Invited Perspective
Lessons Learned Through Leadership Claire V. Wolfe, MD The title of this invitational series of musings from past presidents is “Lessons of Leadership.” I think my lessons, from personal experience, can be stated easily and succinctly: 1. Patience is a virtue because the pace of change in any organization is GLACIAL. 2. It’s never about you e it’s about the organization. The president (or whatever leadership role you hold) is the face of what the organization stands for: its vision and mission. You, as a leader, may help to guide the organization to these core purposes; you may help it adapt to changes in the practice environment. You might even initiate earthshaking changes for the organization’s consideration, but, even if you have a brilliant new plan for the organization that will fit within the vision and mission, it will be years until fruition (ie, glacial). 3. And don’t forget luck: You need to be in the right place at the right time, knowing and being with the “right” people. You do need some substance to go with the luck and it helps to have a decent personality. You can’t be a wimp, but you can’t be autocratic and obnoxious, either. You need to put in your time and do the work at the committee levels and then take advantage of the opportunity to move up, which may take some additional luck. Mentors who have been there and done that help. “Ability is of little account without opportunity.” eNapoleon
HERE’S HOW I LEARNED THE THREE LESSONS When I had just started in practice, I became involved with my county medical society. I knew a couple of older physicians who took me under their wing, and before you could say “what is this all about,” I was elected a delegate to the state medical association. At that time, there were mighty few women involved in anything so I was something of a novelty and, before you could say “what is this all about,” I was chairing the Tellers Committee which gave one a high visibility during elections and debates on contentious resolutions (no computers in those days). And before you could say “what is this all about,” I was pushed (important word) to run for, and then was elected, an alternate delegate from Ohio to the American Medical Association. Now, I had been a member of all these organizations since residency because, at that time, it was the “thing to do.” But, like many people then and now, I had absolutely no idea how the organizations functioned. And there I was, within seven years of going into practice, finding myself in Chicago for the annual AMA meeting, totally confused and, by the way, out of my office and my home, where I had two young children and an orthopedic spouse, for a week! Fortunately, I again was adopted by my more experienced male physician colleagues. The AMA House of Delegates is the policy-setting body of the organization made up of physicians from all the states, a few territories, and a bunch of specialty societies. At that time only 8 members of the AMA House of Delegates were women out of more than 300 total representatives. So when I got up to give my first testimony, on a resolution suggesting that the AMA consider giving a membership break to married physician couples (of which there were not many in those days but the writing was on the wall), it took a great deal of fortitude. And, yes, that resolution was defeated and, to this day, there is no break for two physician families to join the AMA e but there are breaks for old people, young people, people new in practice, and part time people. PM&R 1934-1482/14/$36.00 Printed in U.S.A.
C.V.W. Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, OH. Address correspondence to: C.V.W.; e-mail: [email protected] Disclosure outside this publication: employment, OrthopedicOne
ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. 6, 667-669, August 2014 http://dx.doi.org/10.1016/j.pmrj.2014.07.001
667
668
Wolfe
Before you could say “luck” (that may not be a very propitious word for this history), I was serving on a special Women in Medicine Advisory Panel (“what WERE they going to do with the influx of women in the profession?” e at that time a mere 8-10% of medical students) [1] I became the Chair, then became a full delegate from Ohio, and, 20 years later, decided enough was enough and stepped down to let the younger folk in. Of course, I’m now back, recycled as the delegate of the Senior Physician Section so one does wonder about the folks who take these leadership paths e perhaps “gluttons for punishment” should be added to my “Lessons” list? My paths to leadership for the state medical association (Ohio), the American Academy of Physical Medicine and Rehabilitation, and the American Association of Electrodiagnostic Medicine (now the AANEM) were all frighteningly similar. Once one pronounces themselves ready to work and learn, the luck starts to diminish in importance and the appreciation of a person’s experience, their ability to listen and work with others, and their affection (yes, affection) for the organization takes precedence. “I’m a greater believer in luck, and I find the harder I work the more I have of it.” eThomas Jefferson Did I mention that another trait needed for leadership is patience? I’ve never been very good at this trait and, believe it or not, as glacial the progress made in many medical organizations, I’ve actually turned down a few offers e especially in the political spectrum e because I could not have tolerated the hours of debate with the subsequent inability to getting compromise or resolution. One of my examples of glacial progress (an oxymoron perhaps?) is the presence of women in medicine and academia. One