If You Want to Go Up (Part Two)- You’ll Need to Give Up. The Role of Sacrifice.

“Great achievement is usually born of great sacrifice, and it is never the result of selfishness” – Napoleon Hill

Author: Robert A Felberg MD

Topics: Physician leadership, Career Advancement, Office Politics

Keywords: Financial independence, sacrifice, paying off medical student debt, doctor passive income, doctor early retirement

“1. You have get up to go up.     2. You have to give up to go up.     3. You have to grow up to go up.”

John Maxwell

Physician success is an elusive creature. Each doctor defines success differently. Some crave recognition or a larger voice in the future of healthcare. Others desire financial rewards. All are equally valid. There are some common elements seen in successful physicians- they possess Initiative, Willingness to Sacrifice, Maturity, and Vulnerability. The first post in this series introduced these concepts and reviewed Initiative, especially as it relates to “Personal Energy”. This post will discuss the role of Sacrifice- something that doctors are quite familiar with.

 [Editor’s Note: There are many great doctors out there. Unfortunately, being a superb clinician  does not equate into superb leadership. Physician leadership is a topic that is often overlooked in training and the lack of this professional skillset is a cause of many of modern medicine’s troubles. This post in one of a series from physician advocates LLC, advocatesmd and medical success central exploring the vital skill of physician leadership. Please sign up for the newsletter to be kept up to date.]

In “The 21 Irrefutable Laws of Leadership”, Maxwell explained the secrets to  “making it to the top” or “going up”. This involves Initiative– “getting up”, Sacrifice– “giving up”, and Maturity– “growing up”. I Also believe a leader needs to be Vulnerable– “You have to open up to go up.”


“The medical profession is a feat, it requires self-sacrificepurity of soul and purity of thoughts” – Anton Pavlovich Chekhov

Sacrifice is a common experience for all in the medical field. We all sacrifice tremendously to enter the field. Hours of study while our friends enjoy their youth. Two day shifts without sleep so our patients can rest quietly. Delayed financial return, crippling medical school debt, and constant derision from society about the myth of the wealthy doctor.

Since personal sacrifice is part of the daily experience of every doctor, I’m going to touch on another type of sacrifice that typifies a successful physician- Financial Sacrifice.

It’s my strong belief the financially secure doctors are better clinicians.  The reasons are pretty straightforward-  1. If you are making decisions under financial strain, you may choose what is best for your bank account and not what is best for the patient.   2. There are few stressors worse than financial stress.   If you are focusing on your financial condition, you are taking focus away from the patient’s condition.    3. If you are financially stressed, you are probably in some level of disagreement with your employer and feel less the complete control. This combination of anger, frustration, and helplessness is on the continuum of “burnout” and that never ends well.

For the reasons above- all physicians have the professional duty to achieve financial stability.

Which gets me to my point. Doctors are really good at sacrificing their personal life for their medical career, but they are terrible at making financial sacrifices. It actually somewhat unbelievable. How can the same person who was able to sacrifice all those great parties in college turn into the same person who can’t stop themselves from spending on lavish vacations? Shouldn’t the same reserve of fortitude that allows you to work 48 hours without rest seeing 27 patients each day give you the strength to buy a used Lexus over a new Mercedes?

 Here’s the problem with most doctors- You are not rich, at least not yet. Actually, you probably owe more in debt than you have in total assets. You likely have one of two false beliefs – 1. that you are rich  due to your salary or 2. you are entitled to certain luxuries because you are a doctor.

Being “wealthy” is the ability to spend more money than you earn without incurring debt. Basically, if your investments and passive income allows you to purchase more than your salary, you are wealthy.  If you are able to afford your lifestyle without working, you are “financially independent”. If you can afford your lifestyle without working and can spend luxuriously on your dividend returns alone then you are “rich”. Almost certainly, if you are a typical early-career physician, you are “destitute”- You owe more in debt than you have in assets. Having “zero” in personal worth would be a tremendous step up from your current negative net worth and will take several years of hard work to achieve.

So, unless you are completely debt free, own your house outright, and have saving and investments that can support your lifestyle indefinitely, then you are not even remotely rich. Where does the money come from that you are spending, if you are not currently financially independent? You may answer, “Well, my salary of course.” You’d also be dead wrong.

