Physicians, not the government, will save U.S. healthcare - Dr. Brent Lacey

Speaker A: Welcome to the Scope of Practice podcast where we help busy healthcare professionals learn to manage their businesses successfully and master their personal finances. Now, here's your host, Dr. Brent Lacey. Hey y'. All, thanks so much for joining me for the Scope of Practice podcast where you can get the knowledge and resources you need to grow your leadership skills, your business, and your personal finances. Welcome to episode 100. Don't forget, the podcast is now eligible for category one CME credits and it's free. Just click the link in the podcast description or go to www.thescopeofpractice.comm podcastcme and you can download your CME credits for free. This week's sponsor is Physician Financial Services. They were one of our premier level sponsors at the recent Marriage and Money MD Summit. You know, Larry Keller isn't a physician, but he has dedicated his career to helping physicians with their disability insurance. Many of the physicians and the financial experts you've heard, um, on the podcast have all said the same thing to me. If you need help with disability insurance, just call Larry. Statistically, young physicians are much more likely to become disabled than they are to die. So you need disability insurance. I have family members who have needed to use disability insurance, and trust me, we were incredibly glad that they had it in place so they could keep their income stable while they recovered. So if you don't have disability insurance or if you don't know whether you have the right disability insurance, you need to call Larry. He's a fantastic resource and he is trusted by physicians all over the country. There are a lot of ways to mess up insurance and I don't want that to happen to you. Just go to his website at, uh, www.physicianfinancialservices.com or click the link in the show notes to get the free disability insurance quotes today from Larry Keller. You know, this is going to be a bittersweet episode for me since this is going to be my final podcast. The last two years has been a, ah, phenomenal journey for all of us. I've gotten emails from so many of you telling me how valuable this content has been and, uh, I'm just so grateful to have been part of your journey. You know, I set out to create a platform to empower physicians to take control of their careers, their families, and their personal finances. My hope was to embolden you with knowledge and encouragement so that you can live your best life on your terms. Now, after over 75,000 downloads, 100 weekly episodes, and 19 Sunday specials, I hope that I have given you some of those tools that you need. Well, that's why I'm so excited about today's discussion. As physicians, I think we know better than anyone else what we need to take care of our patients. The government isn't coming to help us. The government is full of people who don't know or can't understand how to care for patients because they've never had to do it. It. You are a physician. You should be the one in charge of making decisions for your patients. But if we're going to make that a reality, we have to start by taking charge of ourselves. So here is our final discussion for the Scope of Practice podcast. Hey y'. All. Uh, for our final discussion today on the Scope of Practice podcast, I'm really excited to talk to you about this topic that I, I've been thinking a lot about over the last couple of years and hopefully a lot of this has kind of come through some of the previous discussions that I've had with other industry experts and uh, other physicians. But I think it's really important for us as physicians to recognize that we are the ones in society who know best what it means to take care of patients, and we're the ones who best know what we need to take care of patients. There are so many other people vying for that opportunity. We've got politicians, we've got government officials, bureaucrats who are all unelected. Uh, we've got hospital administrators. And so many of these people are not physicians. And they want to tell us what we need to do in order to take good care of patients as if we don't know how to do it or as if they do know how to do it. It's frustrating and it's demeaning at times. So, uh, I really want us to talk about this topic in detail because I think that if we can't figure out a way to position ourselves to be the natural choice for leadership in modern healthcare, and maybe that's ah, at the hospital committee level or the hospital board level, or the hospital administration level, the local, state or federal level, uh, if we can't figure out how to make it obvious that physicians need to be doing the leading of this particular industry, then I think we're going to be, be forever at the mercy of people who don't know what they're doing. So I want to start off by, uh, giving you guys a quote that I love, uh, from, uh, a guy named Thomas Sowell. He's an economist. But I think this quote, uh, really sums up, uh, one of the Big problems with, uh, politics and medicine. So this is from Thomas Sowell. He said, it is hard to imagine a more stupid or more dangerous way of making decisions than by putting those decisions in the hands of people who pay no price for being wrong. Close quote. Think about that. I mean, that basically sums up the entire system of US Government. Now, I am a big believer in the United States of America, and I'm a big believer in the constitutional republic that was created. And the founders really put into place important checks and balances and, uh, really big obstacles that make it difficult for us to get things done because they wanted there to be the ability for us to make big, uh, sweeping changes only when an overwhelming majority of the country felt like it was a good idea. The problem that we've run into in modern, um, uh, politics is that, uh, people get elected and they start to do stuff, but they're not the ones that ultimately pay the price. They don't have to come to the patient's bedside and say, uh, sorry, we can't get this test approved, that you need it, or, sorry, uh, your doc wants you to order this one medication. But unfortunately, we're going to make it impossible because of so many administrative regulations, uh, or, you know, this surgery really needs to be done. But unfortunately, uh, you know, we are going to make it difficult for your doctor. They never have to be the ones who actually face up to these consequences. And so as a result, they just do whatever they think they ought to do or think what some interest group has told them is the best idea. But very often what that does is actually puts us at odds with our patients, or it puts, uh, strangleholds and roadblocks in our way that prevent us from being able to take care of patients the way we know that we should. So we're going to talk a little bit more about what it looks like to be, uh, leaders and why it's so important for us as physicians to take the reins of leadership back. But before we do that, I want to give you some examples of what other governments around the world have done, lest you think that this is purely an American problem. So if you're listening in Australia or India or South America or Europe or any of our other, uh, places where listeners tend to listen, um, this is not uniquely a, an American problem or even a North American problem. Okay, so let me give you a few examples of how other governments around the world have really messed up healthcare when they've tried to take control. So in Canada, healthcare is free and universal, but caps on Physician salaries cause