As changes in healthcare occur over the next several decades, physicians will play key roles in shaping new policies as direct leaders of these changes. Psychiatrists possess unique skills gained in psychiatric training that make for superb potential leaders. Emotional intelligence, a term used in the business literature to describe traits essential for “great” leadership, comprises many skills psychiatrists develop in the course of their training. Because of this overlap in skill-set, psychiatrists should be especially well positioned to become important healthcare leaders in the future. Psychiatry residency programs should foster and facilitate these traits as a means to train residents to become leaders.
Physicians, in general, are prepared for leadership positions because of their training in the management of patients and clinical teams. However, among physicians, psychiatrists are especially well trained to serve in active leadership roles. In this article, we will identify and discuss the attributes of “great” leaders, draw attention to the unique overlap between these traits and psychiatric expertise, and encourage psychiatrists to seek out and obtain leadership positions.
Leadership has been defined as the act or instance of providing direction or guidance (1). Leadership in healthcare, as in business, is more specifically defined as working in socially appropriate ways to influence people in subordinate positions so as to achieve the goals that subordinates may not have wanted to achieve, may not have thought of achieving, or may not have had the courage or motivation to achieve on their own (2). Leaders typically facilitate behavioral change through motivation and assignment of others into a pre-established direction (3). This may differ from management, which tends to produce predictability and order through planning, control, and problem-solving (3). Although both management and leadership often coexist, leadership is more apt to be characterized by understanding and articulating an overarching vision for an organization and then motivating others to achieve it.
Physicians typically have and use several sources of power (defined as the social influence used by leaders to move people in “follower” positions toward a certain direction or goal) (4). Power represents the vehicle by which leaders maintain their legitimacy; all physicians hold some forms of power, and all serve in some form of leadership role. Six types of power (expert, informational, reward, coercive, positional, and referent) have been categorized.
First, expert power is conveyed by the unique knowledge brought to bear by being considered an “expert” in a field. Medical doctors (e.g., board-certified psychiatrists) qualify as experts in a field, and, as a result, society expects a certain skill-level from those having such certification. This expertise brings with it the power to influence others (e.g., getting a patient to change his or her mind about taking a new medication).
Second, having more specific informational power allows for targeted knowledge that influences others (e.g., a medical director has expert power as a physician but also uses specific data about intra-unit outcomes to influence quality-improvement initiatives).
Third and fourth are reward power (involving positive reinforcement) and coercive power (involving negative consequences) that influence individuals (e.g., an attending physician can shape a student’s behavior because he or she has the ability to pass or fail the student).
The fifth form of power is positional power (i.e., the legitimate respect and influence carried by a leadership title). For example, a department chair carries positional power (e.g., having the ability to hire or fire employees and to manage budgets) based on the nature of that position.
Last, there is referent power, the most vague but, perhaps, most important type of power. Referent power refers to the ability to make one’s perspective the focus or perspective for another individual; this is often characterized as having “charisma” (5, 6). A particularly popular attending physician can demonstrate referent power if he or she is able to excite and motivate medical students to become excited about a certain specialty that other attending physicians, without particular referent power, may not be able to achieve. Charismatic and influential physicians in medical centers can convey significant referent power, even without having the highest academic rank.
Physicians carry some or all of these forms of power and influence others through their leadership roles. Our discussion will focus on physicians’ roles as clinical and administrative leaders. For example, a one-on-one doctor–patient encounter demonstrates many of the aforementioned types of power and can illustrate how to influence a patient’s health, although the role as a clinician is not often seen by society as a designated “leadership position.” Executive positions (e.g., that of a chairperson), however, carry all six forms of power and psychiatrists, in particular, possess unique tools instrumental for being a great executive.
Learning how to gain the skills necessary for successful leadership has been a popular topic for several decades, as has the concept of emotional intelligence. Dr. Daniel Goleman, a social psychologist and expert in the study of leadership, has found that having emotional intelligence is twice as important as is having technical skills or cognitive abilities when creating a “great” leader (7). Emotional intelligence may account for up to 90% of the difference between an average and an exceptional leader (7); in higher leadership positions, emotional intelligence becomes even more important than cognitive or technical abilities because those at this level already possess a high degree of cognitive or technical skills. Emotional intelligence has been thought of as the key to separating “good” from “great” leaders (7–9).
Five core features (self-awareness, self-regulation, self-motivation, social awareness, and social skills) characterize emotional intelligence (7). The first, self-awareness (i.e., possessing a deep understanding of one’s emotions, strengths, weaknesses, needs, and drives, and their effects on others) allows one to be neither overly critical nor unrealistically hopeful. A leader with highly-tuned self-awareness may realize that running late for appointments leaves them irritable and stressed, which may disrupt their workday; as a result, such individuals arrive early, to avoid disruptive states. In interviews, a person with sufficient self-awareness can honestly, and often humorously, admit to their own shortcomings, while not eschewing critical comments.
Emotional intelligence also involves self-regulation, or the ability to redirect or control one’s impulses or moods. Those who can self-regulate are able to suspend judgment, to think before acting, and to present ideas in a composed fashion. For example, an attending with poor self-regulation might, when confronted by a medical student’s disorganized case presentation, become overtly angry, and then proceed to lambast the student. A leader with good self-regulation might feel irritable and frustrated by the case presentation and, while controlling negative emotions and affect, calmly present constructive feedback. At the executive level, self-regulation creates an environment of trust and fairness. It also conveys the ability to consider all facets of a situation and to avoid impulsive actions, before decision-making.
