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Step right up and take the lead. The opportunities are multiplying.

Fam Pract Manag. 2003;10(9):43-48

Family medicine is changing the face of health care in America and, with it, the future of medicine. For many in the family practice movement, the establishment of this new specialty and its institutionalization in the academic environment is nothing short of a grand cause.

A healthy supply of competent leaders is necessary to propel an endeavor as far-reaching and multifaceted as the development of a medical discipline. Family physicians with the appropriate skills will be called on to guide student groups, residency programs, hospital departments, managed care organizations, university departments, professional groups and political organizations in building the stature of family medicine. Such roles can seem daunting to men and women for whom the word leader conjures up images of charismatic historical figures – the Teddy Roosevelts or Martin Luther Kings of this world.

Actually, most leaders are made, not born. As former President Dwight D. Eisenhower told his son, “The one quality that can develop by studious reflection and practice is the leadership of men.” Not only is successful leadership attainable, but attainment involves an exciting process of inner growth. Understanding and practicing the following 10 skills will help demystify the process.


  • A healthy supply of competent leaders is crucial to the future of family medicine.

  • If you’re comfortable with the theoretical and are willing to take risks, you’re more likely a leader than a manager.

  • A leader’s true power comes from gaining the consent of his or her followers.

1. Define your vision

Former President George Bush may have trivialized an essential aspect of leadership when he called it “the vision thing,” but he was right about the importance of visionary thinking in successful leadership.

Having a vision of what is possible is the currency of leadership; it’s what sets the leader apart from the manager, whose emphasis is on the implementation of someone else’s ideas. Harold Geneen, former chairman of ITT, put it in perspective when he said, “You read a book from beginning to end. You lead an organization the opposite way. You plan the end and then do all you can to reach it.”

Typically, leaders live somewhere in the realm of tomorrow. Their compelling vision helps establish the organizational mission and motivates their colleagues to set aside personal goals and work toward achieving a common goal. Leaders are comfortable with the theoretical, whereas managers tend to retreat to the pages of the policy manual.

Leaders in family practice need to have a vision of how their practice, residency program, department, hospital or organization could be better. They must also be able to communicate their vision to others.

2. Share your vision

Many of the most successful leaders use an image or metaphor to telegraph their vision to others. Charles Darwin wrote of the tree of life to embody his theory of evolution. Bush spoke of the thousand points of light to describe his vision for social services provided by the private sector. The AAFP has used the phrase “family physicians care for America” to underscore the sense of social responsibility at the core of the family practice movement.

The Rev. Martin Luther King’s “I Have a Dream” speech is an excellent example of how a vision can be communicated. Through his skillful use of language and imagery, King brought his vision to life.

A vision can also be communicated informally, through one-on-one discussions in offices and lunchrooms. Retreats provide excellent opportunities to share your ideas with colleagues. You can then develop a mission statement that brings everyone into agreement about the scope of the project at hand and the purpose of the organization.

When it’s coherently and articulately shared, a vision builds excitement. Leaders must have the ability to energize others and be cheerleaders for the cause. Good leaders celebrate achievements, such as the attainment of a promotion, the publication of a paper or the birth of a child. They also acknowledge and reward progress, such as the completion of a training program or an appointment to a hospital committee.

3. Recognize your leadership style

Different leaders lead differently. It is important to recognize which leadership style comes most naturally to you. While you may develop your ability to use various styles of leadership, when the pressure builds, you are likely to revert to the style that best fits your personality type. There is nothing wrong with practicing the style of leadership you prefer; what is essential is knowing which one it is.

One common approach is facilitative, in which the leader seeks to shape consensus; some might consider former President Bill Clinton as one who used a facilitative leadership style. Another style is autocratic. Margaret Thatcher, former Prime Minister of Great Britain, is an example of this method of leadership. So are Ross Perot and Lee Iacocca.

Some leaders function more as managers or bureaucratic leaders, such as former President Jimmy Carter. Such a style, which favors micro-management, works best in peaceful periods.

Another prominent mode of leadership is charismatic – having the gift of power. Former Presidents John F. Kennedy and Franklin D. Roosevelt are two historical figures with special abilities to energize those they led.

Although each of us has a style that comes most naturally, the best leaders can use various styles as the situation requires. For instance, a facilitative leader may need to act more autocratic in times of emergency; if the situation requires swift, bold action, the leader must be able to switch gears and provide what is needed in the crisis.

4. Distinguish leadership from management

Leadership involves communicating a vision. Management is the implementation of another’s vision. To speak metaphorically, leaders build castles in the sky for the managers to live in and run.

Another way to differentiate between leaders and managers is by how they handle risk. A leader’s job requires a willingness to take calculated risks – a manager’s job is to minimize risk.

The successful leader never focuses on failure. A basketball player at the foul line visualizes the ball passing through the net. Karl Wallenda, the tightrope walker, never spoke of failure – until shortly before a difficult stunt in 1978. He worried, he double-checked the ropes and took other precautions that were not part of his usual routine, and he fell to his death during the performance. Leaders pursue their vision with confidence, which helps inspire others and ensure success.

