Let’s Talk About Physician Leadership

Identifying and nurturing it are vital for healthcare success

Recruiting, training and retaining physicians with leadership attributes is essential for a healthcare organization to succeed, yet there are few formal resources that address this pivotal subject.

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In a candid and wide-ranging conversation with Consult QD, Brian J. Bolwell, MD, FACP, Cleveland Clinic’s Director of Physician Leadership and Development and Chairman of Taussig Cancer Institute talks about what he looks for in physician leaders and the challenges and rewards of being one.

Q: As someone who regularly reads leadership books, you’ve noted that few, if any, address leadership in a healthcare setting. Why is that?

Dr. Bolwell: Anyone who has tried to figure out medicine realizes how complex it is, organizationally. It is practiced in different environments. Big academic medical centers are usually the focus, but most medicine is practiced in the community. Then there is the complexity of the healthcare ecosystem, in which the pharmaceutical industry, the insurance industry and government regulation all play huge roles. It is very complicated. Having said that, I think leadership, especially physician leadership, has long been ignored in medicine. And I think there is a new appetite to try to learn about it, because both community and academic organizations realize if they want to get things done, they need physician leaders.

Q: Does medicine produce well-qualified leaders?

Dr. Bolwell: In academic medicine, we teach individuals to excel at skills that do not make a good leader. You are rewarded for self-promotion. You are rewarded for individual achievement — for getting grants, for being the first author of publications in high-impact journals. You are rewarded for being invited to speak in front of thousands of people at national meetings. It is a very egocentric system. Leadership has nothing to do with this. Leadership is about serving the team. I believe your job as a leader is to recruit good people, to support them, to create a psychologically safe atmosphere for people to participate, to remove obstacles, which are frequently political. And when success is achieved, to let the team celebrate it. So to think that an individual who has a well-funded lab and is on all sorts of podiums automatically has the skillset to lead teams and be a serving leader is illogical. And yet, that is how leaders are chosen.

Q: How do you change that?

Dr. Bolwell: By changing the recruitment process for physician leaders. I recruit for emotional intelligence. I recruit for grit, which is a combination of passion and perseverance. I do not care all that much about whether you went to an Ivy League school. Having a huge academic pedigree is nice, but it certainly is not the number one prerequisite for getting a job here.

Q: How do you identify those qualities in a candidate?

Dr. Bolwell: I ask questions. I try to measure how people react in real-world situations. You put candidates in a social situation. Things like recruiting dinners are time-consuming, but if you want to adequately evaluate someone, they are a very good idea. The other thing is, in my role as Director of Physician Leadership, I am revamping the search committee process to make it more uniform, by identifying the traits we are looking for and developing structured interview questions.

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Q: Are search committees necessary?

Dr. Bolwell: Yes. They know the salient issues in fairly short order, which is useful. The key is to educate people within the search process. So we have brought in the Office of Physician Recruitment to sit on search committees, to bring a certain level of expertise.

Q: Does one have to have been a leader to be a good leader? Do you always look for leadership experience?

Dr. Bolwell: Not necessarily. I think you want someone who has the skillset and is willing to learn, willing to be humble, willing to continually study, willing to receive constructive criticism, willing to want to get better. In academic medicine, many leadership jobs are simply about securing big grants and that is how you are judged, as opposed to managing people. Physicians are very difficult to manage. They are an independent lot. They tend to question everything — we’re trained to do that.

Q: In addition to administrative responsibilities, many of Cleveland Clinic’s physician leaders also care for patients. And you supervise other physicians who treat patients. How do you manage that dynamic, especially in the cancer setting, where illnesses often are life-threatening?

Dr. Bolwell: It can be emotionally intense. Some literature suggests that oncologists have the highest suicide rate of any subspecialty. You can probably understand why. We have to be aware of that — to be able to acknowledge the fact that this is a stressful thing to do, and that sometimes that stress carries over into what is going on in an individual’s home and family life. Part of my job is to make sure we have enough resources and support to help everyone get through their day to the best of their ability.

Q: Once you’ve found a good physician leader, how do you keep them?

Dr. Bolwell: If I am adhering to the principles I believe in, like being honest and transparent and creating a psychologically safe environment and being willing to accept feedback, hopefully that is an environment that people like to work in. One my favorite lines from one of the leadership books I have read is that great teams are a magnet for great talent. People are reluctant to leave a great team. Sometimes it happens, but it does not happen very frequently.

Q: What do you like about being a leader?

Dr. Bolwell: Leadership is about forming relationships and developing teams. I really like the people here. We have accomplished a lot of great things together in the past decade, and that has been very rewarding. Being able to do some things that are starting to take hold on a national level, like significantly reducing cancer patients’ waiting times from diagnosis to treatment, is also rewarding. The positives are real, but the job is not made for everyone.

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Q: What have you learned from being a leader?

Dr. Bolwell: I have a lot of resources at my disposal. I have used executive coaching a couple of times, which has been really, really good. I am actually learning how to be an executive coach myself. Deeply exploring psychology and motivation — my own as well as others’ — has been a useful tool to try to manage the challenges and the solitary nature of the job. The hardest thing is to have the courage to speak up when the environment is not psychologically safe to do so. It is the right thing to do, but it is hard.

Q: How do you become a better leader?

Dr. Bolwell: You cannot just read about it. You cannot just talk about it. You actually have to change what you do. Your behaviors have to change. That is very hard for most people, but you can get better. You can transform, you can connect, you can elevate. It is very difficult, but if you do it well, you get a lot of nice rewards.

Dr. Bolwell is Chairman of Taussig Cancer Institute, Cleveland Clinic Cancer Center, Professor of Medicine at Cleveland Clinic Lerner College of Medicine, and Director of Physician Leadership and Development for Cleveland Clinic. He speaks and writes often about healthcare leadership topics, including in his blog, “Straight Talk,” for Oncology Times.