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Lessons from the Medicine Wheel.

THE WORLD OF management is very different from the world of medicine. Understanding and adapting to these differences often determines whether a physician is successful in making the transition to a career in management. If you are new to medical management or looking for opportunities to enter this volatile and exciting world, you will quickly realize that it is important to develop your own personal set of principles to guide your decisions and keep your career in perspective. Without these principles, you'll be making decisions on instinct or emotion. This is not to say that good decisions don't result, but you may sleep better knowing why you take a certain path, but not another.

If you are a veteran in health care management, you have probably developed guiding principles for yourself--sometimes as a result of painful experiences. You surely appreciate paradox in this complex, challenging, and rewarding career.

After nearly ten years in full time management, I've found some principles, or learned some lessons, that work for me. These lessons come from discussions with physician leaders, reading the wisdom of leaders in other ages and industries, and personal observations.

Lesson #1

Don't ever forget your clinical experiences, and always keep in mind what it is like to wear the shoes of a clinician.

If you ever forget the experience of being at the bedside of a critically ill patient at 2 a.m., you will not be an effective leader. Too often physicians in management think of themselves as "executives," rather than "physicians" or "physician executives." Your clinical colleagues can tell whether you have abandoned their concerns. They know whether you empathize with the challenges they face every day in their work. I once asked a physician prominent in American health policy leadership what he viewed as the secret to his success. He said that regardless of the setting, issues, or audience--he always imagined himself at a patient's bedside in the middle of the night to get the proper perspective to his role as a leader.

If you choose to work occasionally in the clinic, be sure your administrative decisions are consistent with the concerns of clinicians, or you will be perceived as insincere. Some physician executives who haven't set foot in the exam room for a decade are viewed by clinicians as more effective and empathetic than others who proclaim to be "practicing physicians" because of their token appearances in the clinic.

Lesson #2

Focus on results, not titles.

Titles are seductive to the physician executive, and certainly are of utmost importance to non-clinician executives. Titles indicate organizational authority, prestige, and a fit within the organization. But, as Charles Dwyer describes in his insightful publication The Shifting Sources of Power and Influence, a title is a privilege bestowed on you by someone higher up in the organization. [1] That person expects certain behaviors of you. The role of organizational authority, or title, that you have worked long and hard to attain is very delicate and fragile. Any number of events within, or outside of, the organization could swiftly jeopardize your role of authority. In short, that title you have sought after is very ephemeral. It can disappear in the blink of an eye.

Instead of focusing on your authority or title, accentuate your leadership skills. If you think about some of the most significant accomplishments in your life, chances are you achieved them because of your leadership ability--not because of your authority or title. In any position of authority, you will be saddled with far more responsibility or accountability than your title (or authority) gives you. The gap between responsibility and authority must be closed by using your leadership talent and focusing on results. If you can't routinely fill that gap, you will not fulfill your organization's expectations of you. A results Orientation also gives you personal satisfaction because you know what you have achieved and can measure your accomplishments.

Lesson #3

Jack Welch, the successful CEO of General Electric, comments that, "Above all else, good leaders are open. They go up, down, and around their organizations to reach people. They don't stick to established channels. They're informal. They're straight with people. They make a religion out of being accessible." [2] These attributes of the effective leader indicate a results orientation, and are qualities that most physicians find appealing in executives.

An advanced degree in management will enhance your credibility with physicians and other clinicians--but only if you practice Lesson #1.

Physicians, in particular, place great emphasis and value on academic rigor and qualifications. They care little about your title, but do care if you have spent the time, effort, and sacrifice to earn a degree, pass a board exam, or earn a special certification. Many physicians will tune out your attempts to teach new concepts if you do not have that advanced degree--no matter how eloquent and articulate you are.

Non-physician executives, however, tend to place more emphasis on title and experience, rather than academic credentials. However, they will expect you to be effective in dealing with physicians regardless of what title you hold, so you must understand this tightrope you walk when maneuvering between the clinical culture of physicians and the management world that you have joined. And you must be optimally prepared if you wish to fulfill your employer's expectations of you. If you keep Lesson #1 in mind, and complete that advanced degree in management, you will be well prepared for your role as a physician executive.

Lesson #4

Don't carry these things with you in your new career: a grudge, your favorite ax that needs grinding, or a bias about who's right or wrong.

The more you learn about health care, it is obvious that many different people, with many points of view, are necessary for success. If you have a grudge against hospital or insurance company executives--get over it! If you have an ax to grind for a favorite cause--primary care, specialty care, nursing care--change your thinking! You must be a leader for each of these groups and open to new ideas. Like the Medicine Wheel of the Native Americans, everything in health care finance and delivery is connected and interrelated. If the health care industry, like other industries before it, is ripe for disruptive innovation, you don't know what changes are coming that will result in a more responsive system for consumers--so don't burn your bridges.

