Are you on the right track?

Physician leaders need to develop and use different skill sets for different levels of responsibility as they advance from bedside clinician, to middle manager, to hospital vice president and possibly even CEO.

During this career progression, physicians initially need technical expertise, followed by more management expertise and, finally, leadership expertise.

When physicians first get interested in leadership, they are front-line or mid-level managers. At this stage they may be leading a receptionist and nurse or a few colleagues and small staff in an office. Or they may be volunteer chairs of hospital departments or committees.

Physicians in those situations should desire to improve their capabilities for leadership at that level, even though they may aspire to become full-time physician executives in the future.

When considering what to spend time learning about and what leadership actions to take, they should concentrate on their current level of leadership and where they might be in the next year or two.

This concern with focus and efficient learning is similar to the steps physicians take to maintain clinical skills. In the clinical realm, physicians are encouraged to read articles about those conditions they are likely to see fairly regularly.

The busy physician reads articles that will he useful in the office in the next few weeks, rather than articles on basic research in animal models, rare diseases one might see once in a lifetime or theoretic possibilities for future treatment based on small nonscientific samples.

This helps reduce the flood of medical data to a stream of clinical information.

What to read

There is a similar flood of leadership information. There are a lot of articles, seemingly even more books, many conferences and innumerable initiatives physicians can spend time on.

With such a daunting array of choices, what's the best use of time?

Front-line or mid-level leaders need to look for information that matters most. Reading the biography of Thomas Watson Sr., the founder of IBM, or about the current travails of HMO CEOs in southern California may be interesting, but they are unlikely to be applicable to the job of a senior partner of a single specialty physician practice.

The Physician Executive and other management journals present this same challenge. The Physician Executive includes articles applicable to physicians considering or beginning their management careers and articles focused on becoming a CEO.

Recent articles run the gamut from how physicians can increase their individual income with moonlighting activities to key strategies for CEO eligibility.

This is similar to the dilemma of looking at a medical journal with articles ranging from lab animal research with chemicals that are years from approval to discussions of psycho-social issues in primary care.

There are some real risks to focusing on the wrong material.

* It can waste valuable developmental time.

* Learning about action steps that are not appropriate at a physician's particular leadership level can also lead to incorrect actions.

An example is physician leaders of clinical departments or outpatient groups--both of which are intimately associated with larger organizations--learning about the importance of mission and vision statements and working to develop statements for their areas. Instead, physicians in these sub units should embrace and have input into the mission and vision of the larger organizations.

* Finally, focusing extensively on information applicable to top positions can lead to significant cynicism.

Physicians may read senior leadership books by Tom Peters or Peter Drucker, or the biography of Jack Welch, and unfairly apply the information to their organization's vice president and CEO. In this comparison, they are likely to see a significant gap in capabilities and this can produce significant doubt and cynicism about their local leaders.

Where to focus

Physicians in front-line or mid-level leadership positions should focus on:

* Time management skills

* Listening and coaching skills

* Interpersonal skills 

* Project planning, facilitation and completion

Incidentally, listening and interpersonal skills are among those listed as "most influential," according to a recent survey of experienced physician executives. (1)

If mid-level physician leaders are interested in more responsible positions in the next few years, they should also find opportunities to conduct effective meetings and make presentations. These are two other skills identified as highly influential by the physician executives who participated in the survey.

AREA or CONCERN       MID-LEVEL LEADERS         VICE PRESIDENTS/CEOS

What managed?         People and projects       Systems and culture
                                                (vision)

Major                 Executive                 Facilitate, delegate,
responsibility                                  coach, cheerlead

Monetary              Thousands/tens of         Millions
responsibility        thousands

Focus                 Internal to department/   Entire organization
                      unit

Uncertainty/risk      Small to moderate         Large

Autonomy              Low to medium             High

Breadth of            Narrow (issues,space,     Broad and deep
authority             people)

Decision making       Preliminary, fairly       Final authority,
                      simple                    complex

Supervised by         Upper-level managers      Board, social values

Time horizon          Days, months, rarely      Months, years, decades
                      year

Motivate/influence    Individuals, small        Large groups, external
                      groups                    leaders

Staff relations       Supervise, coach          Recruit and coach stars

Conflict resolution   Person responsible for    Delegate responsibility

Programs and          Develop and manage        Encourage, coordinate
projects

Data/information      Collect, interpret,       Encourage use, question
                      report, use               conclusions