Formation of a leader.

Jet fighters flying in formation. Hold that image for a moment, because it helps explain the unlikely trajectory of Leslie M. Yee, MD, MPH.

Notice the precision of the pilots, the power and clarity in the jet trails they draw against the sky. They explain how Yee would overcome poverty and family crisis to become a doctor and eventually corporate medical director for Procter & Gamble, the world's largest consumer goods company.

Now picture Yee in his office tucked inside a cluster of cubicles overlooking downtown Cincinnati. Yee is an affable man of 51 with a Midwestern radio-announcer's voice. His thinning hair is a tad disheveled, and his desk?

It's not exactly flying in formation at the moment. Papers and books stand high in crooked stacks. A little disarray can be excused, though, considering his full plate.

In recent months, he's flown to Morocco, India, Spain, China, Japan, and other countries, working largely on the company's merger with Gillette.

"When I was in the Air Force, I spent most of my time as a flight surgeon for operational fighter units," Yee says, motioning toward a photograph of fighter jets above his busy desk, "and I learned a lot from them."

One lesson was especially useful: In fast-changing conditions, you depend on a few simple priorities, your training, and each other.

"When you're flying lead and someone is flying on your wing, you don't look over at them much. You trust them to take care of their part of the sky. This is the way I like to operate."

Yee's part of the sky is unusually expansive. As corporate medical director for a $68 billion company, he helps steer medical and occupational health programs at factories, research centers and offices in more than 80 countries. He makes sure the company responds quickly to a wide range of scenarios--from injured employees to epidemics.

His medical networks also must protect the company's 130,000 employees, the reputations of the company's 300 brands, and the five billion consumers who use Procter & Gamble products. It's a challenge to align all these clinical and financial responsibilities.

But Yee has found--in his work and life--that when those jet trails line up, big things happen.

Growing up poor

By all rights, Yee shouldn't be here in Procter & Gamble's glass-and-steel headquarters. After all, he grew up in Bond Hill, a neighborhood a few miles away but a world apart.

During the late 1960s, Bond Hill was in an economic and social free-fall, hit hard by redlining, blockbusting and other race-based real estate tactics. Yee was very much caught up in this plunge, a middling student distracted by muggings, bomb threats and fights between white and black gangs.

Because he was one of the few Asian Americans in the neighborhood, Yee sometimes attracted the attention of bullies. To survive, he learned about weapons and fighting tactics that would later impress his buddies in the military. Adding to the chaos, when Yee was 11, his father ended up in the emergency room for hernia strangulation.

Doctors quickly discovered something worse: hemophilia. During the next few years, his father's health and spirits deteriorated, and Yee and his mother sometimes took turns staying up through the night to ease his father's suicidal thoughts.

Yee and his mother called the ambulance more and more, and the family's medical bills piled up. Yee was an only child and felt a strong gravitational pull to take care of his family. Though his mother talked about college, Yee figured he would get a job after graduation to help pay the bills.

Then, shortly after Yee's 16th birthday, his father died of a cerebral hemorrhage, a blessing in retrospect, Yee says, considering his father's despair.

Yee eventually won a scholarship to a small Cincinnati college that later merged with Xavier University. He thrived away from the gangs and family turmoil, and by his senior year, was ready for the next challenge.

He entered the University of Cincinnati's medical school and signed up with the Air Force to pay for his tuition.

"The fact that I was able to reach medical school has given me the firm belief that nothing is impossible," Yee would write later in a memo to his colleagues at Procter & Gamble about his core beliefs.

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"Each of you can achieve anything, but you can't achieve everything--you must make choices."

Career takes flight

As a flight surgeon in the Air Force, Yee spent much of his time with F-15 squadrons in Asia and Europe. These bases had aerospace rescue units, and on one mission, Yee found himself in a helicopter during a violent thunderstorm over the Pacific.

Lightning struck the chopper over and over, triggering a cascade of malfunctions. The pilots prepared to ditch while members of the crew readied the life raft. At the last second, the lights from the base runway appeared and the pilots landed the helicopter without incident.

For Yee, the moment reaffirmed his growing belief in the importance of teamwork. "In air combat operations, mutual interdependency--we called it mutual support--is not just a desirable behavior, it's a life-or-death requirement."

In the service, Yee grew more interested in the occupational health aspects of aerospace medicine and the Air Force sent him to Harvard University where he received a master's degree in public health.