many physicians to work less than 12 months in a year. So a lot of specialties like orthopedists and cardiologists and surgeons, and they may meet their salary cap after eight, nine or 10 months, and then they basically have the choice to continue working the rest of the year, but they can't make any additional money because of the caps on their salaries. So there's a lot of physicians in Canada who actually work for nine months out of the year and then come do locum tenants in the United States for three months and just abandon their practice. Well, you essentially are having a physician work only 75% of their possible time over the course of the year, or a lot of other physicians will do it spread out throughout the year, so they'll work three weeks on and one week off. So that decreases capacity and it massively de incentive or, uh, disincentivizes people to work. So that is, uh, a real problem in Canada. In Brazil, only 58% of people report being satisfied with their prescription drug services. Well, that's a problem. I mean, as physicians, there's only so many things that we can even do. Wewe perform procedures, we give advice, and we prescribe medications. That's basically everything that we can do for patients. So if one out of those three is prescribing medications and six out of 10 people aren't happy with it, then that's the system not working. Okay, how about in Australia? In Australia, the median wait time to get an elective hip replacement is seven months. Seven months. Because the healthcare is universal, so everyone has coverage, and there's nothing inherently wrong with that. But, uh, as a result of all the bureaucracy and administration that goes along in the Australian government, it takes forever to get things accomplished. And so here in the States, you need a hip replacement. We get it done in, say, six weeks, not over half a year. That's a long time to tell grandma that she's got to wait, uh, to get her hip repair replaced because she's in agonizing pain all the time. In Spain, public healthcare services don't allow you to choose your doctor or specialist. Now, this is a real problem for the West. Um, this is not something that people want. We want to be able to choose our own physicians and to be able to stick with our physicians and change our physicians if we don't like them. And in Spain, that is not allowed. Okay, how about Austria? So our friends in Austria are government, uh, employed physicians, but they routinely have a side practice that will accept only private insurance because their Salaries are so poor. So you have, uh, physicians in Austria that'll work, uh, their regular job as a government employee, and then they'll have a private practice on the side taking only private insurance. So clearly there are some flaws other places besides just America. So when I've talked about this in the past, I like to show a picture of, um, if you can kind of imagine this, a, uh, physician's hands, uh, folded and holding a stethoscope. And you can see the white coat on their, uh, that they're wearing, but they have handcuffs on their wrists. And I think a lot of us feel like this a lot of the time where, uh, you know, imagine as a primary care doc, you're stuck seeing 30 to 35 patients a day just to be able to make your overhead and, and be able to pay all your employees and everything. But that means you have 8, 10, 12 minutes to complete every encounter. And so you want to be able to sit there and chat with your patients for a couple of minutes about their son's soccer tournament or their daughter's piano recital or their, their wife's new job or their, their own, uh, or their, the, you know, their family's, um, situation and their health. And you just don't have that time. I mean, you have 29 minutes worth of stuff that you have to cram into a nine minute visit. And you've got all these different metrics, uh, that you have to hit. You have all this paperwork that you have to fill out for quality control. And none of that's inherently evil, but it just piles up and piles up and piles up and prevents you from actually doing the work of taking care of your patients that you want to do in the first place. So I think that as physicians, it's time for us to stop listening, start leading. And when I say stop listening, I don't mean stop listening to our patients. I mean stop listening to everybody out there who thinks they know better than us. Uh, stop listening to bureaucrats, stop listening to politicians. I don't mean disobey the law. I mean, just stop taking advice from people who don't know what they're talking about. Okay? I'm a gastroenterologist. I'm not going to be giving a lot of advice about orthopedics or obgyn, all right? That's not my area of expertise. And, and I think politicians need to do the same thing. I think they need to stop talking and start listening to us. But if we're gonna, if they're gonna listen to us, they need to have a good reason. And so what we need to do as physicians is we need to start leading ourselves. And we need to position ourselves with such expertise and such leadership and such confidence that people naturally turn to us and they naturally want our opinion. They want us to be the ones that, that make these decisions for them because they don't know when we show ourselves to be, um, to have no confidence or to have, ah, little, ah, leadership skills, then why in the world would anybody want to listen to us? We have to do our part by showing these people that are in charge of our government that we know what we're talking about. So there's a, uh, quote that you've heard me use on this podcast many times, and it's one that I really think is important, and that is this. Healthy things grow and growing things change. Just like every plant, just like every child, just like every small animal. If they're healthy, they're growing. And when they grow, they change. You think about the. For those of you out there that have kids, especially small kids, six months can make a humongous difference, um, at almost any stage of development. And they, they grow so much, they change so much in so short a time. And that's healthy. That's good. It's hard, you know, it's difficult at times. But if we're gonna be, uh, healthy, uh, you know, from a professional standpoint, if we're gonna show, uh, Washington and our, all of our state governments that we know what we're talking about, we really have to undergo some changes. And what does that really look like, practically speaking? Well, it starts with leading ourselves. It starts with growing and developing ourselves. Okay, I want you to think about this. Have you ever seen a, uh, champagne fountain? So imagine a pyramid made of champagne glasses with a single champagne glass at the very top. Sometimes you'll see this, uh, at weddings, and somebody pours champagne into the very top, uh, glass, and it fills up and it starts to spill over, and it spills over into the three that are resting just underneath that glass. And then it fills those three up and they fill up and they spill over, and they start to spill over into the glasses below, into the next here and the next here and the next here. But it all starts at the top. It starts with you. Now that doesn't matter if you're at the top of your leadership organization. Maybe you're not a, uh, department chair, maybe you're not a, uh, director. You know, you don't, you may not have a title in your name, in your you know, behind your name at all other than staff physician. But you can start leading right where you are. And leadership starts with ourselves. It starts with a M. Man in the mirror moment or