Physiatry Forward: Leadership & Medicine
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Leadership & The Future Structure of Medicine

Author: Joel DeLisa, MD, MS
Former Chair & Professor, Rutgers New Jersey Medical School
Editor, Physiatry Forward

This will conclude my final AAP newsletter editorial. It has been my honor and pleasure to have served for four years and written sixteen editorials which I feel are relevant to academic physiatry and to medicine in general.

One of these topics covered was the United States healthcare system as being too expensive and wasteful. One can obtain the best medical care, but it is not under a cost effective, efficient healthcare system. The cost of completing medical school is unacceptably high as are prescription drugs. The Centers for Medicare and Medicaid Services (CMS) projects that Americans’ spending on prescription drugs will grow, rising an average of 6.3% a year.(1) Also the cost of medical devices is an issue to be considered. Understanding hospital costs for their services is difficult to follow, leaving the question of were they really necessary. The reimbursement system (insurance and/or government Medicare/Medicaid) adds significantly to administrative costs. There is too much money in every portion of medicine and each wants to protect or increase their amount. In 1930, Americans spent $2.6 billion on healthcare - $23/person and 2.3% of Gross Domestic Product (GDP). In 2015, Americans spent approximately $3 trillion on healthcare - $9,336/person and 15% GPD. Adjusted for inflation, this means that per capital costs have risen by a factor of 30 in 90 years.(2)

However, I do not see the leadership, energy, and dedication among physicians to address our rising costs and fragmented healthcare system. Leadership in medicine is a need and a void. It is a difficult topic to define, teach, and/or evaluate. Physicians often find themselves in leadership roles through circumstances and some have the role thrust upon them. Others are born leaders and achieve positions of leadership. Some of the characteristics of leadership are the ability to take risks and having the courage of one’s convictions. That includes a vision and the ability to motivate others to achieve that vision. It requires dealing with change, often unanticipated, unplanned change. It is the will to act in in the face of conventional wisdom, even at times, strong opposition. I believe that leadership and learning are inextricably linked.

Some skills of leaders are collaboration and cooperation; finding compromise and welcoming new ideas. Communication skills, both written and verbal, are very important as well as strong listening skills. That means one must hear the message, not just the words. One needs self-confidence and mental resilience to be a leader as that person will often function as the agent of change. However, one has to accept mistakes and avoid the saying “I say, you do.” Additional qualities of integrity, honesty, and loyalty are important assets to achieving success as well as empathy and optimism.

To be part of effective leadership, one must move from individual to system thinking. One needs to know the culture and values of the institution(s), organization(s), and the formal and informal chain of command. I always listen to what is being said, but at the same time value much more what is actually done. A leader has to be able to say “no”, often to key individuals on the leadership team. A passion for the type of work and being able to multi-task is extremely helpful. Being able to delegate responsibilities is another asset for a leader, but at the same time do not surround yourself with “yes” individuals in your leadership team. Analyze, evaluate productivity, and be willing to change if that is required to meet established standards and goals.

PM&R is in approximately half of the medical schools as either a department or a division. If the AAP sets a goal to be in all medical schools, the specialty needs to train many more chairpersons’ applicants. The position requires the individual to be an administrator, clinician, educator, and researcher. It is rare that one can excel in all four categories, however one can hire individuals with expertise in areas where one feels weak. The AAP‘s Program for Academic Leadership (PAL) is a very valuable resource for someone who wants a leadership position. One can also develop leadership skills through observation and modeling an exemplary mentor, attending courses and workshops, as well as books and articles. One can utilize professional organizations to develop a management portfolio, too.

One last piece of advice is to only send “happy” emails. If you write an email in an angry mood, sit on it awhile, and you will most likely find that sending it gained nothing.

I enjoyed my twenty-five years as Chairman of the Department of PM&R at New Jersey Medical School and being the founder and developer of the Kessler Foundation Research Center. However, my most pleasurable accomplishments would be the Editor of the textbook, DeLisa’s Physical Medicine and Rehabilitation: Principals and Practice (currently in its fifth edition), and for the 200+ residents, clinical fellowship, and post doctorates who graduated from my program and their remarkable career paths. My academic career is now over and I may have had the privilege of being in medicine’s “Golden Age”, but the above issues will face our future practicing physicians, residents, and medical students which they must address.

References

  1. Kirch D.C.; AAMC News-Patient Care, Oct. 23, 2018
  2. John Steele Gordon; Imprimis-A Short History of American Medical Insurance, Sept. 2018, Vol. 47, Number 9