"If you were head of aerospace medicine, you were pretty much in charge of everything related to preventive medicine at the base," he says. That meant understanding everything from the effects of jet lag on fighter pilots to the intricacies of food inspections and chemical exposure. This eclectic mix of responsibilities was just the kind of training Yee needed when he left the Air Force after 10 years and landed a job as medical chief of Procter & Gamble's paper division.

Procter & Gamble, of course, is no ordinary company. It makes some of the most popular and well-known products in the world, everything from Tide detergent to Pampers. Every day, people use these products about three billion times, the company estimates. Its merger with Gillette in 2005 made it the largest consumer goods company, ahead of Unilever.

When Yee joined Procter & Gamble in 1990, the company was pushing hard into overseas markets. In 1993, annual sales hit $30 billion, and for the first time, half of its revenues came from outside the United States. This global march also generated its share of growing pains, and the company's medical operations had become particularly unwieldy, Yee says. Many medical directors had no idea what their peers were working on. "Basically the structure we had made no sense at all."

On April 17, 1994, medical directors from the company's far-flung operations met in Chicago. Half an hour before the meeting, the company's human resources chief took Yee aside and told him he was the new corporate medical director.

"It wasn't much warning," Yee laughs. He wasted little time, walking over to a flip chart and announcing they would create new medical priorities for the company. They came up with five:

1 Save a life. (Protect our people.)

2 Obey the law. (Protect company reputation.)

3 Protect key technologies. (Protect brand integrity.)

4 Enhance speed to market. (Protect emerging technologies.)

5 Optimize employee productivity.

These five priorities would generate what Yee describes as "an interesting journey for us worldwide."

Reaching out in the world

Consider the first priority--saving a life. Among other things, this meant the company would ensure an injured or ill employee had timely access to good emergency care.

That's not much of an issue in the United States and Europe. But in less-developed areas, the company had to train first-responders, provide ambulances to improve emergency response times and donate advanced lifesaving equipment to clinics, among other things.

"And that's where this whole change the world aspect comes in," Yee says. "We made it a global endeavor from the beginning, with the idea that if it's the right thing in the United States, it ought to be the right thing to do in China, Africa or Russia."

In Russia, for example, the company has a large factory in the Tula province where "the medical infrastructure was close to zero," explains Richard Urbanek, MD, who heads Procter & Gamble's medical division in Europe, Africa and the Middle East.

Procter & Gamble made a deal with a Russian insurance company to expand medical coverage to employees and their families--a relatively rare benefit in Russia where many insurance providers are on shaky financial footings, Urbanek says. Procter & Gamble's financial commitment to the Russian insurance company gave it stability. In return, the insurance company agreed to build and upgrade clinics in that region.

"This, of course, also benefits the non-insured people in this area," Urbanek says, adding that the company hopes to replicate this elsewhere in Eastern Europe and Central Asia.

The company's focus on saving a life and protecting employees quickly comes into play during natural disasters.

In 2003, for instance, an alert medical director in China, C.S. Lee, MD, heard about an unusually virulent atypical form of pneumonia in Guangzhou, where Procter & Gamble has a large factory and offices. Yee and the medical director agreed that the company's operations in China should prepare for an epidemic. The disease turned out to be SARS.

"What felt good about that was having people alert to the situation," Yee says. "We actually had warnings out to our people that something bad was out there a month before the World Health Organization and CDC put out anything."

Hurricane Katrina created a different set of medical and occupational health challenges, Yee recalls. Procter & Gamble has four coffee factories in New Orleans, including its Folgers plant, the largest of its kind in the world.

After the storm, the company hauled in 150 trailers to house employees who lost their homes, drilled new drinking water wells and set up dining operations. Within three weeks, the Folgers plant was back in service, the first major business in the area to resume operations and a media magnet for politicians hard-pressed to find positive photo-ops during a controversial recovery.

Yee says his role during the Katrina recovery was mostly hands-off, a sign that the company's priorities and planning were effective. "The fact is that you have a lot of talented people out there, and there is nothing more discouraging for people than to be micromanaged. You're saying you don't trust them."

Sometimes, people ask why "Obey the law" is the second priority, Yee says, explaining that some countries have higher expectations for occupational health and safety than others.

"We know that our people may get into situations where it may be necessary to violate a local law or ordinance to save someone's life. So if you get into that situation, we say, do the right thing, and we'll stand by you."

