broadly across the system than the individual one-on-one direct care,” says Kenneth J. Abrams, MD, MBA, a managing director and physician executive at consulting firm Deloitte.

After 21 years of clinical practice as an anesthesiologist, Abrams transitioned in 2008 to a full-time leadership role at the not-for-profit North Shore-Long Island Jewish Health System, in Lake Success, New York. (Today, the system is known as Northwell Health.) He became the system’s senior vice president for clinical operations and the chief quality officer in his late 40s.

“It was a hard decision to make,” Abrams says of the career leap. “When I went to medical school, I never really thought about becoming a physician executive. I always thought about becoming a physician leader, however.”

He says every physician who transitions from clinical care wrestles with that decision. “It’s not easy to walk away from what you’re trained to do — to leave behind everything you’ve done previously and embark on a career transition that has a significant number of unknowns, where success is measured very differently than in the clinical arena,” he says.

His introduction to physician leadership came two decades earlier as chief anesthesiology resident at Albert Einstein College of Medicine in the Bronx, New York, and its teaching affiliate, Montefiore Medical Center. He also became involved in anesthesiology societies and spearheaded various initiatives while volunteering on committees. After residency, he joined the Einstein faculty. A year later, he accepted a position at Mount Sinai School of Medicine as the health system’s director of trauma anesthesia at hospitals in both Manhattan and Queens.

During that job interview, his future boss asked: “What do you see yourself doing in 10 years?”

Abrams replied: “Being on your side of the desk as the chairman of anesthesiology.”

That ambition held true. Abrams went on to build a thriving trauma anesthesia program, training fellows and setting Mount Sinai’s research agenda. As an anesthesiologist, “there has been no greater privilege or honor for someone to put their life in my hands,” he said. “The concept of someone’s life in your hands is real.”

While undertaking the leadership role at Mount Sinai, Abrams decided to pursue a master’s degree in business ad-ministration. He earned an MBA in 1999, after three years of attending classes two nights a week, and then joined Deloitte five years ago as a thought leader in such areas as value-based care and preparing tomorrow’s doctors for today’s health care climate.

Moving into Leadership

Physician leaders constantly are urged to hone their skills in finance, budgeting and strategy, whether through degree programs, continuing professional education or on-the-job training. Many clinicians stepping into leadership roles have discomfort with business concepts such as these because traditional medical education programs train them to think like scientists — to search for a formula or a solution to a problem. Hard skills such as reading balance sheets and negotiating deals, and soft skills such as reading peer emotions or inspiring others, initially can feel inconvenient to acquire and awkward to use.

Venturing into unfamiliar territory often stirs up anxiety and some self-doubt. However, physicians increasingly are being called upon to steer health care organizations — to take charge of innovations while enhancing efficiency and curbing costs. That’s a formidable task even for those who embrace the idea of making an impact on wide swaths of a patient population. Improving the lives of hundreds, even thousands, of individuals would be impossible to accomplish one patient at a time.

To have the greatest possible influence, experts say, the best physician leaders obtain expertise in the financial and operational realms. Knowledge of managing cash flow, process management and organizational excellence takes on even greater prominence as physicians climb the leadership ladder. Emotional intelligence and leadership presence are also paramount.

“You do have a lot of people who are world-class scientists and talented academicians who struggle to lead a diverse large group outside their lab or scientific area of interest,” says Wesley Millican, founder and president of Texas-based Millican Solutions, a national executive search firm focusing on recruitment for academic medical centers and children’s hospitals.

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The person with the most impressive research port-folio might not be the most inspiring leader. “We re-place a lot of physician leaders who were only looking for the title and influence and had not given meaningful thought to their true capabilities and passions,” he says.

Leaving a legacy beyond their research becomes a catalyst for some physician scientists to gravitate toward leadership. “Their research is their legacy,” Millican says. “They definitely want to impact not only the lives of their patients, but the caliber of the people they train and the teams they lead.”

While mentoring their potential successors, many medical school deans, department heads and even some chief medical officers still are actively engaged in patient care. “Great physician leaders continue to practice their trade,” he says. “A clinical presence is important in maintaining one's credibility.”

Informal Leaders

Not every physician seeks a formal leadership role, although as they gain experience in their areas of practice, they can focus on specific areas, such as quality improvement efforts aimed at reducing hospital readmissions and lengths of stay, says Mary Norine Walsh, MD, president of the American College of Cardiology and medical director of the heart failure and transplant program at St. Vincent Heart Center in Indianapolis, Indiana.

“Physicians are the natural leaders of those efforts because of our natural understanding of the disease processes that patients have,” she says. “Growing expertise early in their careers in the hospital setting lends itself to further leadership down the road.”

Many physicians also develop leadership skills outside the medical environment. By serving on the boards of local organizations — chambers of commerce, youth groups, parks and recreation departments, and the like — they can get a better sense of the communities and the people they serve.

Some physicians regard seeking an advanced degree as a logical trajectory to formal leadership, and a growing number of today’s medical students are enrolling in new dual-degree programs to prepare for the management roles they expect to achieve in the future. Nonetheless, in Walsh’s opinion, “Leadership skills can be attained through on-the-job training and also some level of coaching and peer feedback.”

Even so, many courses within continuing medical education can help develop clinicians sharpen their ability to influence their circumstances — courses in communication, decision-making and ethics, to name a few — and remain relevant and effective.

Specialty-specific education is growing as well. For example, a partnership between the American Society of Anesthesiologists and Northwestern University’s Kellogg School of Management helps anesthesiologists gain specific knowledge about how federal and state regulations pertaining to accreditation and billing can affect themselves and their employers.

In addition, “they learn the ability to inspire, to create, to incentivize a shared vision, and the ability to build consensus and to energize teams,” says James Grant, MD, MBA, incoming president of the American Society of Anesthesiologists and chairman of anesthesiology at Beaumont Hospital in Royal Oak, Michigan.

Risks and Rewards

Learning to take risks also is important for any leader, and it requires bold and aggressive thinking, says Ellen Zane, CEO emeritus of Tufts Medical Center in Boston, Massachusetts, who teaches courses at Harvard Medical School and the Harvard T.H. Chan School of Public Health. “That’s very hard for physicians to do because when they practice medicine, they are dealing with people’s lives — therefore, they don’t like to do risky things,” she explains.

There often isn’t a clear delineation between a right and a wrong answer. After consulting with “people who are smarter than they are,” leaders must make difficult decisions, says Zane, who also is the former president of the physician net-work for Partners Healthcare System in Boston. “The value of taking risks is one of my many pearls of leadership,” she adds.

Whether they’re overseeing the acquisition and divestiture of a hospital or a provider group, physicians’ actions can be controversial. In negotiations with health care plans, they need to know how far to push and when to let go. “They have to deal in shades of gray,” Zane says. “They have to do their very best and then take the leap and the risk.”

As a physician leader in academic medicine, Duke’s Klotman has engaged in “a lot of internal brokering,” coordinating with faculty and understanding their perceived barriers to success in a complex organization. “Clinical care is very often at the forefront of new therapies,” she says. “If you stay as a professor, you can really focus very, very narrowly on what you do and do it extremely well.”

In contrast, moving up to a leadership position shifts the focus away from “what you do as your science and more toward how you enhance those around you, from which I get tremendous satisfaction,” she says. “Something has to give; you have to be realistic” in recognizing that no one can be the best teacher, scientist, clinician and leader, all in one. “That’s pretty much impossible.”

Susan Kreimer is a freelance health care journalist based in New York.