October 7, 2026 Salus Forum

Warren

In American culture, we tend to assume that leadership skills co-vary with clinical skills. In my English family, this isn’t necessarily so. There isn’t an assumption that just because you’re a good doctor, you’re a good leader. This is one of the real challenges we have. Oftentimes being a good doc in some disciplines is doing well on a test, which is far removed from the clinical interpersonal skills that are so important in leadership.

Jack

This is a very rich discussion. Thank you, Jenny, for bringing both a female voice to this group and a youth voice. I’m so glad you’re here. There are a couple things here that I wanted to comment on. This is the difference between leadership and management. I fear that what we have done essentially is to take managers and give them leadership authority. We expect these people to be able to then lead. I believe it’s pretty easy to teach management behaviors like HR and contracting and those things that are within the system. I don’t know about the quality of ABFMs–this group that’s doing leadership. However, I worry that that’s teaching leadership within the current system. And not necessarily leadership that looks outside the system and looks for people who are thinking differently than the status quo. And I think by and large those thinking differently get penalized.

So, technical leadership is important. We should have it. I wrote a paper where we tried to find every family doctor who was in a C-suite in America. We found 30 of them. This total included an insurance and academia dean’s office C-suites. So, there’s not a lot. So, simply doing more of that would be a first benefit. Just getting more people into those sort of management C-suite leadership positions is important. But what kind of leaders are we trying to create? Are we trying to create status quo leaders, or are we trying to create leaders who break the system or at least challenge the system? I don’t know if we need 110,000 family medicine leaders.

I agree with Howard a little bit that we’re all leaders or whoever said that as professionals we are all leaders. However, I want to differentiate between several types of leadership. There’s authority and there’s influence. And Jenny, this is aimed at you specifically in your current position. I wonder if you are only interested in an authority leadership position. That is a C-suite, an elected position, or an appointed position. Warren is in an authority position because he is the CEO and president of the American Board of Family Medicine. But there’s a whole lot of other leadership positions that are geared towards influence. And how do you influence? This gets to the big A and the small A advocacy that I think we also need to teach regarding your day-to-day life as a doctor. Do you influence the patients around you, the colleagues around you, the practices around you, the clinics around you, the hospital systems around you, the county health department, the state and the nation.

That’s a very different set of leadership skills than authority leadership skills. And I want to make sure that we are thinking about both sets of those. I think it’s easy to teach leadership behaviors, but I think we also need to teach when to apply those skills. A lot of people learn a set of leadership skills and then they just fuck up all over applying those leadership skills in bizarre and unusual ways that aren’t helpful. We’ve all seen it. Everybody’s nodding their head that they’ve seen people apply leadership skills poorly. So it’s not just about having leadership skills. It’s about knowing how and when to apply it.