Physicians as leaders: a systematic review through the lens of expert leadership

A call for transforming physicians-as-administrators into professional hybrid medical leaders: insights from northern India

PURPOSE

The purpose of this paper is to understand the non-clinical challenges of physicians in northern India and to re-imagine an alternative scenario of hybrid professional medical management and leadership where physicians enact roles as strategic boundary spanners.

DESIGN/METHODOLOGY/APPROACH

In this qualitative study, 30 in-depth semi-structured interviews were conducted with men and women physicians and thematically analysed.

FINDINGS

Physicians reported that they were unprepared formally for mainly ad hoc non-clinical responsibilities. Findings identified a range of six types of aspirational, willing, incidental, ambivalent, agnostic and actively resistant behaviours among physicians who were expected to undertake administrative, rather than strategic leadership tasks.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this study makes a novel theoretical contribution to the dearth of literature on medical leadership in a low-middle income South Asian country. By examining physicians' views on their non-clinical responsibilities, this study highlights the strategic potential for developing physicians formally as professional hybrid managers and leaders who effectively bridge medical and managerial domains beyond the current scenario of physicians operating as untrained administrators.

Professionalism and Self-Evaluation: Diverging Perspectives Among Physicians and Nurses

Introduction

Professionalism among healthcare professionals is often defined in terms such as altruism, humanism, and excellence. The integration of such professionalism ideals to healthcare professionals' practice poses a challenge to medical tutors. We examined the assessment of professionalism among physicians and nurses by their peers and evaluated the significance of each professional role component within each sector. We also performed a cross-sector assessment whereby physicians assessed nurses' professionalism and vice versa.

Methods

A survey among physicians, interns, and nurses. The participants were asked to rate the extent that each of the 12 characteristics contributes to physicians' and nurses' professionalism of on a scale of 1 (does not contribute at all) to 10 (highly contributes). Each participant rated the contribution of each component to the professionalism of their own occupation (direct scoring) and to the professionalism of the other occupation (cross scoring).

Results

In total, 300 healthcare professionals (mean age 36.6, 46% males) responded to the survey. The most highly contributing characteristics to physicians' professionalism were knowledge, responsibility, decision-making and leadership, clustered as "strategic judgment". The most highly contributing characteristics to nurses' professionalism were responsibility, personal attention, empathy, and skills, clustered as "bedside approach" and "performance abilities". Cross-assessment among professionals was different: Nurses assigned higher ratings in general, interns assigned higher ratings to physicians' characteristics, whereas physicians assigned lower ratings to professionalism characteristics, and especially to those of nurses. Nurses emphasized patient centeredness and communication skills more than physicians. Nurses and interns appreciated teamwork compared to physicians. Major differences in how physicians and nurses perceive professionalism revealed physicians' emphasis on "strategic judgment" while nurses emphasis on "bedside approach".

Conclusion

Physicians and nurses hold differing viewpoints on many topics, including the objectives of their mission, expected performance, and activity types. Medical professionals can assess their colleagues and partners, recognizing both strengths and weaknesses in themselves and others.

Physician Leadership and Burnout: The Need for Agency; a Qualitative Study of an Academic Institution

Purpose

Organizational approaches to physician burnout are limited. Training physician leaders to influence the organizational environment is a growing area of study. This study explored perceived physician leadership behaviors in response to burnout from the viewpoint of faculty physicians not in formal leadership positions. Understanding physician leadership behaviors from the viewpoint of those faculty being led can inform organizational strategy and leadership training to address physician burnout.

Subjects and Methods

Interview requests were sent to 70 randomly identified faculty physicians from a roster containing all 1145 physician faculty that excluded the Pediatric Department, at an academic health care institution in Southern California. The first ten respondents were asked to participate in a 30-to-40-minute semi-structured virtual interview via Zoom. The interviewees were asked two questions pertaining to burnout and their perception of how leadership responded. The two questions were "What has leadership done to address burnout?" and "If you had five minutes to advise your leaders on burnout, what would you say?" The recorded interviews were transcribed, redacted, and then sent to two reviewers. Thematic analysis through iterative coding was completed, and categories were constructed that aligned with the two interview questions.

Results

Overall, five themes were identified. These themes were organized according to the interview questions and broadly categorized as physician leadership behaviors observed that corresponded to the interview question of what leadership had done to address burnout and physician leadership behaviors desired corresponding to the second interview question of what advice should be given. Leadership behaviors observed in the context of burnout included three themes; referral to individual wellness programs, increased number of meetings and events, and a lack of agency in addressing wellness issues. The two themes of leadership behaviors desired were the obtainment of more resources and the granting of greater appreciation and recognition for work done through enhanced communication.

Conclusion

This small study of faculty physician perceptions of leadership behaviors identified several themes that had been identified in previous studies of leadership and burnout; need for relationship building through communication, need for resources to address work issues, and referral to wellness programs. However, the identification of a lack of agency in addressing factors in the wellness environment has not been identified in the previous burnout and physician leadership literature. Further study into the causes of this perceived lack of agency should be explored. Understanding the root causes of physician leaders' lack of agency can further inform physician leadership education as an organizational approach to burnout.