woman in the mirror moment. We have to look inside and decide who are we, what are we doing, what are our goals? Okay, so if you don't start with yourself. Okay. If you think about this champagne, uh, pyramid analogy, if you start by trying to develop other people or trying to help other people without first filling yourself and growing and developing your own skills, then you're, you're going to be missing the opportunity to pour into all the people under you. And then that effect multiplies as you go down each successive tier. And you end up with huge sections of your organization eventually that are not being grown and developed. So it's got to start with you. It's not a matter of being selfish either. Okay. The best way that you can lead your team is to first lead yourself. And so how does that, uh, start practically? Well, let's talk about a few different things. So the first thing. And you've heard me talk about this, I think, a little bit. Uh, I call this concept embracing the 1%. What I mean by that is that in every endeavor in life, whether it's our medical specialty or leadership or your family, there is some aspect of that activity that is very difficult for us. It's not our favorite thing. It's something that is frustrating and it's time consuming and energy draining. Okay. If you can get to a place where you mentally don't hate that 1%, you'll do well. If you constantly are focused on that 1% of things, trust me when I say those things will consume your life. And you talk about being. Well, it's just 1%. It's just a small thing. It's not just this one aspect of my job that I just hate. Trust me when I say that is going to consume your life. It will spread like a cancer. So figure out what the 1% of your job is that you just don't like and embrace it. Decide you're gonna make it a challenge, you're gonna figure out a way to beat it. Maybe that's answering emails. Maybe that's, um, you know, weekly staff meetings. Maybe that's, um, you know, creating, uh, your to do list. I don't know. But figure out what that is and find a way to make that challenging and fun and interesting and innovative for yourself. Otherwise you'll just end up seeing that grows and takes over your entire subconscious. Uh, the second Thing you can do is ask your boss what you can do to grow as a leader. Now, this is going to be more useful for you if you have a boss that's actually willing to help you and help you grow and help you learn. But ask your boss, you know, what does it take to grow as a leader? So just ask him. M what's. What are my biggest liabilities right now? Or if I wanted to be a director in five years, if I wanted to have your job in five years, what should I be doing? What are some mistakes that I'm making? What are mistakes that people in my position commonly make? What are things that I, uh, could be doing differently or better? Or, you know, what are some problems that I could be solving? But ask your boss. Another thing you can do is use some introspection tools. So you may have used things like, uh, the Fascination Advantage. We had an episode, uh, a few months ago where we talked about the Fascination Advantage. I think it's an absolutely fabulous tool. You should definitely consider. It's a way to figure out what people see in you and why people interact well with you. It's mainly designed as a communications tool, uh, or the disc profile D I S C. It, uh, gives you insight into, uh, how you tend to approach situations. Are you a very decisive person? Or do you try to integrate everybody into the decision making process? Or are you trying to, uh, are you very details oriented? Okay. Or maybe many of you have used strengths finders. Uh, these are all very good tools that can help you learn what your strengths are and conversely, what your liabilities are. Another thing that you can do that's really helpful is decide what job you think you want next and then try to emulate the aspects of that person's journey that led them to their success. So let's say that you're a staff physician right now and you've been on the job less than five years, but you know that you're destined for bigger things. You've got great ideas, you're great with people, and you want to be a leader in the organization someday? Let's say you want to be a, you know, department head next. Okay, go to your department head and ask them. Take them to lunch and ask them, what did you, you do that got you to where you are today? You know, what committee, uh, assignments did you look for? Who did you network with? What kinds of metrics were you trying to hit? How did you even determine what jobs would be available? And just start asking people, how did they do it? I mean, it's just like we've talked about with personal finances. If you want to be wealthy, find wealthy people and ask them what they did to get wealthy. If you want someone who's got an incredible marriage that's been going for 40 years, if you want to be that person, go find someone like that and ask them what they did. Uh, but find someone who has what you want and ask them how they did it, and then try to copy that. And finally, the big thing that you can do is read, read, read. We have had so many amazing interviews with people on this podcast. Great authors, great industry experts. I mean, I've given you guys literally dozens and dozens of books that I think are fantastic. And you can certainly go back and listen to some of these podcast episodes to get summaries of a lot of these books. But I encourage you to read the books themselves. If you don't already have my reading list, you can download that@the scopeofpractice.com readinglist. It's got 35 books on personal finance, marketing, business leadership, um, and a few other topics. And it is a masterclass in healthcare, um, leadership and personal finance. You definitely should consider getting that list. So it's the scopeofpractice.com readinglist. You should definitely go check that out. But read, listen to podcasts, go to presentations, go to conferences, uh, learn, learn, learn, learn, learn. The more you can do, the more you will grow. Okay? The next thing that you need to do if you're going to be a leader is start paying attention to the business. Now, this is an area where I think a lot of physicians really fall short, uh, especially if you're in a fairly large organization like, uh, Kaiser Permanente or Healthcare Associates of America, uh, or hca. Now I forget what it stands for. Um, but if you're in a big organization, a lot of times people and, you know, physicians will be very content to just, you know, show up, go to work, take excellent care of your patients, and decide, uh, that's really enough. I don't need to do anymore. The problem with that is that when you do that, you are ceding control of all the decision making in healthcare to the people who may or may not be physicians. And so you can do that. But I contend that it is a superior approach to pay attention to the business. Okay? Learn what it takes to run the business. Because make no mistake, we are in a business. Healthcare is a business. And it's weird to talk about that sometimes. A lot of times physicians feel very squeamish, uh, discussing that. And Feeling like, oh, it's just, it's, it's almost dirty. You feel dirty talking about money. But the truth is, this is a business now. It's important. I think a couple of things. Number one, you have to get the polarity right on that, okay? We don't take care of patients so that we can have a great business and make a lot of money, okay? That's the wrong way to look at this. The right way to look at this is we want to have an