How One Doctor Realized He Was His Own Biggest Management Problem

J. Duncan Moore Jr.

June 09, 2016
J. Duncan Moore Jr.
J. Duncan Moore Jr.

Oh, the things they don't teach you in medical school. . . .

Every practicing physician carries around a list of blunders, miscommunications, errors, and missed chances — a pile-up of regrets and lessons learned the hard way. These doctors carry on by doing the very thing that propelled them through med school and residency: toughing it out, pushing through the next obstacle to achieve their goal. It can sometimes feel like a Pyrrhic victory.

The road can get really rough in the middle of the journey. Frustrations mount, hopes darken — especially for physicians moving into leadership roles. The pressures from all sides can drain the satisfaction out of a career in medicine, leading to depression, lousy home life, self-defeating workaholism, and ultimately, professional burnout.

Geoffrey LeungThat's what Geoffrey Leung, MD, was at risk of experiencing when he applied for the California Health Care Foundation's leadership program two years ago. Now finishing up his second and final year in the fellowship, Leung wants other aspiring physician leaders in California to know there's a path out of the swamp.

The CHCF program gave him a "renewed sense of mission, purpose, and gratitude from both a professional standpoint and a personal standpoint," he said in an interview. "It allowed me to figure out how to make this work that I love sustainable." Without the program, he said, he would have either burned out at work, or work would have affected his personal life "in a detrimental and permanent way."

Leung, 39, is ambulatory medical director at Riverside University Health System, part of Riverside County's public medical infrastructure. He works closely with physicians, nurse practitioners, and physician assistants in all of the county's primary and specialty-based care clinics, including Federally Qualified Health Centers. It's up to him to take the lead in rolling out new initiatives in patient care and provider reimbursement, such as pay for performance. A family physician by training, he still sees patients half a day a week.

Who Is Groomed for Leadership?

People like Leung are groomed for leadership positions because they are good at getting things done. That may be the result of their technical skill as well as certain personality characteristics, such as perfectionism, drive, or just plain obstinacy.

That approach may work on a frontline patient-care level, but as soon as you become responsible for other clinicians and teams, it falls apart, Leung said. "If you are leading or supervising others, you need a different technique to motivate, engage, and inspire others to do the best work they can. The only way you can do that is by truly listening to people — how they make decisions, what they want to achieve — and hopefully align some of that with what you want to do as well."

That means the supervisor needs to be able to speak and understand all the communication styles and inflections used by various kinds of people. "They don't teach us how to do that in college, in medical school, or residency," he said. "This ability to speak in different ways with different people is one of the most valuable lessons we learn in the CHCF program."

Let's say you're in charge of rolling out a new team-based care and clinical process-improvement program at your hospital or medical group practice. You have a good sense of how the program needs to be built and operated, and you know what role each stakeholder has to play.

Keeping It Going

"If you try to micromanage it and push it through the way you want to do it, you can get a program running at a certain level," Leung said. "However, if you have not involved other key stakeholders the right way, you will not be able to ultimately sustain or spread that program. You really need to develop champions and other people who will drive it, get excited, and keep it going even if you're not there."

That's where his motivational skills acquired in the CHCF leadership program kicked in. The second time he tried to roll out this program, he was better at listening, communicating, and understanding people's concerns and hopes for the program. He let other people develop, build, and shape it. That time, the program finally took root and showed continuing results.

Leung, who has a master's degree in education, reported that he was "blown away" by the multiple modalities applied to teach these difficult concepts and soft-skill strategies. That's by design, said Kevin Rodondi, DPharm, associate director of Healthforce Center at UCSF, which runs the leadership program for CHCF.

Transformational leadership development occurs when those who have developed as leaders have moved outside their comfort zone with their peer group. "You get them into a safe environment, it allows them to take risks, and then there's that transformation," Rodondi said.

The program employs exercises that model the vulnerability of sharing doubt and uncertainty to remove barriers to interaction, foster effective brainstorming, and overcome fear of difficult conversations. "We give them a toolkit [from the Myers & Briggs Foundation] to help them understand how others process information. That helps them model a different behavior to their team. As a result, they are able to say, 'I don't know.'"

Fifteen Years, 447 Leaders

In its 15 years, the leadership program has trained 447 California leaders from across the health care system — doctors, nurses, pharmacists, and other providers. The alumni form a tight network of fellows who continue to work together and offer mutual support for the strengthening of health care delivery across the state. "They have a tool set, and they can speak a common language," Rodondi said. "This helps them overcome burnout."

The program is now recruiting for its 16th class of 32 fellows. "We are looking for people who are clinicians, who have been in leadership positions for at least five years, who have an opportunity to influence or create change by virtue of their position, who are willing to embrace the elements of the program and take risks, and commit the time to make this happen," Rodondi said. "And there is some element they bring that lends a positive experience to the group."

It is all too easy to fall into a "victim mentality," Leung said. "This is happening to me; this is someone else's fault; my colleague is making this harder for me. We often place accountability and blame on everything and everyone around us. The CHCF program helps us rebalance that perspective and realize what we do, how we behave, how we see ourselves in relation to the world — all are major determinants of our own success and how we impact people. In order to do transformational work, many of us have to first undergo an inner transformation.

"Because of the program, I am happier at work, and I am happier at home," Leung said. "The work that I do did not change so much. The key thing that changed during this fellowship was me."



The CHCF Health Care Leadership Program transforms today's clinicians into tomorrow's leaders. Up to 32 physicians, nurses, dentists, pharmacists, and other health care professionals are selected annually for this two-year, part-time fellowship. Led by national experts in health care and leadership development from Healthforce Center at UCSF, the program addresses health care issues from the perspectives of business management and public policy. Fellows broaden their management skills and sharpen their leadership capacity while gaining insights into the trends and challenges facing health care in California.

Applications for the program are accepted each spring. Candidates should have a clinical license and at least five years of experience in health care management or leadership roles. For more information about the program and current and alumni fellows, and for complete application instructions and forms, visit the Healthforce Center site. Applications for this year's entering class are due Friday, June 24, 2016.