As stated above, the leader’s currency is his or her vision. In expending that currency, the leader must take the risks necessary to move a group or organization from where it is to where it should be.

The pure leader “lives in the middle of next year.” For this reason, he or she often seems to stand apart from others in the organization and may be viewed as distant. The pure manager lives in the here-and-now, and his or her actions are governed by the policies of the organization. The successful manager has a hands-on approach and is usually perceived as “one of the gang.”

Leaders must maintain a delicate balance. While they must be able to conceptualize a better future for their organizations and shouldn’t be preoccupied with day-to-day minutiae, they must fully understand their vision within the context of the organization. Otherwise, their dreams are unlikely to become realities.

5. Learn the rules – and obey them

Leaders must know the rules within their organizations. Every group has them: A hospital has its rules and regulations; a political organization has its constitution and bylaws.

The leader can use the rules as a way to identify the limits of power, to decide which decisions he or she can make and which must be referred to a higher authority. Knowing the rules makes it possible to understand where the gray areas are and where it might be possible to innovate.

While it is vital to understand the rules, it is equally vital not to be limited to thinking by the rules. The leader’s vision is his or her own. Knowing the rules simply makes it possible to figure out how to implement that vision within the parameters of the organization.

Knowing the rules of an organization – and respecting them – is one way a leader can earn the trust of his or her subordinates. Without that trust, successful leadership is impossible.

6. Earn your colleagues’ trust

Trust is what makes it possible for organizations to function. A leader builds trust by always making good on his or her promises. The good leader listens a great deal, speaks less and makes promises sparingly. Some successful leaders write down every promise they make and place them in a stack of “things to do,” where they remain until acted on. Others confirm all formal agreements in writing.

Such care with promises is essential. The subordinate to whom the promise is made will remember the words of the leader more precisely than the leader will; what might be a small promise to the leader who makes it – more space, increased clerical help or a schedule change – is likely to have major significance for the person to whom the promise is made.

Another aspect of trust is consistency of values. A leader must make clear his or her values. What comes first: the well-being of the staff or the advancement of the organization? Job satisfaction or money? Subordinates usually don’t require that their leaders be saints, only that they be consistent in their values. A hospital director who is dependably profit-oriented is easier to deal with than one who varies between being a bleeding heart and a Scrooge.

7. Understand the role of power

“The fundamental concept in social science is power, in the same sense in which energy is the fundamental concept in physics,” observed the philosopher Bertrand Russell.

In a nutshell, power is the ability to influence other people, to make sure that your ideas are included in decisions. Central to this notion is remembering that power comes from gaining the consent of your followers.

For example, classroom lecturers hold ower by virtue of their knowledge and their position at the front of the group. Such power rapidly vanishes, however, if the audience becomes dissatisfied and leaves the room.

Too obvious a display of power often backfires. In fact, the improper use of power is the greatest source of distrust and causes the downfall of many a leader. That is why facilitative leaders, who seek to build consensus, often enjoy the longest tenure, while autocratic leaders are often quickly replaced.


The Art of the Leader, by William A. Cohen, PhD, Prentice Hall, 1990.

The author, who has a military background, presents tested leadership principles and supports them from his own observations, with anecdotes mostly of military origin. His advice on how to develop self-confidence as a leader and how to motivate and build morale in your organization is particularly helpful.

On Becoming a Leader, by Warren G. Bennis, Addison-Wesley, 1989.

Working from a series of interviews with leaders such as Betty Friedan, Norman Lear and Gloria Steinem, Bennis discusses the aptitudes and skills of leaders. Principles of leadership are well-articulated, although more examples would have been helpful.

Handbook for the Academic Physician, edited by William C. McGaghie and John J. Frey, Springer Verlag, 1986.

This book covers much of what they don’t tell physicians entering academic medicine. The editors, both faculty members at the University of North Carolina School of Medicine, have done a good job of blending experience and current wisdom. Topics include organizational theory, the dynamics of academic institutions and ethical issues facing academic physicians.

Leaders: The Strategies for Taking Charge, by Warren G. Bennis and Burt Nanus, Harper & Row, 1985.

Thoughtful organization, crisp style and clear thinking characterize this book. Much of its leadership theory is based on the notion that good leaders know what they want, communicate their intentions and empower their work force to meet goals. Bennis and Nanus developed the concept of “leading others, managing yourself.”

The Leadership Challenge: How to Get Extraordinary Things Done in Organizations, by James M. Kouzes and Barry Z. Posner, Jossey-Bass, 1987.

The authors surveyed more than 550 managers and asked them to describe their best leadership experiences. Five practices of exemplary leadership (challenging the process, inspiring a shared vision, enabling others to act, modeling the way and encouraging the heart) are described. Useful features include the full text of Martin Luther King’s “I Have a Dream” speech and leadership exercises. Kouzes and Posner have written a new book on leadership titled Credibility: How Leaders Gain and Lose It, which will be released this fall.

