Mind the gap: thoughts on intergenerational relations in medical leadership

Numerous models categorize, characterize, and explain differences among generations in society. Currently, four distinct generations are engaged in the physician pipeline from early training to late career. The distinct differences in how they view the world, their self-perceptions, and how they conduct relationships create real and imagined tensions. However, the significance of these differences is debated, as variability among those within a generation is likely larger than that between generations. Nevertheless, medical leaders and educators will be wise to develop an appreciation for generational differences to ensure that everyone may live up to their full potential. Opportunities exist to gain greater appreciation for how generational differences manifest in day-to-day interactions, adopt new approaches to interacting with those of different generations, and identify points of leverage across generations to optimize relationships and outcomes.

How full is the glass? A perspective on women in medical leadership in Canada

What do we really know about the representation of female physicians in medical leadership in Canada? Female representation on the current boards of the Canadian Medical Association and provincial/territorial medical associations is 23% and 40%, respectively. Identified barriers to female medical leadership include gendered organizational and workplace culture, gender bias, inflexible work practices, unequal childcare and domestic responsibilities, and biased performance assessment criteria and recruitment practices. Identified enablers include flexible tenure policies, systematic parental leave policies, greater inclusivity in the workplace, and formal mentorship structures. More has been written about the costs of leadership for female physicians rather than the benefits.

LGBTQ2S+ diversity: leading and celebrating pride

Organizations that actively promote diversity tend to be learning and practice environments of choice, excellence, and innovation. However, despite all our hard work and successful social equity efforts, discrimination still exists in Canadian health care and medical education. Leaders can influence diversity in their organization by taking four urgent actions.

Building community during the COVID-19 pandemic: a system level approach to physician well-being

Before the COVID-19 pandemic, physician burnout was identified as reaching crisis proportions, and the pandemic is expected to worsen the already perilous state of physician wellness. It has affected physicians’ emotional health, not only by increasing workload demands, but also by eroding resilience under increasing pressures. The mental health consequences are expected to persist long after the pandemic subsides. With physician wellness increasingly recognized as a shared responsibility between individual physicians and the health care system, system-level approaches have been identified as important interventions for addressing physician well-being. In this article, we describe two evidence-guided initiatives implemented in our hospitalist network during the current pandemic: a trained peer-support team and facilitated physician online group discussions. These initiatives acknowledge the emotional strain of physicians’ work and challenge the “iron doc” culture of medicine. Our efforts build community and shift culture toward improved physician wellness. We suggest that the pandemic might be an opportunity for our profession to strengthen our support networks and for physician leaders to advance physician wellness in their work environments.

Postgraduate medical education during the COVID-19 pandemic: lessons learned and calls to action for medical education leaders

The COVID-19 pandemic has led to a rapid transformation in the delivery of postgraduate medical education, causing unexpected effects on the learning experiences of residents in training. Program directors, as educational leaders, are relied on to adapt an established curriculum and clinical experience into a virtual world while navigating the limitations imposed by the pandemic. In this article, we focus on the impact of the dramatic changes to medical education delivery on both learners and leaders and examine the challenges and successes of the new strategies employed. A reflection of the importance of leadership in medical education is discussed, along with a review of the strategies that have emerged as successful and worthy of integration into our new medical education paradigm.

Understanding attention deficit/hyperactivity disorder in physicians: workplace implications and management strategies

Physicians with attention deficit/hyperactivity disorder (ADHD) may have unrecognized workplace difficulties because of inattention and impulsivity. If these behaviours interfere with patient care or organizational functioning, leaders may erroneously attribute the physician’s actions to unprofessionalism. As such, corrective efforts with punitive measures may be ineffective. ADHD is a neurodevelopmental disorder that responds to evidence-based treatments, including medications, accommodations, and supports. Physician leaders who understand the unique presentations of ADHD in physicians may better identify when this condition may be contributing to workplace behaviour. Furthermore, physician leaders may have a professional or legal duty to accommodate or support physicians with underlying medical and/or psychiatric conditions, such as ADHD. Using our own clinical experience, we provide a general overview of ADHD in physicians and guide physician leaders on how to help physicians who may be struggling with ADHD in the workplace. We hope that our clinical experience and observations of this hidden problem will spur discussion, awareness, and action for further research and support.

It’s not what you know, it’s who you know: diagnosing and healing your informal professional networks

Traditional medical training fails to address the competitive realities of the job market and the critical role of informal professional networks in career development and advancement. Moreover, the concept of informal professional networking is scarcely represented in the medical literature. Borrowing from management science, I discuss the roles of informal professional networks; strategies to establish healthy and effective networks; and important barriers encountered by networkers, namely feelings of inauthenticity and inequities resulting from gender and race.

Training and certification for hospital medicine programs support the essential role of hospitalists for complex multi-morbid patients in acute care

The current COVID-19 pandemic has resulted in significant strain on acute care delivery in Canada and around the world. It has highlighted the importance of hospitals rapidly increasing their resources to meet the capacity demands brought on by a disruptive change. Hospital medicine teams have become central to many acute care sites, caring for increasingly complex hospitalized patients. We believe that the ongoing implementation of hospitalist teams of generalist physicians is critical in ensuring that health care organizations are well positioned to provide high-quality care in uncertain times. We also highlight the need for adequate training and certification for physicians who aim to work as part of such programs.

Leading through COVID-19: understanding and supporting grief and loss

The COVID-19 pandemic has created an environment in which grief and loss are being experienced collectively. This grief can lead to increased burnout, decreased productivity, and increased likelihood of job turnover. With health care workers already facing increased risks because of their frontline pandemic responsibilities, it is important to provide leaders with knowledge and tools to support their grieving team members. Understanding the Kübler-Ross grief model, as well as grief-related concepts such as anticipatory grief, disenfranchised grief, moral injury, and complicated grief, will help leaders provide normalizing support. This approach may include building and fostering trusting relationships, engaging in self-reflection, participating in supportive conversations, and, when appropriate, sharing information around grief-support resources. There is no universal timeline for the resolution of grief; mental health impacts can last for many months and can continue to resurface for years. During the COVID-19 pandemic, we educated health care workers around the issues of grief and loss by focusing on the relationship side of the Wheel of Change, interviewing people with expertise in the area, holding town hall meetings, and hosting online “coffee and chat” sessions for physicians. We recommend relying less on policy development and, instead, focus on strengthening workplace relationships and creating opportunities for connection and discussions.

Building belief: establishing credibility as a medical leader

Credibility depends upon both an individual’s personal characteristics and how they are perceived. Because a leader’s credibility profoundly affects what they are able to accomplish, establishing credibility can be an important component of leadership development. However, while some factors that affect credibility may be modified through deliberate effort, others cannot. In this article, we explore steps leaders can take to increase their credibility and the limitations imposed by factors beyond the individual’s control.