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Physicians are frequently called upon to take on leadership roles. These roles can come in various forms, ranging from academic leadership roles (eg, division or department chief or chair) to educational leadership roles (eg, clerkship or residency program director) to leadership roles in a practice setting (eg, director of a practice group). Although some of the desired skills and competencies for the leader may be specific to particular roles and responsibilities, others are more generic and applicable to any of these leadership positions. This chapter concentrates initially on the generic aspects of leadership and concludes by discussing some of the challenges that are more specific to hospitalists and to the hospital environment. In addition, instead of trying to review the voluminous leadership literature, presented here will be a personal perspective, based upon experiences in a variety of leadership positions over many years. Discussion of leadership will be divided into four primary components: the personal attributes that a leader should demonstrate, the skills that should be acquired, a suggested approach to reach a goal, and leadership challenges for hospitalists in the hospital environment.


Before considering the important attributes of a leader, it is worthwhile to understand the distinction between a leader and a manager. Much has been written about these differences, which can be readily summarized and understood by any of several descriptions or aphorisms:

  • Leaders have followers; managers have subordinates. Individuals voluntarily follow a leader because of the qualities of the leader; subordinates work for managers because of the reporting relationship and the organizational authority vested in the manager.

  • Leaders lead people; managers manage tasks.

  • Leadership is doing the right thing; management is doing things right.

  • Managers focus on tactics and tasks; leaders focus on strategy and direction.

In fact, however, these distinctions often blur in the setting of actual roles and responsibilities in the workplace. The individuals who are most successful in assuming roles with greater authority and responsibility are those who are both effective leaders and effective managers. A leader who does not have good management skills can generate visionary ideas but will be unable to implement or operationalize them. A manager who does not have good leadership skills will be unable to mobilize and motivate a supportive team.

Some activities and responsibilities of a physician leading a group of hospitalists can readily illustrate the differences between leadership and management. “Managing” the group means assuring that the patients are covered, that transitions of care are effectively handled, that chart and billing documentation is complete and accurate, and that teaching responsibilities are assigned and well integrated with patient care responsibilities. In contrast, “leading” the group means exploring and developing ideas for improving the system and its productivity, improving quality of care, developing the skills of the team, and facilitating the professional development of the team members.


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