excellent, thriving business so that we have the opportunity to continue taking excellent care of our patients. Our, our patient's well being and our patient's care has to be our top priority. But if we don't pay attention to the fact that a business mindset is required in order for that, uh, to be made possible, then eventually we will end up losing, okay? And our patients are the ones that really lose. So we really have to pay attention to the business, frankly, for our patients sake. Another thing that you should think about as you start to think about, how does your business thrive? Uh, we had Mike Michalowicz on an earlier episode talking, uh, about his book, uh, Profit First. And I think that's a really important thing to think about, okay? Taking profit first. When you take profit out of the business, you can do it one of two ways. You can take it first and then spend whatever is left over on payroll and taxes and upgrades and expansion and things like that. Or, uh, you can take it last and you know, you spend as much money as you feel like you need to and you take whatever profit may be left over. The problem is that if you do that, most of the time you'll spend everything and you won't even take any profit home. And then you'll end up stressed. You'll end up not paying off your student loans, you'll end up not being able to feed your family, and you just run into trouble. So don't be afraid to take profit first, okay? Reasonable profit. Not crazy, but take reasonable profit out of the business, uh, and then spend what's left. You will make different decisions if you are forcing yourself to spend based on what is remaining after you've taken profit out. Another thing you should think about doing is hire out things that you can't do. So for me, I am not good with taxes, okay? I can do a little bit of stuff with taxes. I can do QuickBooks and H& R block software and that kind of thing. But, but man, when it comes to business taxes, that gets beyond me fairly quick. So we hire that out. You know, that's not something that, uh, any of the docs in my group try to do ourselves, right? So that's something that we have tax accountants for. So that's okay. Uh, maybe hiring and firing is not your thing, or at least hiring is not your thing. Uh, so consider having a chief of HR or a chief hiring officer or something like that. Something where you feel like you're not very good at it and you can hire it out to be done. Okay? Um, so don't feel like you have to be good at every single aspect of your business. Figure out what you can do great. And the stuff that only you can do and focus on that and everything else that isn't your top strength. Hire that stuff out. And the final thing that I'll say is we're paying attention to our business is encourage innovation. So one of the challenges of being in an organization where innovation is discouraged, or at least not incentivized, is that nobody wants to think about stuff. You, uh, know, nobody wants to come up with great ideas for how to make things better because there's just no incentive to do that. So as a leader, you need to pay attention to that. If everyone is dependent on you to come up with the next great idea, we are limited by your innovative capabilities. Okay? So you can only come up with one brilliant idea at a time. But if you empower all of your team members, okay? And it doesn't matter what size you have, if it's eight employees or 15 or 27 or 160 or 3,000, okay. You can come up with that many brilliant ideas at a time. You massively expand your ability to come up with great solutions to problems. If you encourage everyone in your organization to act like an owner. So encourage innovation within your business. Okay, I wanna take a second and talk about the concept of leading when you're not in charge. And we talked about this here recently with Clay Scroggins. So if you haven't heard that episode, go back and listen to it. Cause it was amazing. Oh, my gosh. It's one of my favorite episodes. But go back and listen to that. But for now, I wanna talk about just a couple of aspects of this. Okay? As physicians, I think a lot of times we feel like we're not in charge, you know, and this starts very, uh, early on. This starts off when you're in med school. You're the lowest person on the totem pole, and you feel like you're not in charge. And really, you're not. Okay. Then when you get to be an intern. All your residents are over you, okay? But guess what? The nurses are asking you questions. They're asking for orders. Your patients are asking for you. Other interns are asking you questions. Okay? So someone that hasn't been on the, uh, rotation that you've already done, okay? So think about this, all right? I love this definition of expert. Okay? What is an expert? Well, one definition of expert is someone who knows 5% more than someone else about something. Okay? So if you think about that as the definition of expert, you are an expert in something relative to somebody else, okay? So you have the ability to lead, even if you don't have a title behind your name. And you spend a lot more time being a leader than you realize. Your nurses look up to you. Your medical assistants look up to you. The patients look up to you. Your peers, uh, look to you. Trust me when I say that you are a leader whether you want to be or not. So you need to decide what kind of leader you want to be. One of the things that Clay Scroggins talked about in that podcast episode on how to lead when you're not in charge was the idea that leadership is not authority. Those are not equivalent. Okay, so you don't have leadership capability, or you don't have leadership, uh, just because you have been given authority. Okay. Leadership is really about influence. And, um, that's an important distinction because you can be an influencer when you're very new in your job. You can be an influencer when you don't have a title. You can be an influencer when you don't have people that directly report to you. So how do you do that? Well, there's a few different things that you can do. Like I said, start small. You're an expert relative to somebody about something. Start by looking for problems to solve. We're going to talk about this in detail in a second. But that's one of the best things that you can do. Everybody's going around doing their job, and everyone feels like they've got a problem. And if you can figure out a way to solve their problems, or at least bring their problems up to someone's attention, who can solve them? Oh, trust me, you will build influence quickly. So what are some other ways that you can build influence? Well, you could join a committee, uh, at your hospital or on your private practice group, or join a national society and get involved, or join a medical organization at the state or local or even national level. Those are great ways to build networking. Meet, uh, new people, figure out what are the problems that we're trying to tackle at various levels of uh, the government and just get involved. Right? You'd be amazed at how small the medical community is. So I remember I started doing a lot of work with uh, the American College of Physicians when I was in medical school and uh, really in residency especially and you know, got to know some really amazing people, made some great connections, uh, with people who are now in leadership positions in those organizations. And I've got really great connections with those folks that I wouldn't have had had I not bothered to get involved. So there are lots of ways that you can build influence, uh, just by joining some of these organizations. Another thing you can do to