might assume, with the dramatic increase of women in medical schools, (8% in 1964 when I began in medical school to over 50% in 2003-2004, but now slightly less at 47% in 2011-2012) [1,2], and the increase of women on medical school faculties, that there would have been substantial progress in the leadership levels. Not so much, depending on how you define “leadership levels.” Although more women than men medical school graduates become medical school faculty, 19% of women faculty in 2011 were at the full professor level compared with 31% of all men faculty. (It had been 10.7% in 2004 [2].) In PM&R, 28% of the full professors are women, a percentage higher than all specialties except pediatrics (30%) and public health (34%). Most women, however, still remain instructors or assistant professors. In positions of authority, there has been a small improvement in deanships: medical schools have gone from 6 to 14 women deans out of 119 (12%). This percentage, however, is lower than the number of deans of law schools (20%
LESSONS LEARNED THROUGH LEADERSHIP
women) and even presidents of universities (23% women). Interestingly, only hospitals have as few women at the helm (12% of CEOs) [1-3]. The issue of women in leadership roles is in the same quandary for general higher education: “For the past 35 years, women have represented the majority of undergraduate students. Yet they fill only one in four college presidencies and represent a mere 29 percent of full professors e with women still overrepresented in the feminized disciplines of education and nursing and underrepresented in engineering and the sciences. Obtaining the rank of full professor affords opportunities for leadership in faculty governance, extends national influence in the disciplines, and is a traditional prerequisite for climbing the leadership ladder.[4]” Glacial is not a bad word . One other lesson that I neglected to mention: The same set of people who desire to run things, to be in the thick of things, to “lead,” become the same folks selected over and over again for various jobs as they arise. This lack of volunteers in all aspects of life has been the subject of many observations, speculations, debates, articles, and books. “Studies of volunteer organizations consistently show that about 10% of the membership is likely to be active to some degree in the group. The percentage that actually takes on leadership roles is far smaller.[5]” And don’t forget the seminal essay and then book, “Bowling Alone,” by Robert Putnam [6] “It is not just the voting booth that has been increasingly deserted by Americans. . [S]ince 1973 the number of Americans who report that ‘in the past year’ they have ‘attended a public meeting on town or school affairs’ has fallen by more than a third (from 22% in 1973 to 13% in 1993). Similar (or even greater) relative declines are evident in responses to questions about attending a political rally or speech, serving on a committee of some local organization, and working for a political party.” Next, we turn to evidence on membership in (and volunteering for) civic and fraternal organizations. These data show some striking patterns, ”declining steadily since the mid-1960s . with membership in the League of Women Voters (LWV) off 42 percent since 1969.”
CONCLUSION So I say this to you about leadership, man or woman: If you want to prove Putnam wrong, if you wish to add to the social capital of your specialty, your institutions, your country, if you are among the 10% who want to
PM&R
contribute your energy, ideas and time to making a success of the organizations that represent you, medical-politicallocal school boards-whatever, find a mentor and jump right in. If reading the newspaper, or the medical journal, or the internet makes you crazy at the way things are being done that will affect you and your family, jump right in. If you aren’t one of the “doers,” stay involved by being a member of the groups that affect your life. Communicate with the leaders through websites, blogs, Facebook, Twitter, letters (I know, I know, I’m ancient) e let them know what drives you crazy, what makes you feel good, what you’d like to see them do. Encourage folks who do like to “do,” that you would like to see represent you, to pursue their opportunities. If you’re a woman, let’s keep working at changing the face of “leadership.” And some day you too in your dotage can ruminate on lessons to pass on . I feel that luck is preparation meeting opportunity. eOprah Winfrey
Vol. 6, Iss. 8, 2014
669
My success was due to good luck, hard work, and support and advice from friends and mentors. But most importantly, it depended on me to keep trying after I had failed. eMark Warner
REFERENCES 1. Salsberg ES, Gaetano JF. Trends in the physician workforce, 1980-2000. Health Affairs 2002;21:165-173. 2. The Association of Medical Colleges (AAMC). Available at: https://www. aamc.org/data/. Accessed July 6, 2014. 3. Lee VS. Women medical school deans and a culture of encouragement. University of Utah Health Sciences, Sep 24, 2012. Available at: http://healthsciences. utah.edu/notes/postings/september_2012/092412womenanddeanships. php#.U4zmMXKwIs0. Accessed July 6, 2014. 4. Ward K, Eddy PL. Women and academic leadership: Leaning out. The Chronicle of Higher Education, Dec 9, 2013. Available at: http://chronicle. com/article/WomenAcademic-Leadership-/143503/. Accessed July 7, 2014. 5. Member and leadership development. National Audobon Society. Available at: http://web4.audubon.org/local/pdf/member_leadership_ development.pdf. Accessed July 6, 2014. 6. Putnam RD. Bowling alone: America’s declining social capital. Journal of Democracy 1995;6:65-78