The Leadership Equation, by Lee and Norma Barr, PhD, Eakin Press, 1989.

Leadership theory is approached in the context of the Myers-Briggs Type Indicator. Although the various types are described, you really should begin the book only after determining your own Myers-Briggs type. Chapter 7 provides good information on identifying managerial and organizational styles.

Managing With Power: Politics and Influence in Organizations, by Jeffrey Pfeffer, Harvard Business School Press, 1992.

This scholarly work has four sections: power in organizations, sources of power, strategies and tactics for employing power effectively and power dynamics. Pfeffer discusses the use and misuse of power in mobilizing people and resources to achieve shared goals, incorporating insights from former President Lyndon B. Johnson, Henry Kissinger and others.

The Tao of Leadership: Lao Tzu’s Tao Te Ching Adapted for a New Age, by John Heider, Bantam Books, 1985.

A classic of world literature, Tao Te Ching was written by Lao Tzu, a sixth-century b.c. Chinese philosopher, and addressed to the political rulers of the time. The Tao of Leadership is Heider’s adaptation of the original. Its advice on self-improvement and selflessness are pertinent to present-day leaders and aspiring leaders.

8. Act like a leader

Everything a leader says and does is watched closely by his or her subordinates. They try to discern the future by observing the behavior of their leader. Thus, those in charge should remind themselves every morning, “Remember your role. Everyone is watching.” The leader sets the example in values, work style and personal actions. Good leaders arrive early, work collaboratively, respect the opinions of colleagues and bring new ideas to the organization: They model the kind of performance they want to see in their organization.

The leader must be on the scene. This becomes more complicated as a leader achieves success and his or her presence at outside meetings and other important events is increasingly sought. A delicate balance must be achieved. On the one hand, the leader is often the person who carries the organization’s message to others. On the other hand, the troops at home need the leader to make important decisions and to serve as a mentor.

9. Turn followers into leaders

One of the most important jobs of a leader is to turn subordinates into leaders for the future. Recruiting people with high potential is an essential aspect of this process.

Nurturing the careers of promising colleagues and turning more decisions over to them as they progress ensures good morale. The leader shares both the power to make decisions and the responsibility for the results. For example, in a residency program, the residency director may initially conduct all negotiations for rotations on the other services. Eventually, other faculty may be able to perform this task, which will help prepare them for a higher level of responsibility. In the practice setting, the senior partner may ask younger colleagues to make more decisions as they gain knowledge and experience.

Successful leaders do not hoard control; they must allow less experienced colleagues to take some appropriate risks. Leaders may not always agree with their colleagues’ decisions about hiring, time allocation or management issues. But if these decisions prove faulty, it is better that the individual learn now, rather than when he or she has a higher level of responsibility.

Leaders should acknowledge the good work of colleagues and the progress they have made. Plaques, memos, a congratulatory lunch – these are the gestures that can show a genuine interest in subordinates’ careers. When something good happens to a co-worker, tell the group. The creative use of rewards to stimulate and motivate is another way to nurture leadership capabilities in others. One of the ways a leader is judged is by the success of those he or she has mentored.


The best of all leaders is the one who helps people so that, eventually, they don’t need him. Then comes the one they love and admire.

Then comes the one they fear.

The worst is the one who lets people push him around.

Where there is no trust, people will act in bad faith.

The best leader doesn’t say much, but what he says carries weight.

When he is finished with his work, the people say, “It happened naturally.”

– Lao Tzu, Chinese philosopher

10. Maintain balance in your life

How well a leader achieves his or her vision is one important way he or she is evaluated by colleagues. Another important benchmark is the quality of the leader’s life.

If an individual has held powerful professional positions, written widely quoted papers and influenced the thinking of a medical specialty, yet is in the midst of a third divorce, is addicted to tobacco or alcohol and has children who are drug users, is this person’s life considered a success?

The best leaders are able to maintain a balance in their lives. They have learned to say no. They have given their families and their subordinates the license to say no. They believe that personal and family time, as well as a healthy lifestyle, are their rights. They schedule these activities into their busy lives on a regular basis. Some of the happier people – and more successful professionals – are those who turn their work into play and then play hard.

As William A. Cohen, author of The Art of the Leader, has written, “Success does not come from working hard. Success comes from playing hard. Therefore, if you want success, you must position yourself so that the duties that you perform, no matter how difficult or challenging, are considered play to you and not work. If you do this, not only will you gain success, but you will have fun doing it.”

Becoming a leader

Successful leadership is not a mystery, accessible only to individuals born with the charisma and power drive of Napoleon. It is within your reach.

The family medicine movement will be enriched and strengthened by an array of individuals skilled in leadership. The principles of leadership can be learned from books and seminars, its techniques can be practiced in your work each day, and your mentors and family can help you balance your career and other facets of your life.

As you develop and practice your leadership skills, remember the advice of the Chinese philosopher Lao Tzu: “The best of all leaders is the one who helps people so that, eventually, they don’t need him.”

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