build influence is teach. This is so valuable. So one of our nurse practitioners, um, that we hired one time, I remember, was very, very motivated and a phenomenal nurse and had some pretty big knowledge gaps, uh, knowledge deficits as a nurse practitioner. Uh, but she was motivated and she was a go getter and she was constantly looking to improve. And, and so we set about to teach her, teach her, teach her. And uh, she has just done a phenomenal job for us in our practice. She takes excellent care of her patients. Um, she knows her capabilities, she knows her limitations, um, and she is just really, really solid. Um, but you can do that with your nurses, you can do that with your advanced level providers, you can do that with your med students, your residents, uh, your peers, you can do that with your patients. Um, it's amazing how many opportunities you have to teach during the day. So definitely think about uh, being a teacher. That's a great way to build influence by helping people learn things that they wouldn't have been able to learn otherwise. Another way that you can build influence is to have an opinion. Alright? So if someone comes to you and asks you a question and your answer is always I don't know, then they're gonna stop asking you at some point. Now I'm not suggesting that you just make things up whenever someone comes to you with a problem or with a question. But um, you know, have an opinion on something and if you genuinely don't know anything about it, say, you know what, I don't really know what I think about that, but that sounds like an important question. That sounds like an important thing for us to know. Let's learn about that together. Let's go ask someone, let's go ask one of the other doctors, let's go ask one of the senior nurses, let's go ask one of the um, administrators, let's Go find a way to answer that question for you, but have an opinion. You know, be someone who people, uh, look to for advice and for judgment. Okay. And the final way that you can build influence, perhaps the best way is to elevate other people. Trust me, nothing seals your role as an influencer or as a mentor better than elevating someone else. Okay. Give other people credit. We had, ah, a PA one time that came up with a solution to solve a problem we've been having with our medical record, electronic medical record, that it probably saved us, um, oh, I don't even know how many hundreds of man hours it saves us during the year. But it was just a very small change that she figured out and coached us on and turned out was a huge thing when you multiply it across 20 docs in the system plus, you know, how many hours a week we're spending with that particular task, and it was huge. Well, when we, when we brought that up solution up to our, uh, physicians meeting, we gave her credit and that filtered down. We had half a dozen different docs that, uh, came up to her later and said, thank you so much, it's helped me so much. I really appreciate how much time it's given me. It was a great idea that you had. And man, I tell you what, she really felt great about that and looks to us as, you know, people who are in her corner and really want us, uh, to, we really want her to succeed and we really have shown her that we want her to succeed. And so naturally we were able to, uh, build some pretty significant influence with her. The next thing that you can do to, uh, be a leader is solve a problem. This is pretty much 90 plus percent of leadership. Uh, leadership is not fancy speeches and big dinners and, you know, awards for, uh, excellence and this and that. I mean, that's all fine if that's something that happens along your way, but that's a very tiny portion, I mean, a couple percent of your time. Most of the time that you spend as a leader is not dealing with the fun stuff and the easy stuff. It's dealing with the biggest problems, the biggest frustrations, um, all the drama, all the nonsense that nobody else wants to tackle and handle. That is what you do as a leader. And, and one of the things that you can do that will solidify your, solidify you as a leader in the eyes of your team is by being someone who can solve problems, uh, or someone who knows how to find the right people to solve problems. So how do you do that? Well, one way that you can do that is just by going around and asking people, what is your number one frustration right now? I guarantee you, you could turn to anybody in your entire team this minute and point to them and go, you, what is your biggest frustration right now? What's the number one thing that drives you crazy at work? Everybody has an answer to that because they spend hours every week thinking about it and talking about it and complaining about it to their team members. Okay? So everybody knows the answer to that, uh, question. So feel free to ask that, because if you can figure out a way to solve a person's biggest frustration, oh, my goodness, they will look to you for influence for forever. Okay? And the more of that that you do, the more people start to recognize, hey, this is someone who knows how to get something done. And this is someone who cares enough about me to try to get something done. Sometimes that's as simple as just helping eliminate roadblocks. Uh, you know, I'll never forget when I was a, um, I guess I was a second year resident, or perhaps I was an intern. Um, and our program director was going to be, I found out, was going to be our attending on the medicine wards. And I was very nervous. So, uh, she was an amazing physician and still one of my great mentors and a wonderful leader, and I just think the world of her. But as an intern, you can imagine I was quite nervous. Uh, you know, she's got tremendous influence over our careers and over our, um, fellowship prospects and military assignments at the time and things like that. And she's also someone whose respect I desperately craved. And I was very nervous because I thought, oh, man, what if I make a mistake? You know, this is, you know, she's gonna, this is how she's gonna think about me for the rest of my time in residency. But she ended up being one of my all time favorite attendings on the wards. But I'll never forget this one time on, uh, the Medicine Medicine rotation that we had a particular service that we needed to consult. And I called the other team's intern and, uh, the intern passed back to me that they had passed it up with their team and said, no, we're not gonna come see that patient. And so I was like, okay, I'm an intern. What am I gonna do? So I told my resident, hey, um, so I went and talked to him. They're not gonna come see the patient. So the resident called their resident, like, hey, listen, we really need you to come see this patient. We're worried about him for this and this. So can you please come take a look? And you know, they called back and said, now we are declining, uh, the consult. Sorry. And so then we have our, uh, morning rounds and we tell our, um, attending, hey, uh, so we consulted the service, but, uh, they blocked us. They're declining the consult. She's like, what do you mean they're declining the consult? I said, well, I don't know what to tell you, man. They're just not gonna come see her. And I'll never forget her response. She's like, well, that doesn't work for me. And she picks up her phone and calls the other attending directly and says, hello, this is insert, uh, physician name. I, uh, need you to come and see this patient as soon as possible. I'll expect your report immediately. Now, some of this was probably helped by the fact that we're in the military and she was a captain, uh, which carries