The third component of emotional intelligence is self-motivation. Self-motivation describes the passion to work, the propensity to persistently pursue goals while remaining energetic and optimistic, even in the face of failure. Those who are highly self-motivated constantly strive to improve their performance and to look for more successful solutions to problems.
Social awareness, the fourth key trait in emotional intelligence, may be best characterized as empathy. Social awareness is the ability to be thoughtful and considerate of one’s employees’ feelings—along with other factors—during decision-making; too much social awareness may lead to indecision (e.g., the inability to lay off an employee). Leaders with high social awareness are capable of understanding what makes their employees “tick” and using this knowledge in their role as a coach or motivator. Having social awareness makes it easier for one to be supportive during hard times and considerate in the midst of conflict and chaos.
The fifth and final aspect of emotional intelligence is having social skills that allow a person to move others in a desired direction. Social skills enhance the ability to develop a wide circle of acquaintances (e.g., having a knack for finding common ground and building rapport with people of all types and backgrounds). Individuals endowed with social skills tend to be good negotiators; they usually possess other components of emotional intelligence, as well. By building rapport easily with others, a person with good social skills is often in a better position to negotiate and move people in the direction that they desire.
Having emotional intelligence is a key to separating “good” from “great” leaders. What the business literature refers to as emotional intelligence should sound familiar to psychiatrists because their training encompasses many of its key components. Psychiatric training and practice often employs autognosis (i.e., the process of understanding oneself and one’s emotions) and self-awareness. Psychiatrists spend years thinking about their own feelings, to better understand interpersonal interactions among them, their patients, and their colleagues. Many training programs even encourage psychiatry residents to undergo their own psychotherapy, to develop a better understanding of their inner experiences. Whereas other medical specialists may discuss the benefits of self-awareness, no other field of medicine provides as rigorous an emphasis on self-awareness as does psychiatry.
Just as psychiatric training and practice emphasizes self-awareness, so, too, does it use training in self-regulation. For example, on the consultation–liaison psychiatry service and in psychiatric emergency rooms at many hospitals, analysis of the impact of patients’ and colleagues’ reactions to the feelings of consultants (and vice versa) is commonplace. Strategies for becoming aware of one’s feelings, to quell impulsive actions or responses to patients, are reviewed so that trainees can remain composed in the face of catastrophe and compassionate in the face of enraged or irritable individuals. These experiences provide excellent opportunities for self-regulation in the challenging situations that are faced by leaders.
Self-motivation may not necessarily be more characteristic of psychiatrists (most physicians are dedicated, tireless, academic achievers) but it remains important. If self-motivation is characterized by a passion for work beyond the motivation of money, psychiatrists may possess more self-motivation than do those in other disciplines; at least one study has hypothesized that those who choose psychiatry over more procedure-based specialties are less driven by financial incentives (10).
Fourth, social awareness represents an important component of psychiatric training and practice. Surveys of medical school graduates have revealed that students who match in non–procedure-based fields (such as medicine and psychiatry) are more empathic than those who choose procedure-based fields (e.g., surgery) (11, 12). Psychotherapy training, in particular, entails at least 3 years of development of skills important to becoming an empathic listener and treater, and the intricate consideration of how one’s affects influence others, no doubt, provides for a level of empathy that is often absent in other specialties.
Finally, the ability to build rapport and to negotiate (typical of those having good social skills) may be utilized more by psychiatrists who emphasize interpersonal therapy. Similar to self-motivation, this may be a component that psychiatry does not necessarily develop more than those in other medical specialties; practitioners of all medical disciplines may not enhance their social skills in training as much as do graduates of business or law schools.
Psychiatrists develop and use many of the traits (e.g., emotional intelligence) that have been identified as being necessary for “great” leadership. Other traits common to psychiatric training and practice have been described as being vital for leadership, as well (e.g., the understanding of group dynamics, defenses, and transference, as well as the presence of unconscious motivation). Management of conflict and the importance of reward and reinforcement are also important (13). Thinking about displacement and passive-aggressive styles, in addition to the difference between what one intends to say and what others hear, have been viewed as being important traits for psychiatrists as leaders (14).
There is limited information on psychiatrists in leadership positions (including their roles as executives in healthcare) across the country; therefore, clear conclusions cannot be drawn about their relative representation in these roles. However, psychiatrists comprise about 6% of designated institutional officials, the academic positions responsible for implementing the Accreditation Council for Graduate Medical Education (ACGME) rules at American medical schools, and they comprise about 4.5% of all physicians in the United States (14). By way of comparison, internists account for 17% of all physicians in the U.S., but account for 37% of designated institutional officials. In 2011, psychiatrists served as deans for 4.6% of academic medical centers, roughly equivalent to their proportion of all physicians nationally (15).
Physicians will be integral in the implementation of the upcoming healthcare reforms. Leadership in medicine, as in other fields, will require the ability to move people in a direction they may otherwise not have moved. Emotional intelligence and its components (self-awareness, self-regulation, self-motivation, social awareness, social skills), represent a skill-set that differentiates “good” from “great” leaders. Psychiatrists, more so than any other medical specialty, are primed to serve as “great” leaders and as active contributors to the changing healthcare landscape because of their unique abilities that overlap with emotional intelligence. More educational efforts should be initiated by psychiatry training programs to emphasize leadership skills as a means to encourage psychiatrists’ involvement in healthcare leadership. This strategy would augment the existing training and skills that allow psychiatrists to become great leaders. Psychiatrists are poised to help lead medicine in the 21st century.