Leadership: The Seventh Competency

The Accreditation Council for Graduate Medical Education has mandated recently that all residency programs begin to evaluate residents in terms of six core competencies, including 1) patient care, 2) medical knowledge, 3) practice-based learning and improvement, 4) interpersonal and communication skills, 5) professionalism and 6) systems-based practice. The American Board of Medical Specialties is planning to follow suit, and soon the process of specialty certification and recertification will depend on demonstration of competency in these specific areas. The ASA Annual Meeting will soon be re-engineered to address this new concept. I propose that our specialty add a seventh competency to that list and specifically work toward the development of leadership skills during residency training and education.

More than any other specialty, anesthesiology has defined itself as a “group” practice and a systems-based practice. When I mention leadership skills to my colleagues in private practice, heads start nodding in affirmation as they understand the necessity for their group to show value, cohesiveness and responsiveness to their practice environment and for certain individuals to represent them to patients, hospital administrators, surgeons, payers and the press and to provide vision and establish goals. Leadership is difficult to define. Run a query on the Amazon.com Web site under the keyword “leadership,” and you will find more than 3,000 entries published within the past several years. The lay press and business community are fascinated with this topic, especially in view of recent misconduct by high-powered corporate executive officers and elected officials. The one thin line of agreement is that leadership skills are not innate but must be developed and nurtured.

There is a crisis of leadership in academic medicine, and anesthesiologists have not been spared. The lifespan of a dean, according to the Association of American Medical Colleges, is now just over two years. A new chair may be selected by a dean who embraces the dean’s vision, only to find that in a short time, the chair is working for and with a new dean with an entirely different agenda. This is not the sole reason, but only one of many reasons why so many chairs in anesthesiology (and surgery!) are empty, while at other institutions, acting/interim chairs are struggling to maintain their departments during an ongoing selection process. Compound this situation with the issues presented in the workforce shortage study that appeared in the February 2001 ASA NEWSLETTER article as “The Perfect Storm” ¹ and the reason for concern escalates. Academic and private practices are competing for new resident graduates, and it is estimated that there are 500 unfilled academic positions each of these past few years. Most academic practices are aging in the sense that senior faculty see fewer young physicians following in their footsteps. Those individuals who do choose an academic career need special attention so that their professional and personal development and their sense of satisfaction are maintained at a high level.

But no matter what a graduating resident chooses for his or her next career step, the groundwork for leadership skills must begin during the residency years. Committee work and special projects and opportunities within and outside the academic health center are there and must be actively pursued. The personal characteristics necessary to lead, such as honesty, integrity, fairness and the ability to communicate and resolve conflict, have to be part of the culture and value system. Only then will a newly developed leader be able to deal with the rapidly changing health care scene we live in today.

What is my favorite definition of leadership? The author Max Depree writes, “The first responsibility of a leader is to define reality. The last is to say, thank you. In between, the leader is a servant.”² The reality for our specialty is that we must continue to develop this seventh competency.

Philip G. Boysen, M.D., is Professor of Anesthesiology and Medicine and Chair, Department of Anesthesiology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, North Carolina.