Physician Leadership – 3 Reasons Doctors Make Naturally Lousy Leaders

Posted by Dike Drummond MD

physician-leadership-dirty-little-secrets-300WPhysician Leadership Skills – Why Doctors Make Poor Leaders and What YOU Can Do About It

In ten years of coaching physicians, I have found one thing to be constant.

All physicians work too hard.

We take on too much, do too much, worry about too much try to control too much. This overwork is a key cause of physician burnout and a direct result of our medical education.

The reason is simple. You were never taught how to lead your team effectively. Key leadership skills never made into the curriculum of your medical education.

As a result, we naturally and automatically fail to tap our team's skills and experience. We block them from sharing the workload more effectively. 

Fortunately, the leadership skills to share the load are simple and can be quickly deployed in your practice day.

Here are three ways to begin your leadership upgrade.


Physician Leadership 101

Residency teaches you how to lead nurses and MA's in the standard top-down physician fashion. Remember that you never took a leadership class in residency. No one taught you how to lead this way. We absorbed this leadership style by osmosis as we learned how to care for patients.

Physician leadership 101 says:

  • You give orders
  • The patient complies
  • The team obeys

Unfortunately this puts all responsibility on you and turns your people into sheep, waiting passively for your orders before taking action.

Practice is also different from residency in a couple more important ways. Now you are the leader of a larger, multifunctional care team, wedged into the middle of a huge bureaucracy of non-physician administrators.

Our new leadership role can be daunting. We are prepared to diagnose and treat … but what about all the other questions about patient flow and personnel issues that come our way? No matter what the question, your team looks to you for answers. And let's admit, there are plenty of times when we come up empty. "How am I supposed to know what to do here."

You can even start to question if you "have what it takes” or whether you are an imposter of some kind. You can relax here.

This physician leadership skills vacuum is a natural consequence of our medical training and medicine’s unique business model.

If you take on a formal leadership role in your organization - say, a medical director, department chair or CMO - your inability to navigate a complex bureaucracy and intricate matrix of relationships will become immediately apparent. How can you be an effective physician leader, when all you were taught to do is give orders and expect people to obey your every command?


Here are three challenges to acquiring effective physician leadership skills that are hard wired into our training process – with suggestions on how to bypass them for a better day at the office for you, your staff and your patients.

Without these skills you are doing most of the heavy lifting for your team and working WAY too hard.



1) A Dysfunctional Default Physician Leadership Style

Our medical training is almost exclusively focused on our clinical skill set. We take a minimum of 7 years in medical school and residency to learn and practice the ability to diagnose and treat. That knowledge base is nearly overwhelming all by itself and it is unfortunately not sufficient once we are out in practice.

Once we graduate we quickly recognize that the act of seeing patients and delivering our treatment plan is dependent on a whole team of people. We are meant to be an effective team leader right out of the gate, but were never taught the basic physician leadership skills to play this role.

We automatically adopt a dysfunctional physician leadership style based on “giving orders”

The clinical actions of diagnosis and treatment are simply adopted as our default physician leadership style. When faced with any practice challenge, we assume we must be the one who comes up with the answers (diagnose) and then tell everyone on the team what to do (treat).

We learn a “top-down” physician leadership style naturally and automatically

This default “command and control” physician leadership style – the same one used in the military – has its consequences. It turns your team into sheep. Here’s what I mean …

It will seem to you like they have lost the ability to make independent decisions.  

Have you ever felt overwhelmed by people asking you non-clinical questions about scheduling, billing and such? Everything anyone perceives as a problem — from the front desk to the billing office — is brought to you for a solution.

The top-down physician leadership paradigm produces that naturally. They all look to you for answers because you are the apex of the top-down pyramid. It does not have to be that way. A simple change to a more collaborative and team centered physician leadership style can make a huge and immediate difference.

Become an Effective Physician Wellness Champion
The Quadruple Aim Physician Leadership Retreat


What you can do differently?

Physician Leadership begins when you understand there are multiple areas of your practice where YOU ARE NOT THE EXPERT — and start to use the whole team’s expertise to address the problems you are facing.

After all, you are in the room with the patient, doing your best to solve the clinical issues while the rest of your staff spends their day actually working in your scheduling and billing systems. They are the experts in what is going on in those areas … not you. The key to leveraged physician leadership is not you figuring out the answers … it is easier than that.

