“On any team, in any organization, all responsibility for success and failure rests with the leader. The leader must own everything in his or her world. There is no one else to blame. The leader must acknowledge mistakes and admit failures, take ownership of them, and develop a plan to win.”1
Leadership development and education in the domains that are critical in need of competent leaders is a crucial and often overlooked component of medical education. In the debate about whether good leaders are born or made, the existence of institutions like the United States Military Academy at West Point and the United States Naval Academy would strongly suggest that, while some have some innate qualities of a leader, the continuous development of our leaders is the key to success.
During the evaluation process for admissions to medical school and possibly more so for the Orthopaedic Surgery residency match, we seek an applicant’s demonstration of leadership ability and potential. However, we often do nothing during the various steps in medical education to help medical students, residents, or fellows foster their development of the qualities we claim to seek. On the other hand, trainees proudly document their leadership experiences. Still, they can “take their foot off the gas pedal” when it comes to their pursuit of leadership opportunities once they have gotten their coveted spot in medical school, residency, or fellowship. Obviously, there are some exceptions, but this is a missed opportunity for most learners. As young orthopaedic surgeons face practicing in systems disrupted by incursions from private equity firms, hospital and health system conglomeration, government mandates, and overall uncertainty, the survival of the pure doctor-patient relationship depends on persistent action from physician leaders. Whether a surgeon practices in an employed setting or solo private practice, their ability to lead a team, as well as their ability to employ emotional intelligence, is every bit as important as their surgical skills.
Even if trainee or early career surgeons feel like they aren’t inclined to tackle the large, strategic leadership challenges facing our profession, they are still the leaders of their healthcare team in their outpatient offices and their surgical team in the operating room. Their performance in this role directly and substantially impacts their patients’ outcomes. Destructive leadership behavior patterns among surgeons in the operating room predict a lower overall efficacy of every person in the room, while transformational (team-oriented) leadership qualities improve team behavior and patient outcomes.2–4 The concept of military leadership may be more applicable to our practice of surgery than it is to most other industries, as we not only have to be the “Captain of the ship,” but we have to do so in high-stakes, high-stress environments while usually working with constantly changing small teams. So, while the quote that opened this manuscript was written in a military context and may seem intense, it is a clarion call to those of us that would advocate for orthopaedic surgeons to assume the mantle of leadership. The definition of “success and failure” applies not just to our practices but to our patients.
It is incumbent on the current academic leaders in orthopaedic surgery to incorporate dedicated training in leadership development within residency and fellowship training programs while also supporting efforts from our state, regional, and national societies in offering these leadership development programs across the spectrum of an orthopaedic surgeon’s career. From the C. McCollister Evarts Resident Leadership Forum offered by the American Orthopaedic Association and the Leadership Skills Training Program for Chief Residents presented by the Accreditation Council for Graduate Medical Education (ACGME) to programs like the American Academy of Orthopaedic Surgeons’ Leadership Institute (among many others), there are ample opportunities to learn about and develop the crucial and universal skills of leadership.