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PRESIDENT’S
MESSAGE

Leadership in Medicine

By Rodolfo “Rudy” Molina, MD, MACR, FACP, 2021 BCMS President

I’m a big fan of Winston Churchill who once said, “if you are going being a scientist or mathe-
through hell, keep going.” As much as I admire his leadership skills as matician, Flexner’s early suc-
Prime Minister during World War II, I don’t think I would hire Mr. cesses as an administrator at
Churchill to run my outpatient rheumatology clinic. IAS inspired Dr. Hromas to
How often in medicine have you heard the phrase, “we are all lead- create ten rules for leading geniuses. He emphasizes the importance
ers”? Well, we are leaders. We are imbued with the expectation to lead of recognizing individuals’ strengths and connecting with team mem-
a patient out of their illness and into health. The patient, nurses, staff, bers with respect and empathy to achieve a common goal. I recom-
pharmacists and patient’s family are all expecting your guidance. We mend this book to all those interested in this topic.
are thus required to understand the patient’s circumstances and com- Doris Kearns Goodwin outlines the skills that defined four Presi-
municate well with all team members. dents of the United States as great leaders during times of national cri-
The world of medicine is complex, existing in many different sis in her book “Leadership in Turbulent Times.” She asks the
spheres. If we were to draw a Venn diagram where all circles converge question, “are leaders born or made?” I was amazed to find how many
on a patient afflicted with a malady, the existing circles would demon- differing opinions there are with a simple internet search. The over-
strate a very complex system. Furthermore, within each of these circles whelming majority of authors I found believe that circumstances cre-
exists a hierarchical framework requiring its own leader. So, when we ate opportunities to lead. Interestingly, the same is stated for the
speak of leaders in medicine, we should first define the circumstances emergence of genius; circumstances allow for genius to be witnessed
and then ask what all great leaders have in common. I will provide you and appreciated. In a podcast, Goodwin argues that great leaders,
with three different scenarios where leadership was needed and then whether they lead in a field of battle or a boardroom, have several
reflect upon the common variables found in each example. things in common — empathy, ambition for self, ambition for some-
Mulligan and Rehman describe the evolving role of the physician thing larger than self, resilience, to be nonjudgmental and the ability
since the 1970s with the advent of corporate medicine in “The Evolv- to communicate and tell stories.
ing Crisis of Physician Leadership.” They describe that in the early I recognize that we are not all in a position of leading in the corpo-
‘70s, physicians enjoyed unrivaled access to ‘legitimate authority.’ Sub- rate world of medicine, leading geniuses or even leading a country in
sequently, “the profession became less responsive to legitimate external a crisis. Still, I do believe that we can all learn from these seemingly
critiques and blind to structural changes, such as hospital corporati- distinct scenarios. To counter some of the articles I alluded to earlier,
zation and market privatization.” In the 1980s, corporate medicine it is important to consider that great leaders have the qualities and
began influencing health care professionals to experiment with differ- motivation before circumstances define them. Whether you are run-
ent payment models such as investor-owned health care corporations, ning a code blue or a clinic, successful leaders are team players. Fur-
multi-institutional alliances and popularized group practice instead thermore, a great leader defines setbacks as learning opportunities and
of working solo. Mulligan and Rehman argue that “the real threat to not as failures.
physician sovereignty is corporate medicine” and that physicians have Yes, we are all leaders. I do believe that some have inherent skills
a moral obligation to insert themselves in institutional-political de- that have been nurtured; however, we as physicians are proverbial stu-
bates in order to preserve values understood by physicians as central dents and should strive to become exceptional leaders. To that aim,
to the practice of medicine and that best serve the interest of the pa- your Bexar County Medical Society offers a leadership course that I
tient. Leadership in this context requires transparency and a full un- recommend to all. This course is taught by Trinity University profes-
derstanding of the desired outcomes from all parties involved. sors and besides describing leadership styles, it also gives insights on
Dr. Hromas writes a very entertaining and insightful book titled how to be a more effective leader.
“Einstein’s Boss.” Abraham Flexner hired Einstein to work at the In-
stitute for Advanced Studies (IAS) at Princeton University, where it Rodolfo “Rudy” Molina MD, MACR, FACP is the 2021 President of
eventually became home to 33 Nobel Laureates, 38 Fields Medalists the Bexar County Medical Society.
and many winners of the Wolf and MacArthur prizes. Despite not

8 SAN ANTONIO MEDICINE • July 2021