Academic Medicine

Choosing Academic Medical Leaders

I think that every search committee assembled for nominating academic medical center leaders should be required to watch the movie The Replacements before starting their search.

In the movie, Gene Hackman is the coach of the Washington Sentinels, a fictitious professional football team. In the midst of a player’s strike, the team has been repopulated with a group of has-beens and want-t0-be football players, led by Keanu Reeves. Reeves plays the character Shane Falco, a former All-American quarterback from the Ohio State University whose football career crumbled after playing a horrendous Sugar Bowel game and who ends up living on a houseboat and doing boat repair work rather than playing professional football. What makes Falco successful with the Sentinels is not so much his quarterback skills but the fact that he brings out the best in all of the other replacement players, making the team win games as a consequence.

In the last game of the season, the Sentinels’ regular quarterback, Eddie Martel, crosses the picket line to return to the team, sending Falco back to his regular job as a boat mechanic. Martel is one of the best quarterbacks in the country but is a bit of a prima donna and looks down on rest of the team’s replacement players, who he considers rejects and inferiors. Meanwhile, the all of the regular players on the opposing Dallas team have crossed the picket line and returned to work. The first half of the game is a disaster for Washington because even though Martel is an all-star, he can’t relate well to the rest of the Washington players and consequently, they do not play well as a team. As the team is walking into the locker room for half time, Gene Hackman is asked by a reporter what it would take for Washington to get back into the game and he looks at the reporter and says:

“You’ve gotta have heart. Miles and miles of heart.”

That was a verbal signal to Falco, who was watching the game from his houseboat, that the team needed him and so he suited up and returned to the locker room where the rest of the players kick Martel out. Falco and the rest of the Washington replacements then go on to win with a touchdown in the final seconds of the game.

So what does a sports comedy movie have to do with selecting academic medical leaders? Over the past 30 years, I’ve seen good leaders and bad leaders. I’ve seen effective leaders and ineffective leaders. I’ve seen leaders with a long tenure and those with a short tenure. And all too often, I’ve seen leaders selected for the wrong reasons.

We often select our leaders based on their previous personal successes – because they’ve become famous doctors on their own right, because they’ve gotten a lot of research grants, or because they’ve published lots of papers in medical journals. And often what we get is the Eddie Martels of the academic world, people who have had enormous individual success but no track record of making those around him or her successful.

Former Ohio State quarterback Shane Falco was successful with the replacements not because he was the best quarterback himself, but because he brought out the best in all of the other players around him. Or, as his coach said, he had heart.

I think that is what is often missing when we select academic medical leaders. We overlook their passion for the institution and their passion for those who work at the institution. The rank and file faculty and physicians at any given academic medical center are mostly “lifers” – women and men who spend all or most of their careers at that single institution. They take pride in being a part of their university. They’re die-hard fans of their university’s athletic teams. They have jackets, ties, sweatshirts, scarves, and hats with their university’s mascot on them. They bleed (name your school colors). And if they are asked what they do by someone sitting next to them in a bar, they’re more likely to say “I’m on the faculty at the university” rather than “I’m a cardiologist”.

For a leader at an academic medical center to be truly successful, she or he has to have passion for that university. And I think that passion is the overlooked quality that leadership search committees overlook when they are evaluating candidates. A successful leader has to have more than just passion but passion is the catalyst that brings out the best in all of the rest of us. Passion doesn’t show up on a CV. Passion isn’t something that a hired recruitment company looks for. Passion isn’t something you can measure by number of grants or publications.

The best leaders are not the ones who accept your job offer because it was the best of the 4 or 5 that he or she has at the moment. The best leaders are those who accept your job offer because it is what they have always aspired for. Skills are what makes us succeed as individuals; passion is what makes those that we lead successful.

February 17, 2018

Academic Medicine

The Chief Petty Officers Run The Ship…And The Hospital

A few years ago, I took a tour of the USS Midway, an aircraft carrier that is now a museum anchored in San Diego. One of the things that I learned was that the Chief Petty Officers are the people who really run the ship from an operational standpoint with the Captains making the tactical and strategic decisions. There are a lot of analogies with hospital leaders.

Two weeks ago, we had some turmoil at Ohio State when the Vice President for Health Sciences and CEO of the Medical System resigned under pressure from the physician faculty. It caused me to examine who our medical system leaders are and I realized that there are really two tiers of leadership, a lot like the Chief Petty Officers and Captains.

At the top, are the executive leaders: the Chief Executive Officer of the Medical Center, the Dean, the Chief Financial Officer, and the Chief Operating Officer. These are professional leaders; by that, I mean that they are either leaders with a business background who have specialized in overseeing large health systems or they are physicians who have evolved into  leadership roles and no longer are doing clinical care. These are like the Captains. Of note, at Ohio State, all of them are people who were recruited from outside of the University.

In the middle, there are all of the operational medical directors: The Chief Medical Officer, the Medical Directors of each of the hospitals in our health system, and the Medical Directors of every procedure area and clinical program. Every one of these individuals are physicians who have been at our Medical Center for many years who started off as regular clinicians and then were home-grown into their leadership roles. I’m one of them – we are like the Chief Petty Officers.

In academic medicine, the captains have differentiated themselves so much that about all they can do is be full-time leaders. The chief petty officers are generally a lot less differentiated and they typically are also doing clinical care or teaching; in other words, they are not full-time leaders.

Because so many of the captains come from outside of an institution, they are by definition geographically mobile. Because they are mobile, you are always at risk of them leaving to go to some other academic institution, much like the Medical Rock Stars that I wrote about in a previous post. On the other hand, the chief petty officers tend to be geographically fixed, loyal to a single institution, and are less mobile.

In the navy, the chief petty officer is the highest rank that an enlisted sailor can achieve. Because they started off as regular sailors, the rest of the ship’s crew knows and trusts them – the chief petty officers have “been there” and the crew considers them to be one of their own. In medicine, the chief petty officers are the same – they started off as regular doctors and at their core, they still identify themselves as clinicians. They hold the institutional memory of the past years and decades and they are the ones that the rest of the physicians know and trust. They also know all of the bad things that have happened in the past that were swept under the carpet; in other words, they have institutional wisdom.

An academic medical center needs both captains and chief petty officers. For me, I’m very comfortable being a chief petty officer.

June 12, 2017