The key is to ask more questions … and give fewer orders

Questions create the context where your team can solve the team's problems.

=> You don't have to figure it all out and tell them what to do.

=> They don't have to sit on their hands waiting for you to give orders.

Just asking a couple questions to your team this week ... rather than always giving orders ... will make a huge difference in your practice.

Become more of a facilitator … not “the boss” and source of all the answers.  Ask your people what THEY suggest as the solutions to the problems they discover. You might even tell them to only bring you a problem if they bring their thoughts on a solution at the same time.

Have regular meetings where you work “on” the practice and deal with these issues as a collaborative team … rather than spending all your time working “in” your practice. This is the key to a much more effective physician leadership style. You begin leveraging the skills and experience of your entire team.

When you work together to systemize and delegate you won’t feel like you are doing all the work and your team will feel honored and more involved. A better practice experience for you, your staff and your patients will result.

2) No Physician Leadership Training & a Nonsensical Business Model

When did you ever receive training on physician leadership skills? Didn’t happen in my residency. It is foreign territory for most of us. Physicians as a group tend to see physician leadership, facilitation and the meetings required to coordinate the actions of a team as necessary evils we would like someone else to address.

I have heard this over and over. “I just want to see patients.” That is because you were only trained to perform that activity. The subjects of physician leadership and organizational development are absent in our medical training and yet become crucial to our success out in practice.

Then there is our business model … which often makes no sense at all.

Imagine the CEO of a automobile manufacturer who is simultaneously the only person who can put the doors on the cars in the assembly line. The boss is the biggest bottleneck in the system. Who would design a business like that? Welcome to the world of medicine. You are the leader and the piece worker on the line at the same time.

You have the complete skill set to do your work on the line … seeing patients behind a closed door in the office. You don't have the leadership skill to use your team effectively. So the doctor plays the Lone Ranger and always ends up working too hard.

The key is to respect, understand and begin acquiring physician leadership skills. Understand how to lead effectively will make your life easier and your team and patients happier and healthier.

A great place to start is to beef up your physician leadership skills with some of best books on the general subject of business leadership. Books like these classics.
“First Break All the Rules”
“The E-Myth”
“The Five Dysfunctions of a Team”
“7 Habits of Highly Effective People”
“The Leadership Challenge”
“What Got You Here, Won’t Get You There”
Any of these books will give you multiple instantly effective tools you can use with your teams.
[please put your favorite physician leadership book in the comments ... thanks]

Build A System-Wide Burnout Prevention Strategy
Our Corporate Support Services are Here

3) We Demonize Managers and Become Part of the Problem

If I say – “Medical Director” to you … what are the first words that come into your head? I will wager they were not positive ones.

This common knee jerk reaction has important negative consequences for everyone.

Physicians as a group tend to see anyone in a management role as “the enemy”. If these people would just do their jobs, we could finally left alone to “just see patients”. These are the “bean counters” and “pencil pushers”.

It gets even worse if that same manager, medical director or administrator is also a physician. For those of our brothers and sisters who have stepped into administrative roles … we tend to see them as failures, traitors … “they’ve gone over to the dark side” or worse.

We demonize managers/administrators at our own risk

These organizational leaders are charged with managing and improving the function of the larger systems that play such a big role in your practice. We can fight them and become part of the problem. We have all seen and done this …  bringing them only problems and complaints. Our interactions can become hostile venting sessions and nothing gets accomplished.

Or we can take responsibility to become part of the solution

As a team leader in the front lines of patient care, you can make a difference by working to influence and support these managers and administrators. You and your team have valuable experience to share with those who are charged with running and improving these larger systems. This physician leadership role at this larger system level is even more important now as hospital based physician networks are rapidly forming across the nation from what used to be independent practices.

- What are your suggestions for improvement in these larger systems?
- Who needs to know and how can you help them implement the changes you recommend?

We can each play a role in helping these larger systems become more functional, but not if we retreat to our exam rooms and simply complain.


In my experience, any efforts doctors put into their own physician leadership development pays immediate dividends.

Putting some effort into
- Studying Physician Leadership
- Leveraging your team with your new physician leadership skills
- Playing a role in improving the larger systems
is a way to quickly improve the practice experience for you and your staff and the quality of care you and your team provide to your patients.


PLEASE LEAVE A COMMENT with your favorite physician leadership skills or physician leadership book suggestions. THANKS.


Tags: Physician Leadership, stop physician burnout, physician communication skills