Published 8/1/2019
Kerri Fitzgerald

NOLC Symposium: Surgeons Discuss Their Paths to Leadership

Common theme underscores a lot was learned along the way versus innate ability

The Academy must broaden its leadership opportunities, said AAOS First Vice President Joseph A. Bosco III, MD, during a presentation at the 2019 National Orthopaedic Leadership Conference. “Today, we assembled three speakers from diverse backgrounds,” said Dr. Bosco, introducing presenters Dirk H. Alander, MD, MHA; Robert M. Orfaly, MD; and Thomas C. Barber, MD, who discussed their own paths to leadership positions and provided lessons learned along the way.

Be adaptable

Dr. Alander, chief of quality at the Musculoskeletal Institute in the Department of Orthopaedic Surgery and professor of orthopaedic surgery at Geisinger Commonwealth School of Medicine in Pennsylvania, charted his journey from “the Congo to AAOS.” In the first 18 years of his life, he moved 14 times, which he said exposed him to different social and cultural contexts. Because Dr. Alander moved often, he learned to be adaptable, focused on listening, learned the value of mentors, and gained perspective. His childhood also removed any fear about moving for job opportunities.

“Leadership is not a hierarchy; it’s not a position. … It’s an attitude,” he said. Leadership is committing to achieving a goal and convincing others to reach that goal. Dr. Alander noted that new technology, stakeholder expectations, changing practice patterns, and different skills required in leadership are challenges leaders in medicine face. “If we’re going to build leaders, we have to be able to meet people where they are,” he said.

Look for opportunities

Dr. Orfaly, chair of the AAOS Board of Councilors, suggested that the master plan for personal leadership enlightenment is to figure out what matters most to you, look for opportunities to serve that coincide with your interests, and develop leadership skills to better serve. His own path to leadership included guiding and serving on teams to improve all areas of academic medicine, including scholarships, teaching, and service. “Within organized medicine, a lot of what we do is work on committees,” he said, noting that not everyone has a positive view of committee work. However, there are opportunities within committees to effect improvements in education, societal advocacy, professional advocacy, and many other leadership initiatives one might wish to undertake.

Dr. Orfaly said what matters most to him is creating a care team that provides the best possible care for his patients and expanding his reach through leadership opportunities to improve the care of all patients.

Cultivate a leadership style

Dr. Barber, an orthopaedic surgeon at the University of California San Francisco (UCSF) Medical Center, said he has served in various leadership positions and served many leaders, “both positive and negative,” which has given him a sense for what leadership can and cannot do.

Dr. Barber said the leadership training he received at Kaiser Permanente was robust and covered everything from “finance 101 to meeting planning,” and more. Along the way on his leadership journey, Dr. Barber said he learned the difference between managers and leaders: “I saw a lot of managers out there trying to be leaders. We all need to recognize what the difference is.”

According to John P. Kotter’s 2012 book “Leading Change”: “Management is a set of processes that keep a complicated system of people and technology running smoothly. Leadership is a set of processes that create organizations in the first place or adjust them to significant change in circumstances—defining what the future should be like.”

He also noted that the book details eight principles for developing a model of change:

  1. Establish a sense of urgency.
  2. Create a guiding coalition of leaders in your organization.
  3. Develop a vision of where you want to go.
  4. Communicate that vision.
  5. Empower a broad-based coalition.
  6. Achieve general short-term wins.
  7. Consolidate your gains.
  8. Change the culture.

He said that the need for leadership in health care is greater than ever due to rapid industry changes. He quoted John Chambers’ 2018 book, “Connecting the Dots,” which advises:

  • Disrupt or be disrupted.
  • Keep learning.
  • Change before you have to.
  • Take risks and move fast.
  • Anchor on core values and strengths.

Individuals do not have to follow one leadership style throughout their careers; it should vary because circumstances, people, and timing differ. He gave an example of his move from Kaiser Permanente to UCSF and said he had to amend his leadership style to be most effective and to prevent misinterpretation.

“In the Academy, we have seen a change in leadership … and style, and that is very appropriate when we have challenges that we are facing that are significant,” he said. “We need to continually improve to make our Academy as good for the members as we can.”

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.