The assets you spend today, while you are still in debt are not coming from your present salary- They are coming from your future self!  You are indebting yourself to work more years in the future to pay for your current spending.

You are sacrificing your future retirement, financial stability, and happiness by emphasizing work/life balance, luxury, time off, and spending today. For every dollar you spend today, with the compounded interest on that debt, you need to earn 3-4 times more money in the future to pay it off. This is not the type of sacrifice you want to make.

Several physician personal financial bloggers post about this topic in the blog-o-sphere so I won’t go into depth. However, the basic ideas are as follows- Live frugally, earn aggressively, pay down debt determinedly, and invest wisely. Soon, you’ll be debt free and on your way towards building enough invested assets to be achieve financial independence. The alternative is unthinkable– saddled with debt, living paycheck to paycheck, unable to slow down or retire due to a combination of divorces, luxury cars, vacations, and an inability to conquer debt in your early career. Imagine being 62 and facing that future? It’s modern indebted servitude.


Here are a few tips to help you with the financial sacrifices you’ll need to make to succeed-

  • Looking at someone else and trying to determine their financial status is like looking into a fun house mirror. What you see barely reflects reality. You may look at your colleagues and see the new Condo and leased Mercedes. What you don’t see is the $450,000 in medical student debt and the inability to save a single dollar in their 401k. Ignore the financial appearance of others and any peer pressure to “keep up appearances.”

  • Calculate the actual cost of purchases. The typical doctor works 60 hours/week. Although most of us work far more than that. Take a look at your taxes from last year and determine your actual take home pay- after taxes, benefits, and tax-deferred investment. Then subtract non-negotiable spending like mortgage, student loan service, gas, life insurance and internet. That left over amount is your discretionary income. Divide your discretionary income by the number of hours you work annually- 3120 if 60hr./week. That’s your hourly discretionary income return.
    • For example, you earn $200,000 annually. You gross $157,000 when you take out your 401k, 457b, and traditional IRA. Then you subtract $10,400 for benefits leaving $147,300. You pay taxes in the 28% bracket + 3% state tax leaving $102,874. Then your mortgage, student loans, and utilities eat another 5000/month, leaving $42,874. You divide $42,874/3,120 hours worked annually= $13.74! That’s the spending money you earn every hour you work. Depressing right? No wonder your Dad votes Republican!
    • Now, when you go to buy something consider it in terms of hours you need to work to pay it off. Is that $270 dinner worth 19 hours of work? How about the $75,000 Mercedes vs the used Camry at $24,000? That’s an extra 3,711 hours of work or entire year of labor! Not including the interest you lose borrowing to buy the car, or the compounded dividends you could make investing that money instead. Would you really trade a year or more of labor to drive one car over another? Add a few cars, a few houses, a few luxury vacations, and college for your kids. You’ll be lucky to retire at 96!
  • “Work/Life balance” is for rich people. Sorry to be the one to break it to you, but you don’t have a work/ life balance option. You have a debt/future poverty issue. And the solution is to earn aggressively and pay off your looming debt now before you are buried in the avalanche of compounding interest.

You have a personal responsibility to become financially independent so you may practice your profession without conflict, burnout, or distraction.

You have to “give up” to “go up”. Learn to make the sacrifices you need to succeed, both professionally and from a monetary standpoint. Personally, I never felt a sense of loss hiking and camping with my family instead of flying first class to Paris. Over time, I just learned to appreciate the simpler things- like the peace of mind of financial stability. The stress relief of paying off my student loans in less than 5 years more than made up for anything I may have missed by luxury spending.  Soon, you’ll find your debts paid off, your wealth increasing, and your financial independence a source of freedom and strength. With sacrifice and hard work you be able to succeed… really succeed.

Bonus Hint: The easiest to reach financial independence is to earn more income. And the best way to improve your compensation package is to negotiate a better deal! Get a high quality market value report, develop a solid negotiation strategy, determine your anchor number, up your skills set, and consider a CME approved negotiation and professional skills seminar developed for physicians.

What do you think? Do you dream of an early retirement? Do you long for the day you can tell your boss to take this job and shove it? Or, do you think I’m crazy for living a modest upper middle class lifestyle and saving instead of partying like a rock star? Share your thoughts in the comment section




If You Want to Go Up (Part One)- You’ll Need to Get Up.

