How To Wield Physician Power and Avoid Leading Like an Evil Dictator (Or a Namby-Pamby)

We were sitting around the room, and they were silently thinking: “How are we going to get rid of him?” And they were thinking of me.

How To Wield Physician Power
Some avoided eye contact. Some smiled vacantly. Others shook their heads affirmatively in a tolerant manner.

I was decisive and divisive and though I spoke of the big picture, I was self-interested. And if I didn’t change my approach, my power would wane and my position of leadership would be endangered.

I needed to pause and ask myself two questions:

“What kind of physician leader do I want to be?”
“What kind of physician leader do they need me to be?”

Who Are You as a Physician Leader?

Do you wield your power like Kim Jong Il or MLK?
Do you lead like Dr. Jeckyl or Mr. Hyde?
Will you use the Dark Side of the Force or do you follow the footsteps of the Jedi?

Don’t Fear Power

As a physician leader, you need to want power. You need to want to influence, to be strong, to make an impact. Wanting power is a good thing: Embrace it. Don’t fear it. Don’t apologize for it.

The important question to ask is, “Why do I want power?

Do you want…

  • people to like you?
  • prestige and bling?
  • to be able to get things done, without anybody interfering?
  • to build a great organization?

These reasons drive your leadership style, and your ability to lead. These reasons also drive your success (or failure).

Four Kinds of Power

1. Just-Get-It-Done Power

Physicians have natural Just-Get-It-Done Power. They excel at personal achievement and feel accomplished checking off tasks. “Make patient better.” “Do procedure.” “Take call.”

However, transitioning from a bedside physician who just gets things done to a physician leader who inspires others to get things done isn’t always easy. The need to complete tasks – and completing them – may fulfill a sense of achievement, but it can leave followers wondering what to do with no understanding of how to improve.

Power from task completion does not scale. This is a common derailer for new physician leaders. You may be able to do the work of three or four people, but you can’t do the work of twenty or a hundred. As the Just-Get-It-Done Physician’s team gets bigger and bigger, things are left incomplete.

The Just-Get-It-Done Physician needs to learn to inspire others to get-it-done.

2. Evil Dictator Power

Evil Dictator Physicians crave power for personal benefit and are controlled by self-serving impulses. They live in a binary world where people are either “for” or “against” them. Coercion and threats are their power tools. They demand attention and entitlement, rather than a need to be liked.

Ironically, Evil Dictators have very loyal teams. However, their teams have been built to benefit the Evil Dictator’s needs, rather than the needs of the organization. Once the evil dictator leaves, the team often falls apart as the hollow group of followers have no capable heir to the throne.

3. Namby-Pamby Power

Namby-Pamby Physicians just want to be liked. They are the opposite of the Evil Dictator Physicians. They want what is best for the organization; however, they can’t make the difficult decisions necessary to improve the organization because they’re afraid to hurt feelings.

Namby-Pamby Physician leaders act based on how they think people will feel about a decision. As a result, their teams are victims of ad hoc decisions. Their teams fall prey to unclear structure. Their teams exhibit little pride in their job, and they lack a sense of personal accountability and responsibility.

People try to avoid working with a Namby-Pamby team. Ugh! Each decision needs to go through an emotional filter and this sucks the life out of effective action.

4. Leadership Power

Leadership Power is rooted in a desire to benefit the organization – a desire that’s stronger than the desire to be liked. Physician leaders make the difficult decisions while understanding the broader effects of those decisions on others.

Physician leaders shine a light on the mission of the organization, rather than themselves. They gain power collaboratively and democratically through clear vision and reason. They communicate with a future-focus while dealing with the problems of the present.

Physician leaders exhibit self-control and promote individual accountability and responsibility to the organization, rather than to themselves. They are not defensive. They seek advice from experts and maintain a mindset of learning.

The New Physician Leader

As we move toward a more collaborative and shared economic approach to medicine, there is a strong need for Leadership Power to lead medical organizations. There is good news: Leadership Power can be developed. Physicians can change their power motivation. They can learn it. It can be coached.

Many Just-Get-It-Done physicians will be called into leadership roles (because they can get things done). They will need to fulfill their strong sense of achievement through others. They can learn the steps of management and leadership, and if they do, they will build strong organizations.

Many physician dictators did very well during the age of fee-for-service medicine. These physicians built teams of loyal physicians and staff who followed their charge. As smart business thinkers, they know how to negotiate and identify value. These physician dictators can become physician leaders when given a clear understanding of the new rules of healthcare. They can shed personal goals for organizational goals; they can play by the new rules–and they will win.

The Namby-Pamby physicians who gain the confidence to understand the value of a strong organization and its benefits for the individual can learn the tools to have difficult conversations. They can learn to say no, and they can learn to lead effectively.

What You Can Do Now

Read Power is the Great Motivator by David McLelland and David Burnham. This is the source article that inspired this blog. The needs to achieve and to be liked lead managers to behave in ways that aren’t necessarily good management. The most effective leaders focus their power towards organizational goals. I encourage you to get a subscription to Harvard Business Review, they routinely publish thought provoking articles.

Get a physician leadership coach. Leading and managing physicians is very different from seeing patients. My typical coaching client is a great physician leader who wants to be better. Coaching helps leaders build upon their strengths and promotes a recognition and improvement of blind spots. A coach is that independent third-party who can help you strategize and learn to be even more effective.