a lot of weight. Uh, but it was an absolutely amazing, amazing thing to watch. Just, well, that doesn't work for me. And just calling and immediately she had the problem fixed for us. She's like, okay, now we've got it. Moving on to the next thing. So a lot of what you're going to do as a leader is just eliminating roadblocks. So the more you can find ways to do that for your team, the more they'll trust you and the more they'll see you as an influencer. All right? Another thing that you can do is develop leaders under you. This is really important. And I think that if you're not developing leaders under you, you're not really reaching your maximum leadership potential. Okay? So I think as leaders, one of the things we should be doing is constantly trying to work ourselves out of a job. So the more that we can empower people underneath us, or more that we can empower our subordinates and our team members to do the jobs that we need them to do. Uh, the less they become reliant on us, and so the more they're able to do on their own. And so I think that's something that we need to be doing constantly. So how do we do that? Well, there's a few things that you can do. Specifically. Number one is you can give people small problems to solve. Okay. Like we were talking about a minute ago, so much of leadership is problem solving. Okay, well, think about this, alright? If you give someone a big problem and they haven't proven to you previously that they can handle a small problem, they may very well be in over their head very quickly. Okay? So start small Start with something simple. Give people small problems to solve. Let them get a, uh, win under their belts. And when they've proven to you that they're able to handle small things, give them more responsibility, Give them additional things that they can try to solve, and give them gradually bigger and bigger issues to tackle. Another thing that you can do is support your team members. And that can mean encouragement, but that can also mean materially. It can mean, uh, giving them adequate time to complete projects. It can mean making sure they're adequately supplied, making sure that they have, uh, enough team members assigned to a job that needs, uh, to be done, as opposed to having one person do something that's really designed for four people. Okay? Uh, another thing you can do is invite people to participate in decision making processes. So, sure, you can, as a leader, just decide unilaterally how you're going to manage every single problem that comes your way. But, but that is going to very quickly breed resentment. Okay? So invite people to participate in the decision making process. Ask for people's opinions. Trust me when I say if you're trying to solve a problem, there are people who work for you that have a very strong opinion and not everyone's going to have a valid opinion. Or maybe people's opinions will be, uh, considered in the absence of all the facts. Okay? But it is very helpful to get people's thoughts on the matter for two reasons. One is that they will be more likely to be inclined to accept your ideas, uh, once they feel like their voice has been heard. But the other thing is that they may give you an idea that you haven't thought of or give you an aspect of things that you hadn't considered that will affect the ultimate decision that gets made. So invite people to participate in decision making processes. And the final thing is provide growth opportunities. Give people opportunities to excel. Give them projects to manage. Give them, uh, places where they can become leaders. Give, uh, them people to manage. Give them tasks to complete. But find ways to help people grow. Maybe it's sending people to, uh, a personal development conference or professional development conference. Um, maybe it's having people join committees. Maybe it's inviting people to participate in national or state medical societies. But find ways that you can get people involved and help other people grow. And the final big thing that, uh, you need to be doing is cultivate your culture. Okay, now we've talked about this before. We had, uh, an episode with William Vanderblumen reading, uh, a book called Culture Wins where we talked about the fact that culture eats strategy for Breakfast. So you can have the best strategy in the world and have the vision and have, uh, the execution and all your resources and all your supplies. And if you don't have a culture that is thriving and robust and everybody's working together and everybody is, um, you know, like a Swiss watch with jeweled movements and every, every gear fits together perfectly, if you don't have that, it's going to come to a grinding halt. Okay, so you need to be actively cultivating your team culture. And so the first thing you need to figure out is what do you want your culture to be? Okay, who do you want on your team? What is the, what are the core values of your team? What are you focused on? Are you guys all about, uh, being incredibly responsive so somebody gets a patient message and they're going to answer within 15 minutes? Or, uh, are you about, uh, making care as affordable as possible and finding ways to help patients save money and help the, uh, help patients find cheap or lower cost alternatives to things? Okay, so, or is it just, uh, is it a fun place to work? Everyone's excited to be there every day and their best friends outside of work, what is your culture? What do you want it to be? So you have to decide that first. Another thing you have to think about is the fact that the dominant personality in an organization tends to drive the culture. Now if that's you, then that's one way that you can see that your culture develops. So if you are the most, um, boisterous or most, uh, I guess dominant's really the best word personality in your organization, for good or for ill, you're going to tend to shape your culture. Now if you're not, maybe you're more of an introvert. You tend to like to lead behind the scenes a little more. Whoever is the most influential personality in your company is going to tend to drive the culture. So you think about this like if you've ever worked in an operating room, uh, and you've got a big team in there, you got an anesthesiologist, you got a surgeon or two, you've got a surgical tech or two, uh, you've got a radiologist maybe, or radiology tech, um, so if you have one person who comes in and they're loud and they're rude and they're making, uh, inappropriate jokes, and they're the ones that are constantly making the most comments, then they are going to be the ones who tend to influence how that culture runs. And everyone's going to feel how they're going to feel. Maybe they all join in, and that's part of your team culture. Or maybe they just are very uncomfortable because of. Because, uh, it rubs them the wrong way. Okay? So if you're not the dominant personality in your organization, you need to figure out who the most influential personality is and make sure that that person is on board with your vision for what your team culture is going to be so that they can help you shape it the right way. And the last thing that you can do, and we've talked about this before as well, is, uh, celebrating cultural values more than you celebrate accomplishments. Okay? So here's what that looks like. So let's say that one of your, um, core values is exceptional safety. Okay? So you have a nurse that had a great catch. You know, there was a near miss, an incident that could have resulted in patient harm, but Susan figured out what was going to happen, figured out a way to prevent it, and the patient was okay, all