“Let him who would move the world first move himself” -Socrates

Author: Robert A Felberg MD

Topics: Physician leadership, Career Advancement, Office Politics

Keywords: Doctor opportunities, effective time management skills for doctors, advancement for a doctor

“1. You have get up to go up.      2. You have to give up to go up.      3. You have to grow up to go up.”

John Maxwell

John Maxwell is one of the best resources available for anyone interested in self-improvement and leadership. It’s amazing how little his work has percolated through the medical field where it could be well applied. I have listened to nearly every audiobook he has put out and have found each one to be valuable. There is no financial relationship between us. I’ve never met the man- I’m just an admirer of his work.

[Editor’s Note: There are many great doctors out there. Unfortunately, being a superb clinical does not equate into superb leadership. Physician leadership is a topic that is often overlooked in training and the lack of this professional skillset is a cause of many of modern medicine’s troubles. This post in one of a series from physician advocates LLC, advocatesmd.com and medical success central exploring the vital skill of physician leadership. Please sign up for the newsletter to be kept up to date.]

In “The 21 Irrefutable Laws of Leadership”, Maxwell laid out some of the simplest advice I have ever read about “making it to the top” or “going up”. This involves Initiative– “getting up”, Sacrifice– “giving up”, and Maturity– “growing up”. Although it’s been several years since I first read that book, this has always stuck with me as powerful advice. There’s not much I could add other than a leader needs be able to be Vulnerable– “You have to open up to go up.”

I’m going to explore each of these concepts- Initiative, Sacrifice, Maturity, and Vulnerability as it related to medical leadership and success. In this post I going to discuss Initiative. In future posts, I’ll review Sacrifice, Maturity, and Vulnerability as it relates to medical leadership.  After reading the series, please consider an honest assessment of your personality traits. There is a great amount of information and mentorship available, but first you need to “know yourself” before you can really benefit.

Initiative amongst physician really takes two forms, Energy and Innovation. I will focus on Energy for the rest of this post.  Energy is one of the “4 E’s and one P” of leadership often discussed by Jack Welch. To succeed and move forward, you need to be energetic- you need to have a high level of enthusiasm, stamina, and personal fortitude. You also need to avoid the opposite of “energetic”, i.e.; laziness, apathy, and a tendency to shirk work and responsibility.

Energy as it relates to medical leadership has a few characteristics. The first is embracing challenges and accepting the work that needs to be done. When your business partner calls in sick do you spend 40 minutes whining to whoever will listen about the unfairness of it all? Do you internally seethe in anger at the injustice? Or do you quickly get over the change in plans and rally your team to get the work done? Although, you may feel like acting the first way, the second course of action is clearly the role of a leader and will lead to personal success.

“Action creates opportunity”- Unattributed

A bias towards action characterizes energetic people. When given two choices, they will choose the one that leads to increased value and mutual benefit over the one that defends the current status quo. They are willing to take the risk to grow the business over protective policies designed to just hang on to a shrinking share.

Another, often overlooked characteristic of Initiative is personal fortitude or “grit”. This is the quality that leads to perseverance and an optimistic outlook when faced with adversity. It’s my belief that this personality trait is learned through experience. How else is it possible for a doctor to learn to cover a 36 hour shift or see 27 patients in a day? Clearly, it’s not something you can do the first day of internship. You slowly gain the experience and confidence facing continued challenge and triumphing over it. This leads to a personal sense of accomplishment and a reservoir of fortitude. Your dad was right- mowing the lawn in the rain does build character.

Many physicians lack personal energy for many different causes. The most common manifestations are laziness and shirking of responsibility. Often physicians express the combination of sarcasm, insult, and blaming best defined as “snarky”- a defensive mechanism consisting of low-level attacks with the hope that the requesting person avoid the unpleasantness in the future. It’s sort of the personality equivalent of porcupine quills.

All of these low energy traits have one attribute in common- they are geared towards short term benefit. They all trade immediate gain against long-term relationship, future program development, or care delivery improvement. Leadership is primarily focused on the future, often at the cost of the immediate. It’s easy to see why low-energy physicians are considered to have poor advancement and leadership potential.

