Crossing the culture chasm: making the jump from medicine to management

Physician Executive, July-August, 2004 by Christopher Gorton

IN THIS ARTICLE ...

Recognizing the differences between the culture of business and the culture of clinical medicine is a key to success for business leaders. Learn how to identify and adapt to a new management culture.

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As a physician, when you make the transition from the medical ward to the executive suite, there are a variety of challenges that you encounter.

You know you need to understand what the performance expectations will be, the impact on your job security and personal finances, and how your new leadership role will alter your relationships with family, friends and colleagues.

But many new physician executives--and more than a few seasoned ones--neglect to give serious thought to the cultural changes imbedded in the transition.

Culture, both professional and organizational, can be the pivotal factor in whether you will succeed and be happy in your new roles. So what is this phenomenon we call culture and why is it important?

Culture is the unspoken framework for how people interact, implicitly defining values and expectations. It's easy to overlook until you get pulled up short after crossing some invisible line in the sand. Every culture has built-in strengths and weaknesses that can improve or destroy relationships.

Unidentified cultural differences are a major contributor to leadership failures. Successful leaders know the power of culture and look for ways it can help them or hurt them.

No training needed?

Last year, our organization hired a physician as a utilization review consultant. This gentleman was everything we were looking for: board certified, academic background, peer-reviewed publications. Exactly the kind of credible clinical expert we wanted to make critical decisions about the medical necessity of services.

His second day on the job, he asked to be excused from the remainder of his utilization review training--he was, he said, an experienced and expert clinician and didn't want to waste his time on matters of such little importance. He felt he was ready to get down to the "real work."

When the nurse manager responsible for his orientation patiently tried to explain the importance of completing his training, he responded that a nurse wouldn't understand and requested a meeting with me. I repeated the explanation about why training on our policies and procedures was important, observed that administrative work is very different from clinical work and requires different skills, and asked him to give the training protocol a chance.

Two weeks later he failed the required examination at the end of his training and I was forced to let him go.

How could such an apparently capable clinician fall so flat when he tried to take on a relatively simple administrative position? He didn't see the cultural chasm. He made several very common mistakes that ultimately cost him his job.

For starters, he assumed his clinical expertise and skills were immediately transferable to an administrative role. These were the skills people had always valued in the past and he couldn't see that they were necessary but not sufficient for his new role. He didn't listen when we tried to explain our perspective. We knew this job would be new and different for him--that's why we had the training protocols in the first place.

He did not accept the new social structure; it particularly rankled him to be reporting to a nurse and it was of no importance to him that the nurse in question is a seasoned and effective manager with years of experience in cleaning up the messes that occur when utilization review is badly done.

Ultimately, he expected that we would change our policies, our procedures and our culture to accommodate him and his preferences. It was a recipe for disaster.

Crossing the chasm

The first step to harnessing the power of culture is to recognize that everyone is immersed in at least one. Like Neo waking up and seeing the Matrix clearly for the first time, you need to understand your own cultural framework in order to successfully function in different ones.

Most of us were acculturated into a pretty traditional model of medicine. The traditional physician is intellectually analytical, works autonomously and is highly self-motivated. Physicians are trained to maintain emotional detachment and to think and act at a fast pace. Medicine values and rewards calm, rational practitioners capable of deftly handling life-threatening situations as they occur.

Contrast this with the traditional culture of management. The world of business and finance faces different challenges so it's not surprising that it has evolved a different model. Prototypical business leaders are intellectually empirical and team-oriented. They are emotionally engaged in the work and get a great deal of their motivation from accomplishing the mission of the organization. They move forward at a measured pace, considering options and making thoughtful deliberate decisions.

Management values and rewards committed visionaries capable of using a relational approach that strategically leads people to improve performance and accommodate change.