The purpose of this little podcast, 10 minutes on Tuesdays and Fridays, is to give you the skills to be an excellent physician leader. And in order to do that, I have to show you physician leadership's dirty little secrets. Last time, I showed you how burnout is a tried and true path to leadership, and that bad physician leaders burn out their direct reports. Physician leadership was a primary cause of burnout. Let me show you another one of the dirty little secrets today.

It is a trend that was first diagnosed by a man named Lawrence J. Peter, a Canadian educator, who found that, and this is his famous quote: in a hierarchy, employees tend to rise to the level of their incompetence. Meaning, he saw patterns over and over again where the folks in senior leadership positions were incompetent, while the front-line workers were pretty good at their jobs. Have you ever noticed that in a healthcare setting? Let's talk about why that happens and how you can avoid it. It's actually quite simple. You have all the tools that you need; we just need to point them in the right direction. Ready? Let's get started.

Hello and welcome to the latest episode of the Stop Physician Burnout podcast, a physician leadership podcast where you will learn the skills so that we can join together and lead the charge to physician well-being, skills to earn the respect of your colleagues on the front lines, skills to exercise true influence in the C-suite, and take back your job, your practice, your career, and your life. All of these tools have been proven effective in my 40,000-doctor physician coaching and training practice. And if I know one thing, I know you're super busy. So let's get started.

Back in the 1970s, Lawrence J. Peter was an administrator and educator who noticed a pattern over time: the higher you go up the org chart in an educational organization, the more incompetent the people appeared to be. The front-line workers were pretty darn good, but the leaders were terrible. He actually coined a phrase: people rise to the level of their incompetence inside a hierarchy. And he tried to figure out why this happened because he saw this pattern across every industry. And I bet you've seen it in healthcare — the frontline doctors are doing a good job, but as we move up the org chart, things get more and more strange, and the leadership skills don't seem to match the clinical skills of the folks on the front line.

How does this happen? Well, just go with me, and you'll see why it's automatic. This pattern became known as the Peter Principle. Let me show you how you can avoid falling victim to it.

You have a department — say it's the pediatrics department, and the department is growing. You've got a bunch of good pediatricians in it, but now you need a head of Pediatrics, a chairperson of the department, a program director, whatever the role is called. But you need to bring in a person who is an administrative leader, and you're probably going to hire them from within the staff that you have right now.

How are you going to pick the person who's going to be the leader? Well, you're probably going to make the mistake of picking the best doctor. So, you say, this person is the best doctor in pediatrics; let's make them the chairperson of the department. Sounds like a great idea on the surface, doesn't it? Except let me ask you this: what are the qualifications, the knowledge base, and the experience to be a good pediatrician? And do those qualifications, knowledge, and experience match the qualifications to be a great head of the pediatrics department, to be a great administrator, manager — not a doctor, but a manager, an administrator? The answer is obviously no.

So, if you take the best frontline worker and put them in a leadership role, they're naturally and automatically incompetent. They actually were never qualified to have the job in the first place. Think about it. When you move from a clinical role to an administrative role, the whole time you've been working, you've been in the room with the patient, and all the administrative stuff happens outside the room while you're seeing patients; you don't even have exposure to some of the issues that will be brought to you as an administrative leader.

So, how do we get around this? First of all, acknowledge it's true. Just like last time, burnout is a tried and true path to leadership for many doctors. That's okay; let's acknowledge it. And yes, poor leaders burn out their followers. Let's admit that that's true too. Thirty percent of my coaching clients have to leave their job and get a new one to recover simply because they have a challenge with a poor boss.

When you get promoted to a leadership position in the administrative side of the house, you don't know what you're doing, naturally and automatically, unless you've been a successful administrator of that size department before — and you probably haven't. So, admit your ignorance, admit your incompetence, and stick close to what you're best at. You're best at being a diagnostician, you're best at asking questions and putting the answers together to solve the puzzle of the patient's disease. Just so you know, that's a universal business skill set.

Doctors are great to have on your board of directors, doctors are great to have in the C-suite if we remember our question-asking skills and our diagnostic skills to solve puzzles, to help everybody get on the same page by asking great questions and connecting the dots into a unifying thesis of where the issue sits and how we might therapeutically address it. It's a universal business skill set if you just relax into it and don't think you have to know everything. You're there to ask the best questions and help everybody figure out how to proceed.

So admit you're almost certainly not qualified. You may have been burned out to get here, and I would ask you to make one of two choices. If you're not up to this game — to be an excellent leader, put your heart into it and make a difference — I encourage you to quit the administrative job or retire. And if you are up to it and realize you've got some work to do to be the leader you're capable of, then go back to Lesson 101, and start watching 10 minutes at a time so I can show you how to be a four-tool leader in today's deteriorating U.S. healthcare workforce.

We haven't got the time for us to continue to be mediocre leaders in healthcare. I encourage you to dedicate yourself to leadership excellence, and if you'd like to accelerate that path, my discovery session link is in the show notes. I'd love to talk to you about your specific situation. That's it for now. Until we're together in the next podcast, you keep breathing and have a great rest of your day.