Here are some tips to help you “Go up by Getting Up”:

  • “I wasted time and now doth time waste me.”- Shakespeare. Learn the difference between “restorative rest” and “dawdling”. I love surfing the net and posting cat pictures to facebook as much as everyone else. But, I do those activities after I get my important work done. At the same time, learn to take useful breaks during the day- whether that involves meditation, pleasure reading, or contemplative walking.
  • Pomodoro is more than fancy talk for tomato. It’s amazing how much you can accomplish if you just focus. The Pomodoro technique leverages this idea. You set aside 25 minutes of uninterrupted, highly-focused work. Then you do it. Then you take a short break and do it again. After a while, your task is done, but it’s done so much more quickly than you ever imagined possible. As a neurologist, I could lecture for several hours about how this method ideally harmonizes brain function and neurotransmitter regeneration, but suffice it to say- it works and is the “secret sauce” to my success (tomato pun intended).
  • “As a man thinketh in his heart, so is he”- Proverbs 23:7. Much can be said about how your inner thoughts influence your life. Try to pay attention to your “inner dialogue”. If your thoughts turn negative or start to move towards the “snarky” beliefs mentioned above, try to get a handle on them. Change your inner dialogue to one of action, teamwork, success, and triumph. This may take practice, but will lead to solid personal fortitude. Consider “As a Man Thinketh” by James Allen. Be aware that J. Allen was a man of his times and several of his characterizations would be considered outdated by modern criteria. Nonetheless, it’s an excellent read.
  • Develop an Internal Locus of Control. People with an external locus of control believe that they have very little power over what happens to them and that external forces- the hospital, the government, fate, luck, karma, vast hidden conspiracies- have ultimate control over their lives. Those with an internal locus believe that, although unable to regulate every circumstance, they have considerable influence over the events in their life. Work to achieve an internal locus of control. This will give you a sense of leverage when facing difficult times and the motivation that will give you the energy to achieve.
  • Dedication trumps motivation every time. We all have passions. Many of us attempt to turn these passions into businesses or careers. Yet, despite being passionate, many of us fail. Not because the idea is poor, but rather we lack the energy to follow through. The reason is that passion relies on motivation and motivation is an uphill battle. You are fighting entropy, laziness, and 2 million years of human evolution trying to convince yourself to do something out of love when there are other activities that lead to actual gains.

Rely on dedication instead.  This blog is a great example –   I am tremendously passionate about teaching and helping the next generation of doctors succeed.  But, when I first started, I could barely convince myself to complete one post monthly. Finally, I stopped treating the blog like a hobby and approached it like a business. I set a goal of 4 blog posts weekly. Now I rely on dedication rather than waiting for the proper mood to strike with much better results.


Initiative is one of the personality traits that characterize successful physicians. By embracing change, challenges, and action you will quickly become a physician leader.  Like all physician professional and medical business skills, changing your approach to obstacles and building personal fortitude can be difficult at first and is something you can master with practice and experience.  Having a solid skillset will give you the tools you need to implement the changes you desire.  Up your skillset and consider taking a CME approved course designed for physicians. Through study, practice, and hard work you’ll be able to achieve your dreams and succeed… really succeed.

What do you think? Is there a formula to physician success? Do you have any advice? How have you overcome procrastination? Share your thoughts in the comment section below.



When your Best Doctors Go Quiet – My Doctor Leadership Credo: Part Two

All physician leaders need a personal playbook that defines their core values.

Author: Robert A Felberg MD

Topic: Physician Leadership

Keywords: physician leadership training, turning doctor into leaders, leadership skill in medicine

In Part One, I discussed an example of poor leadership, and argued that how you deal with you your top-performing doctors, your thought leaders, and your change agents defines your success. I discussed the behaviors that can result, especially employee silence.  In this post, I’ll go into my personal philosophy of physician leadership. I’ll discuss the core beliefs and processes that I’ve found effective, recognizing that none of these ideas were discovered by me, but are rather an amalgam of mentors, courses, and other sources over the decades. I will give credit where I can, but honestly at this point I can’t remember all of the influencers.

[Editor Note: physician leadership is a complex skillset. This post is part of a series produced by Physician Advocates LLC and Medical Success Central discussing physician professional and business skills– the things you weren’t taught in medical school, but define your career success. Please sign up for our newsletter to be kept informed.]

