How a dysfunctional residency trained me to run a department

Ideal jobs are rare. If you find one, you’d better do your best to keep it. Likewise, there are very few ideal residency programs. Everyone who I’ve spoken to has a list of reasons why their residency or fellowship program is the worst in the world. I get that. This is a painful time in our lives. My experience was no different. We encountered numerous inefficiencies in the department that hindered our education and experience. It wasn’t until several years later that I realized that this experience actually helped prepare me to run a department.

There is often a silver lining in the midst of despair.

I had the unfortunate (or fortunate) opportunity of having to fire staff during residency. Not one, but two members who had been working at the hospital for over 15 years. Everyone knew that they were disruptive, but this impacted mostly the residents. Many generations of trainees had attempted to rid of the inefficient staff, but there was always a hurdle that prevented us from doing so.  As transient workers in the hospital (residents and fellows), we knew that our pain was finite. Most trainees gave up after seeing the logistical nightmares in dealing with departmental protocol. If you worked with union employees, you are fighting against a brick wall.  Let me tell you, it is nearly impossible to fire union workers.

Somehow my class succeeded. It took several years, hundreds of hours of documentation, and probably fifty hours of meetings, but we fired the deadweight and hired better staff. We left a better legacy for those after us and essentially forgot about the pain that we endured.

What I did not realize was that the process that we went through to discharge staff during residency is no different in any business or medical practice. I now run a department using those same skills that I honed during the painful years of residency.

The following is a list of core applicable principles that I discovered during residency that still apply to managing a practice:

  1. Everything is political. Yelling, screaming, and demands never fly in the course of business.
  2. Everything can be negotiated. It does not matter what the terms are. Life is not a multiple choice test.
  3. Running a business boils down to profits and losses. If you don’t make a profit in a line of service, then you must correct that or risk going out of business.
  4. Negotiate upon what your perceived value is. In this regard, you have to grow your value and prove that you deserve what you are asking for.
  5. Expect to fail. If you don’t fail, then you won’t learn from your mistakes.

I can write a book about my mistakes (I might do just that!), but hopefully the principles above will serve as a good start for you to build yourself into a leader.

What other tips do you have to become a leader?

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