Avoid using the terms "right" and "wrong" in conflict situations. These words cause further polarization, and harden the positions of adversaries. Instead of thinking "right or wrong" and "either-or," try thinking "and." Why? Because many problems in health care require collaboration-- creating something new, literally "working together." If compromise or accommodation is the common approach to dealing with conflict, you won't be dealing with new, creative, innovative solutions. When engineers finally find a solution to a highly complex problem, they often refer to it as an "elegant" solution. In health care, you can find those "elegant" solutions by trying to incorporate diverse ideas from clinicians, financiers, and managers. In other words, try thinking "and."

There is plenty of conflict inherent in health care. Principles of Tao suggest that the path out of conflict begins at the center. [3] Whether nature creates a hurricane in the Atlantic, or a cyclone on the prairie, there is--in the midst of chaos and destruction-- a point of relative calm at the center. It is this calm and power at the center of a conflict--not the chaos and destruction at the edges--that we should seek as physician executives.

Lesson #5

Think "honesty," not "loyalty," in your new career--even if it means disagreeing with your colleagues and superiors.

Good organizations and leaders encourage honest communication among their leaders and employees. Clinicians place great importance on honesty, perhaps because of our acceptance of the principles of medical ethics, which demand truth telling and keeping one's promises. Individuals and organizations that place a premium on honesty and integrity usually benefit by loyalty from others.

When you are hired as a physician executive, your employer wants your honest opinion on matters of importance--not blind loyalty to your superiors. You can offer your contrary opinion with grace and good humor, debate the merits of differing positions, and then support the organization's decision without alienating your managerial colleagues. But don't be afraid to offer your views of a situation because they differ from your colleagues, or because you believe that by offering them, you would be disloyal to the organization.

Ultimately, an individual cannot be loyal to an individual or organization that does not have honesty as the core value of human interaction. No individual or organization can ask for your loyalty without having a foundation of honesty in communication. In fact, there is probably no need to even consider the concept of loyalty in an organization with such a foundation; honesty engenders loyalty in work and in personal interaction.

Lesson #6

Be kind to yourself in your new career.

Your work is difficult enough, so don't add distress to your life by harsh self-criticism (common among physicians), or getting out of balance with other key parts of your life. Understand that your management style is an expression of your artistry and creativity with people. How you treat others and make them feel about themselves--not your brilliant strategies, medical loss ratios, or profit margin percentage--is what you will be remembered for years from now. Look for the good in others, even your enemies. Take time to reflect on what you've learned, and the power of group process.

On the personal side, try to live simply even though you have finally achieved that powerful management position. If it takes you, your spouse, and children more than an hour to clean the house on Saturday, you might not be living very simply. I like to remember that if I spend money on activities or items that don't improve my mind or my spirit, they are relatively worthless.

Lesson #7

Finally, and most importantly, remember that your family, friends, and loved ones deserve your greatest attention in your new career.

When your career is over, or fizzles, or soars to unimaginable heights, what matters most are the bonds and relationships with your spouse, children, family, and friends. They will be there for you in difficult times and will keep you balanced in your perspectives. Show them, through your actions, that they are the most important part of your life. Save your greatest energy for them.

Your journey into the world of health care leadership and management will be exciting, energizing, and perilous. You will become adept at balancing risk and reward in your career. Take the time to develop your own style and principles to guide your adventure. Begin with the end in mind!.

Barry silbaugh, MD, MS, FACPE, is Vice President of Medical Operations at Catholic Health Initiatives in Denver, Colorado. He is a 1995 graduate of the University of Wisconsin-Madison Administrative Medicine Program.


(1.) Dwyer, charles. The Shifting Sources of Power and Influence. Tampa, Florida: American college of Physician Executives, 1991.

(2.) Lowe, Janet. Jack Welch Speaks: Wisdom from the World's Greatest Business Leader. New York, New York: John Wiley & Sons, 1998, p.73.

(3.) Heider, John. The Tao of Leadership. Atlanta, Georgia: Humanics New Age, 1985.


* Developing Guiding Principles

* Making the Transition to Medical Management

* Keeping Your Career in Perspective

* Lessons for Physicians Entering Management

* Effective Leadership

This article is adapted from the May 9, 2000, Commencement Address given to the physician graduates of ACPE's University of Wisconsin Masters Program in Administrative Medicine. Barry Silbaugh, MD, MS, FACPE, comments on lessons he's learned in a decade of full time management in health care that may be helpful for physician executives in transition from clinical practice to management roles. The lessons for physicians entering a new career in management include: Don't forget your clinical experiences; focus on results, not titles; think "honesty," not "loyalty;" and remember that your family, friends, and loved ones deserve your greatest attention. The Medicine Wheel is a Native American symbol of dynamic wholeness. It is a reminder that there is a place for each of us--individual and unique--in the world, and that all things are equal within it.
COPYRIGHT 2001 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2001, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:tips on being a health care manager
Author:Silbaugh, Barry
Publication:Physician Executive
Date:Jan 1, 2001
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