Lessons Learned Through Leadership Claire V. Wolfe, MD The title of this invitational series of musings from past presidents is “Lessons of Leadership.” I think my lessons, from personal experience, can be stated easily and succinctly: 1. Patience is a virtue because the pace of change in any organization is GLACIAL. 2. It’s never about you e it’s about the organization. The president (or whatever leadership role you hold) is the face of what the organization stands for: its vision and mission. You, as a leader, may help to guide the organization to these core purposes; you may help it adapt to changes in the practice environment. You might even initiate earthshaking changes for the organization’s consideration, but, even if you have a brilliant new plan for the organization that will fit within the vision and mission, it will be years until fruition (ie, glacial). 3. And don’t forget luck: You need to be in the right place at the right time, knowing and being with the “right” people. You do need some substance to go with the luck and it helps to have a decent personality. You can’t be a wimp, but you can’t be autocratic and obnoxious, either. You need to put in your time and do the work at the committee levels and then take advantage of the opportunity to move up, which may take some additional luck. Mentors who have been there and done that help. “Ability is of little account without opportunity.” eNapoleon
HERE’S HOW I LEARNED THE THREE LESSONS When I had just started in practice, I became involved with my county medical society. I knew a couple of older physicians who took me under their wing, and before you could say “what is this all about,” I was elected a delegate to the state medical association. At that time, there were mighty few women involved in anything so I was something of a novelty and, before you could say “what is this all about,” I was chairing the Tellers Committee which gave one a high visibility during elections and debates on contentious resolutions (no computers in those days). And before you could say “what is this all about,” I was pushed (important word) to run for, and then was elected, an alternate delegate from Ohio to the American Medical Association. Now, I had been a member of all these organizations since residency because, at that time, it was the “thing to do.” But, like many people then and now, I had absolutely no idea how the organizations functioned. And there I was, within seven years of going into practice, finding myself in Chicago for the annual AMA meeting, totally confused and, by the way, out of my office and my home, where I had two young children and an orthopedic spouse, for a week! Fortunately, I again was adopted by my more experienced male physician colleagues. The AMA House of Delegates is the policy-setting body of the organization made up of physicians from all the states, a few territories, and a bunch of specialty societies. At that time only 8 members of the AMA House of Delegates were women out of more than 300 total representatives. So when I got up to give my first testimony, on a resolution suggesting that the AMA consider giving a membership break to married physician couples (of which there were not many in those days but the writing was on the wall), it took a great deal of fortitude. And, yes, that resolution was defeated and, to this day, there is no break for two physician families to join the AMA e but there are breaks for old people, young people, people new in practice, and part time people. PM&R 1934-1482/14/$36.00 Printed in U.S.A.
C.V.W. Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, OH. Address correspondence to: C.V.W.; e-mail: [email protected] Disclosure outside this publication: employment, OrthopedicOne
ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. 6, 667-669, August 2014 http://dx.doi.org/10.1016/j.pmrj.2014.07.001
667
668
Wolfe
Before you could say “luck” (that may not be a very propitious word for this history), I was serving on a special Women in Medicine Advisory Panel (“what WERE they going to do with the influx of women in the profession?” e at that time a mere 8-10% of medical students) [1] I became the Chair, then became a full delegate from Ohio, and, 20 years later, decided enough was enough and stepped down to let the younger folk in. Of course, I’m now back, recycled as the delegate of the Senior Physician Section so one does wonder about the folks who take these leadership paths e perhaps “gluttons for punishment” should be added to my “Lessons” list? My paths to leadership for the state medical association (Ohio), the American Academy of Physical Medicine and Rehabilitation, and the American Association of Electrodiagnostic Medicine (now the AANEM) were all frighteningly similar. Once one pronounces themselves ready to work and learn, the luck starts to diminish in importance and the appreciation of a person’s experience, their ability to listen and work with others, and their affection (yes, affection) for the organization takes precedence. “I’m a greater believer in luck, and I find the harder I work the more I have of it.” eThomas Jefferson Did I mention that another trait needed for leadership is patience? I’ve never been very good at this trait and, believe it or not, as glacial the progress made in many medical organizations, I’ve actually turned down a few offers e especially in the political spectrum e because I could not have tolerated the hours of debate with the subsequent inability to getting compromise or resolution. One of my examples of glacial progress (an oxymoron perhaps?) is the presence of women in medicine and academia. One might