right? There are two ways that you could potentially celebrate that person. Okay? And here's. Here's how that might look. Okay, here's scenario A. You're at your weekly staff meeting, and you say, okay, so I wanted to celebrate Susan, uh, for a minute, guys. Susan had a, uh, great catch this week. She saw this harmful, um, event that was, uh, potentially coming down the way for one of the patients because of, uh, this series of errors that could have been made. But she figured it out and prevented this from happening to the patient. Patient's doing great, and we want to celebrate Susan. Let's all have a round of applause. Thanks, Susan. We appreciate it. You are awesome. Okay, now, there's nothing particularly wrong with that, but what if you consider this alternative? Okay, so you're at your weekly staff meeting, and maybe it goes something like this. All right, guys, so, uh, you all know that one of our big core values is exceptional safety. Well, I want to tell you guys about a way that I saw that value lived out this week by one of our staff members. So Susan had a, uh, great catch on a patient this week that resulted in narrowly, um, avoiding what could have been a frankly, health disaster for a patient. But the patient's doing fine, and it was a really, really great catch. And the fact that Susan was so on the ball and paying attention. Right. Really embodies this core value of exceptional safety that we try to live out as an organization. And I'm really proud that people like Susan are helping us to achieve that goal as a company. Thanks, Susan, for, uh, being the embodiment of exceptional safety in our culture. Okay? So what you're doing there is you're celebrating the value as much as you are the person. And that is really important because brings people into a larger purpose. And so instead of people saying, you know, being, tending to be jealous that, oh, Susan got recognized, instead people go, oh, man, Susan, uh, got recognized for, you know, being incredibly safe. There's no reason I couldn't do that. So I need to be. I'm gonna be looking out for things too. And, um, everybody then starts to buy into the culture more. The other thing that'll happen is that when Susan leaves someday, as people eventually do, everybody leaves every job, either because they quit or because they're fired or because they die. But everybody leaves every job someday. So when Susan leaves that job, if you use scenario A as your primary celebration, uh, technique, then losing Susan is like losing a part of you. It changes who you are as a culture, as an organization. But if instead you celebrate the cultural values, then Susan leaving isn't. It's sad because you're losing a friend and a valued colleague, but you're not losing who you are as an organization. Instead, you're exporting your culture through Susan to the new job that she is going to. And that's a very, very different scenario. Okay? So think about ways that you want to cultivate your culture. And another thing that I want you to think about is hiring and keeping the right people. This is so important as leaders. If you're going to have the right team, okay, you gotta find the right team, train the right team, keep the right team, and get rid of the wrong team. Okay? This is hugely important. Two of the books you've heard me talk about on the podcast multiple times that I think everybody needs to read are Good to Great and Built to Last. Both books by Jim Collins, and they're on that reading list that I mentioned. TheScopeOfPractice.com ReadingList. You can download it for free. But in those books, one of the, uh, topics or one of the concepts that Collins talks about is the idea of a company being like a bus. And the bus is going to a particular location, and you need to have all the right people on the bus to get there. But there's, uh, three aspects to that that are very important. You need the right people on the bus, you need the wrong people off the bus, and you need the right people in the right team, the right places on the bus, or the right seats on the bus. So you need to keep the right people on the bus. So hire good people. Hire the right people. All right? Second thing is put them in the right roles, put them in the right seats. The person who drives the bus doesn't need to be the person who plans the team activities, who doesn't need to be the person who runs the budget, who doesn't need to be the person who packs all the suitcases, uh, under the bus, okay? Everybody's gonna have different strengths and be right for different roles. So hire the right people and assign the right roles. And, and in particular, when you're thinking about hiring the right people, hire them based on a cultural fit, not just a skills fit. So you can train people to do a lot of things, but you can't train work ethic, you can't train integrity, you can't train, um, the desire to elevate other people on your team. Okay? So you need to hire people who already have those character traits and then you can train them how to do the job that they want to do or uh, that you want them to do. The second thing, like I said, you got to assign them the right roles. So if you've got someone who you feel like isn't meeting your standards, maybe you've got them in the wrong role, okay? Maybe you've got someone at the front desk and they're so introverted they're just not good with people. But they're a whiz on the, uh, computer. So maybe they need to be in medical records instead. Okay? So figure out where people best belong. The next thing you need to do is fire people who don't meet standards. Now this is a hard thing for physicians to do, but here's the problem, okay? If you don't fire people that are bringing your organization down, you will eventually see that the good people leave and the bad people will be all you're left with. Okay? Think of it like uh, a, uh, cancer, alright? When we're getting rid of cancer, when we're attacking cancer, we attack it with extreme prejudice, right? So, and what I mean by that is we areit's not enough just to take a cancer out surgically. We're hitting them with chemotherapy, maybe radiation, because we know if we leave one cancer cell behind, then for sure the cancer is coming back. We have to get it all out. And a team member who is like that on your organization, um, you know, it doesn't matter what their, what their background is. If they are not meeting your standards, then they are going to be a cancer in your organization and you need to get them out. Okay? Now what I want you to think about is how to do this the right way. Okay, so there's a lot of different ways that you can fire people, but here's a great way that I have found, and I think this is a really good, uh, way to do it. If you've got someone who is obviously committing, uh, some kind of breach in a significant way, sexual harassment, inappropriate behavior, just fire them, send them out the door, give them free 2 weeks pay for their severance or whatever, and send them packing. Okay? Don't wait on that one. But if you've got someone who is, uh, not bringing it every day, they're not hungry, they're just not quite living up to your expectations of excellence, but they're doing enough to get by. Start by giving them a chance to rehab themselves, because maybe part of it is that you haven't given them the right expectations. So maybe part of it is your fault because you haven't made clear to them what you expect of them. And so here's how this might look. Okay? You have a team member. Let's call him John. Okay? You bring John into your office, uh, with you, and probably one other person, maybe someone from