The third priority reflects the nature of Procter & Gamble's business, Yee adds. The company depends on its brands for its success, and a brand's success depends largely on its image and reputation. Because of this, the company does extensive testing on ingredients and manufacturing processes, he says. That way, if a controversy arises over the safety of a product, the company can quickly provide data to government regulators, universities and others to address any concerns.

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"We can't have our reputation impugned by having people doubt the safety of our products."

Going corporate

Elaine Draper, a sociologist, spent more than eight years interviewing 100 corporate medical directors and physicians and scientists for her book, The Company Doctor: Risk, Responsibility, and Corporate Professionalism, published by the Russell Sage Foundation in 2003.

Draper found that many doctors went into corporate medicine because the work offered more predictable hours, a steady income and relief from the stresses of emergency medicine, malpractice issues and conflicts over managed care.

But many also told her that they sometimes walked an ethical tightrope, especially when pressured by heavy-handed business and legal managers. Draper concluded that "the corporate model of loyalty and service to the employer is in tension with the medical profession's model of loyalty to the patient and advocacy for health."

Yee says that some companies have different values than Procter & Gamble, which has a long history of aligning its corporate goals with those of its employees and customers.

In 1887, for instance, the company was one of the first to establish an employee profit-sharing program.

In a memo to his colleagues, Yee once acknowledged that headhunters often dangle better-paying jobs in front of them. "I know that many of us choose to stay, because the principles-driven nature of this company enables us to help change the world," he wrote.

Still, when Yee and his colleagues came up with the five medical priorities in 1994, some Procter & Gamble leaders and "many of my fellow corporate medical directors thought I was dreaming," Yee recalls.

But he pressed his case. Referring to the creation of a global standard for emergency care, "I asked our business leadership, 'Are you arguing it's not the right thing to do? Because if you are, I can come back with tons of scientific data that show if we aren't meeting this expectation, people's likelihood of survival will go to hell in a hand-basket in a life-threatening situation.'"

The company's board bought into this approach, and 12 years later, the five medical priorities drawn up on Yee's first day as corporate medical director still help steer the company.

Improving employee health

In late December, about a dozen medical directors from the company's global business units gathered in Cincinnati for a weeklong meeting, including Urbanek, who called Yee "a walking encyclopedia of occupational health and epidemiology."

On a typical day, Yee spends a good portion of his mornings going through e-mails from across the world, or on the phone discussing everything from wellness programs to medical benefits. Nonetheless, he says you still need these face-to-face meetings to keep everyone in sync.

During the week, much of the talk revolved around the improving employee health and performance, a reflection of the company's fifth medical priority.

In recent years, Procter & Gamble has experimented with yoga and other wellness programs in Europe to boost productivity. For his part, Yee co-authored a study eight years ago of 8,334 Procter & Gamble employees in Cincinnati. The study concluded that employees who participated in a three-year wellness push with high-risk screening and special counseling had 29 percent lower health care costs than non-participants--good for employees, good for the company.

Yee and his colleagues know that their work has a direct effect on the welfare of the company's employees and the reputation of its brands, and by extension, the viability of the company itself. They also understand the power and potential of a global company to improve medical systems in the many places where it has factories and offices.

But Yee says this can't happen when the company's goals and priorities aren't aligned, so after the December meeting broke up and his colleagues jetted back to China, Europe and other corners of the world, Yee was back at his desk inside Procter & Gamble's towers, "calibrating" the group's work, he says, once again making sure the formation was flying true.

Tony Bartelme is an award-winning freelance writer and newspaper reporter based in Charleston, S.C.

RELATED ARTICLE: How to Land a Job as a Corporate Physician Executive

Leslie M. Yee, MD, MPH, first learned about a medical director opening at Procter & Gamble through an executive recruiter. What advice does he offer to other physician executives interested in working for a corporation?:

"Attend professional conferences with corporate medical content (such as the American College of Physician Executives, American College of Occupational & Environmental Medicine, American College of Preventive Medicine, International Congress of Occupational Health meetings) to attend presentations on corporate medical topics and interact with corporate physicians.

"I also strongly recommend postgraduate training in bio-statistics, environmental sciences, epidemiology, industrial hygiene & safety, risk communication, toxicology, and basic management disciplines (e.g., decision analysis, finance & accounting, marketing, operations, organizational behavior, organization design). The customary mechanism for getting this training is through an MBA or MPH degree program. It would also be prudent for those interested in working within a multinational corporation context to obtain training in public health and tropical medicine."