assume, with the dramatic increase of women in medical schools, (8% in 1964 when I began in medical school to over 50% in 2003-2004, but now slightly less at 47% in 2011-2012) [1,2], and the increase of women on medical school faculties, that there would have been substantial progress in the leadership levels. Not so much, depending on how you define “leadership levels.” Although more women than men medical school graduates become medical school faculty, 19% of women faculty in 2011 were at the full professor level compared with 31% of all men faculty. (It had been 10.7% in 2004 [2].) In PM&R, 28% of the full professors are women, a percentage higher than all specialties except pediatrics (30%) and public health (34%). Most women, however, still remain instructors or assistant professors. In positions of authority, there has been a small improvement in deanships: medical schools have gone from 6 to 14 women deans out of 119 (12%). This percentage, however, is lower than the number of deans of law schools (20%
LESSONS LEARNED THROUGH LEADERSHIP
women) and even presidents of universities (23% women). Interestingly, only hospitals have as few women at the helm (12% of CEOs) [1-3]. The issue of women in leadership roles is in the same quandary for general higher education: “For the past 35 years, women have represented the majority of undergraduate students. Yet they fill only one in four college presidencies and represent a mere 29 percent of full professors e with women still overrepresented in the feminized disciplines of education and nursing and underrepresented in engineering and the sciences. Obtaining the rank of full professor affords opportunities for leadership in faculty governance, extends national influence in the disciplines, and is a traditional prerequisite for climbing the leadership ladder.[4]” Glacial is not a bad word . One other lesson that I neglected to mention: The same set of people who desire to run things, to be in the thick of things, to “lead,” become the same folks selected over and over again for various jobs as they arise. This lack of volunteers in all aspects of life has been the subject of many observations, speculations, debates, articles, and books. “Studies of volunteer organizations consistently show that about 10% of the membership is likely to be active to some degree in the group. The percentage that actually takes on leadership roles is far smaller.[5]” And don’t forget the seminal essay and then book, “Bowling Alone,” by Robert Putnam [6] “It is not just the voting booth that has been increasingly deserted by Americans. . [S]ince 1973 the number of Americans who report that ‘in the past year’ they have ‘attended a public meeting on town or school affairs’ has fallen by more than a third (from 22% in 1973 to 13% in 1993). Similar (or even greater) relative declines are evident in responses to questions about attending a political rally or speech, serving on a committee of some local organization, and working for a political party.” Next, we turn to evidence on membership in (and volunteering for) civic and fraternal organizations. These data show some striking patterns, ”declining steadily since the mid-1960s . with membership in the League of Women Voters (LWV) off 42 percent since 1969.”
CONCLUSION So I say this to you about leadership, man or woman: If you want to prove Putnam wrong, if you wish to add to the social capital of your specialty, your institutions, your country, if you are among the 10% who want to
PM&R
contribute your energy, ideas and time to making a success of the organizations that represent you, medical-politicallocal school boards-whatever, find a mentor and jump right in. If reading the newspaper, or the medical journal, or the internet makes you crazy at the way things are being done that will affect you and your family, jump right in. If you aren’t one of the “doers,” stay involved by being a member of the groups that affect your life. Communicate with the leaders through websites, blogs, Facebook, Twitter, letters (I know, I know, I’m ancient) e let them know what drives you crazy, what makes you feel good, what you’d like to see them do. Encourage folks who do like to “do,” that you would like to see represent you, to pursue their opportunities. If you’re a woman, let’s keep working at changing the face of “leadership.” And some day you too in your dotage can ruminate on lessons to pass on . I feel that luck is preparation meeting opportunity. eOprah Winfrey
Vol. 6, Iss. 8, 2014
669
My success was due to good luck, hard work, and support and advice from friends and mentors. But most importantly, it depended on me to keep trying after I had failed. eMark Warner
REFERENCES 1. Salsberg ES, Gaetano JF. Trends in the physician workforce, 1980-2000. Health Affairs 2002;21:165-173. 2. The Association of Medical Colleges (AAMC). Available at: https://www. aamc.org/data/. Accessed July 6, 2014. 3. Lee VS. Women medical school deans and a culture of encouragement. University of Utah Health Sciences, Sep 24, 2012. Available at: http://healthsciences. utah.edu/notes/postings/september_2012/092412womenanddeanships. php#.U4zmMXKwIs0. Accessed July 6, 2014. 4. Ward K, Eddy PL. Women and academic leadership: Leaning out. The Chronicle of Higher Education, Dec 9, 2013. Available at: http://chronicle. com/article/WomenAcademic-Leadership-/143503/. Accessed July 7, 2014. 5. Member and leadership development. National Audobon Society. Available at: http://web4.audubon.org/local/pdf/member_leadership_ development.pdf. Accessed July 6, 2014. 6. Putnam RD. Bowling alone: America’s declining social capital. Journal of Democracy 1995;6:65-78
