Follow the Leader: Leadership in Medicine


Leadership is an important concept for all of us as physicians. We are all leaders and will be for the entirety of our career, whether it be managing the clinical team caring for patients or holding a specific leadership position in a department.


“I suppose leadership at one time meant muscles, but today it means getting along with people.”

-Mahatma Gandhi


This quote reflects a paradigm shift in the idea of power in the modern world as well as medicine. It is not about who can yell the loudest or push people around. Medicine is a team sport, and patient care at every level is interdisciplinary. We need to exhibit effective leadership skills in the appropriate settings. Below we will discuss different leadership styles and the appropriate settings and pitfalls.


Pace Setting Leadership

“Do as I do, now!”

The leader expects and models excellence and self direction. This should be used in the setting of a motivated and skilled team looking for quick results. I think of this as a busy Pod A shift. The senior resident or attending moves the room using their team to provide efficient and effective patient care.

Pitfall: This style can overwhelm the team and squelch innovation.


Visionary Leadership

“Come with Me”

The leader motivates the team toward a common goal. The focus is on the end goals, and the means are left to the individuals. This style should be used in the setting of change where motivation is needed. This is the beginning of a research or academic project. The leader sets the goals and outcomes and lets the team brainstorm the “how”.

Pitfall: This is not useful when working with a team of experts who know more than the leader.


Affiliative Leadership

“People come first”

The leader forms emotional bonds and makes team members feel belonging. This is done through praise and nurturing. This style is useful during times of stress, such as after a trauma, or to rebuild trust. An example of this is during intern orientation or during times of poor morale.

Pitfall: The sole reliance on this style will create mediocre performance and lack of direction.


Coaching Leadership

“Try this”

The leader builds lasting strengths and looks to make the team more successful overall. This style is beneficial in training or education settings. This is whenever there are teaching opportunities in the clinical area, simulation, or debriefing.

Pitfall: This style is ineffective with defiant or unwilling team members or when the leader lacks expertise.


Commanding Leadership

“Do what I tell you”

The leader is authoritative and tells teammates what needs to be done. This style is useful in an emergency or crisis. It can be effective in controlling a problem team member when all other strategies fail. An example is during a code or disaster situation.

Pitfall: This style can alienate people and stifle flexibility and inventiveness.


Democratic Leadership

“What do you think?”

The leader looks for input from the team members and uses their suggestions to make a plan. This style is useful when team buy-in or ownership of the decision or project is needed. It is also useful when the leader is uncertain and needs fresh ideas from a qualified team. The breakthrough processes using LEAN techniques is a good example of this.

Pitfall: This style does not work in a crisis.


One of the most difficult and important things about being an effective leader is being flexible. Most people gravitate towards a certain leadership style. As described above not every situation or team will respond to one method. So it is important to first recognize your style. The hard part is then practicing the transitioning to other styles when needed. This will be difficult at first but important to be an effective long-term leader.


“A leader is best when people barely know he exists, when his work is done, his aim is fulfilled, they will say: we did it ourselves.”  -Lao Tzu


This post is based on the following article about leadership in medicine:

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Assistant Program Director of SUNY Downstate EM Residency

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