How to Lead Up in Your Organization


Leading up is about setting an example and building influence so you can be more effective. It starts with these seven skills.

Fam Pract Manag. 2017 Nov-Dec;24(6):6-9.

Author disclosure: no relevant financial affiliations disclosed.

As more physicians become employed rather than joining or opening an independent practice, they are finding themselves in large organizations with a well-defined chain of command. Maneuvering in this hierarchy can be difficult for physicians, who are accustomed to being “captain of the ship” when making clinical decisions, but it's an essential skill for garnering the resources and support we need to do our jobs well.

“Leading up,” a concept popularized in the book by Michael Useem,1 is the ability to influence decisions made by those at higher levels in the organization, especially your direct supervisor. All physicians are leaders at some level, whether or not they have supervisory roles. Using our leadership skills to influence our colleagues and those in positions of authority enables everyone in the organization to be more successful.


  1. Develop emotional intelligence.

  2. Use power and politics for good.

  3. Choose being effective over being right.

  4. Be intentional and prepared.

  5. Help your supervisor.

  6. Disagree without being disagreeable.

  7. Don't expect credit.

It is common for physicians to express concerns about the leadership skills of their leaders. We need to recognize that those placed in positions of authority are not always (or even often) chosen for their leadership skills. They may be good administrators or managers, they may have been “next in line,” or they may have not stepped backward quickly enough when a volunteer was sought for a job no one else wanted. While focusing on the flaws in our leaders is easy, it's not usually effective or healthy. Instead, one of the best ways to influence the organization is to develop our own leadership skills and use them in a positive way. Here are seven ways to do that.

1. Develop emotional intelligence

A major component of being an effective leader at any level is emotional intelligence (EI).2 Although some people come by the attribute of EI naturally, others don't. Fortunately, this key element of leadership can, with effort and intent, be developed over time. EI is the ability to monitor one's own and other people's emotions, discriminate between different emotions, label them appropriately, and use this information to guide thinking and behavior.3 (A full discussion of EI is beyond the scope of this article but can be found in the book referenced.2)

Monitoring our emotions and how they affect others is vitally important. Our feelings happen without much cognitive control, and if we react to them without slowing down and allowing our cognitive self to process our emotions, we often end up with leadership and interpersonal

About the Author

Dr. Franko is the senior academic chair of primary care and chair of the Department of Family Medicine at Carolinas HealthCare System in Charlotte, N.C.

Author disclosure: no relevant financial affiliations disclosed.



show all references

1. Useem M. Leading Up: How to Lead Your Boss So You Both Win. New York: Three Rivers Press; 2001....

2. Bradberry T, Greaves J. Emotional Intelligence 2.0. San Diego: TalentSmart; 2009.

3. Greenawald M, Belknap L, Longenecker R, Franko J. Calibrating the leader. Presented at: 48th Annual Spring Conference of the Society of Teachers of Family Medicine; April 2015; Orlando, FL. Accessed September 28, 2017.

4. Merriam-Webster's Collegiate Dictionary. Springfield, MA: Merriam-Webster Incorporated; 2017.


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