legal, someone from hr, um, uh, so someone else that isn't in their direct chain of reporting. And you say something like this. So, John, we really want you to succeed here. We're excited to have you as part of the team. But as your leader, I feel like maybe I haven't done a great job keeping, uh, my expectations clear for you, because, unfortunately, you're just not meeting my expectations. And I want to own up to the part that I've played in that. And I hope you'll, um, accept and forgive that, uh, my lack of clarity, uh, in this area. But I want to be very clear to you now. Um, these are going to be my expectations for you going forward. And here's where I feel like you're falling short of those expectations. And have these written down, okay? And go through them very clearly with people, okay? Extreme clarity is incredibly important in this situation. Okay? So be very clear, have it in writing and go through it with them and make sure that they really understand what you expect of them. And then you're going to tell them, um, okay, so let's say this is on a Friday, okay? So you're going to say, okay, so we're going to give you a certain amount of time, let's say 30 days, okay, to meet, Start meeting these expectations. And each week we're going to meet together again and track your progress and see where we are. Okay? And we want to see you making progress week by week. And so, um, that way we can make sure that you're on track to be wherever we want you to be by the time that we've set and have something in writing. Have everybody sign it, okay? And then a week later you meet together and you say, John, you've done an amazing job. You're on track to meet our expectations. Here's some things you've done differently this week that have really worked. Here's what I want you to start doing for next week, uh, to continue improving. Keep it up or it's going to be, John, you are just not making the progress we want. Here's where you're still falling short. Here's what I want to see you do differently. Okay? You do that for several weeks in a row, okay? And then on the final week, say it's been 30 days or four weeks or whatever, and you say, okay, John, uh, it's been four weeks, we've been meeting together every week, and unfortunately you're still not meeting our expectations. Uh, I don't think that this is a good fit for you. Uh, you are someone who we love, who we want to see succeed, and this is not going to be the place where you're going to succeed. We are just not a good fit for you. So, uh, we're going to let you go. So that is one scenario. Another scenario is where you've been working with them week after week and then they just start to see the writing on the wall. Uh, after the second or third week, after you keep telling them you're not meeting expectations, you're still not, you're still not, you're still not. And a lot of times these people will self select and they go, forget it, I don't need this, I'm out. And they will just up and quit. And that can be actually a, uh, fairly therapeutic thing for everybody because they realize they're not in the right place. You know, they're not in the right place, they're not able or willing to meet your goals and they just self select out and leave. Or maybe they just get themselves up to your level that you want and you've got a great team member and they're doing better from then on out. Okay? But don't be afraid to fire people when they're not meeting expectations. Here's the question that you should ask. Okay? Anytime you're looking at whether or not to keep someone or whether or not you should fire someone, ask the question this way. If I was to Hire someone to, to fill this role today. If this role was empty and I needed to fill it with someone today, is the person who's currently in the role the person I would hire again? And if your answer is not immediately yes. Oh, I'm excited about it. You need to think about whether that's someone you really want in your company. All right, so let's talk about this leadership journey, uh, and just recap. Okay, so the big things that I want you guys to think about. Number one, start by leading yourself, okay? Healthy things grow and growing things change. So develop yourself. Read, read, read. Ask your boss. Ask your peers. Look for ways to grow and develop. Find, um, people that are above you, that you want to be like and try to emulate the things that they've done well. Okay? Number two, pay attention to the business. Don't just stick your head in the sand and say, I'm going to be a doctor and nothing else. Because that will absolutely guarantee that for from now until the end of time, only non physicians will be leading all of medicine in this country. Okay? Number three, learn how to lead when you're not in charge. You are an influencer. Okay? Whether you're a good influencer or a bad influencer is up to you, but you influence people that you work with. So learn how to lead when you're not in charge. Number four, look for problems to solve. Everybody's got a problem, so ask people what their problems are and help them try to solve it. Eliminate roadblocks, Give them the support they need. Empower them, embolden them. But look for problems to solve and help people solve them. Number five, develop leaders under you. You should always be in the business of trying to work yourself out of a job, but find ways to grow people who work for you. Give them small problems to solve, Give them opportunities to grow. Help them participate in the decision making process. And number six, develop a healthy, thriving, robust company culture. Okay? Don't underestimate the power of culture to shape an organization. If you don't pay attention to this, you do so at your peril. Well, that is the discussion that I wanted to have with you for today. I hope that this has been, uh, useful for you. This is a topic that is just so important. And I hope that as physicians, you'll take this advice to heart. Um, decide that it is time for us to take our rightful place in American healthcare and world healthcare, uh, and just recognize that physicians know how to take care of patients and we should be the ones making these decisions. But if we're ever going to do that, we have to show other people that we are more than capable. So I, uh, hope that, uh, you will continue to, uh, thrive. And, uh, I appreciate you joining me for this final discussion on the Scope of Practice podcast. As a physician, you have one of the most difficult, most important jobs in our society. Now, I don't say that to bolster your ego, but just to say that you shouldn't be sitting in the shadows waiting for some politician to come along and fix everything. They won't. You have the abilities, you have the expertise, and, and you have the trust of your patients. So use it to make this world better. Thank you so much for listening to my podcast. I hope that these, uh, conversations have been as enjoyable for you as they have been for me. I mean, we have had some amazing conversations with incredible physicians and industry experts, and I hope that these discussions have given you a window into a new way of thinking about your profession. It has been my great honor to share this with you. I hope that I've been helpful to you, and I hope that I've been able to encourage you, uh, in this journey. I further encourage you to keep listening to other podcasts, reading great books from inspired authors, and growing in your own careers. Thank you so much for joining me on the Scope of Practice podcast. I wish you all the best. Thanks for listening to the Scope of Practice podcast at www.thescopeofpract practice. Com.