If I were to give one piece of advice to a physician leader; be consistent, straightforward, and transparent. Leadership is about setting and living the core values of your organization.  No one should be surprised by any action you take- it should be obvious and based on core values. To a lesser degree it’s about being the one who tells the truth, even when the truth is not what others want to hear. Lastly, it’s about using your skills. knowledge, and resources to plan the future direction of the organization. Leadership is often called “the art of predicting the future.”


Here are my rules that I use as the basis of my leadership style. They certainly aren’t perfect and I often have to deviate, but they may be a good starting point.

  1. Misery is shared equally. There are many things in medicine that are unpleasant. Call, paperwork, seeing difficult patients, working holidays, etc. If something is unpleasant, everyone will be required to do their fair and equal share. No one gets to wriggle out of unpleasant duties.
  2. Positive behavior is rewarded. As Jack Welch said- If you do good work, you will be rewarded with money, recognition, and voice (voice meaning a bigger role in the future of the organization). If you behave poorly, underperform consistently, or in other ways cause negative outcomes, you will be moved out quickly if intervention does not turn this around.
  3. You are there to add value to your team members. As the leader, I have already reached my career goals.   I no longer need attention, recognition, or ego- inflating praise.  My goal is now improving and growing the careers and expertise of my staff.  Don’t worry; I’ll still get lots of recognition- as the leader who discovered and groomed excellent upcoming physicians.  My job everyday is to figure out how to add value to my team and team members.   If you get jealous of your team members or their recognition, you should reconsider your leadership role.   I see jealousy behavior in physician leaders more than you can imagine.
  4. You send up the “skeet”.   Let your team members shoot them down.   This is a euphemism for “don’t micromanage” and “learn to delegate” at the same time.   If you want your team to excel, you need to let them solve problems in their own way.   Of course, they’ll need supervision and someone to help with the tough decisions.   You’ll also need to set parameters, budget, and deadlines.   But, beyond that, do your best to let your staff solve the problems. They may surprise you with a fantastic novel idea.  They’ll also develop into better quality managers as they are forced to take on a greater responsibility.   At the same time, you can monitor them for knowledge gaps and use the opportunity for valuable education.
  5. Learn how to run an effective meeting.  There is nothing worse than bad meetings.  What defines a bad meeting? The information is always the same – “please remember to sign and date your notes”, the information is not interesting, the debate goes on too long or is hijacked, and most importantly no decisions are made.   Try this instead- Introduce with the goals of that meeting.   Assign problems to teams.   Allow the teams present their findings and solutions. Implement the solution.   Assign a team to handle the next problem.  Do not waste time on long debate.   If people have a strong opinion, they can join the team working on the problem. Serve snacks, end on time, and do not tolerate lateness.
  6. Differentiate your staff.   This is an another Jack Welch idea.   Use transparent criteria to determine your top-performers from your middle of the road and bottom performers.   Reward and train your top performers to retain them and develop into solid leaders.   Try to move your bottom performers into middle of the road or better.   If they don’t respond, move them along to other careers.


Physician leadership can be profoundly difficult, but when done right equally rewarding and productive. Always remember your real purpose as the leader.   You are there to ensure that core values are upheld, to make the tough decisions, and to be honest even when it’s unpopular.   You are also there to advance the happiness, productivity, and careers of your staff.  Certainly, there are other elements that are important, but you’ll find your role as leader will be much easier if you can keep these basic requirements in mind.   Judge yourself and your actions by the value you add to your team.

What do you think? Is this a good starting point? Should some things be added? Some things subtracted? Have you found similar advice to be helpful in your leadership roles? Share your thoughts in the comment section below.

When your Best Doctors Go Quiet – an Ominous Sign: Part One

Sometimes a confluence of events comes together in a strange way. This was one of those weeks.

Author: Robert A Felberg MD

Topic: Conflict management, Negotiation, Physician leadership

Keywords: difficult discussion in the workplace, how to manage a team, employee silence, medical leadership.

First–  Richard Thaler wins the Nobel Prize in economics. Richard Thaler has long been a hero of mine. If you don’t know his work, he basically showed that humans are not rational economic agents, in opposition to what was first proposed by Adam Smith. It’s his work that led to the change in retirement funding where people are automatically signed up into their 401ks and have to opt out. I’ve been advocating the findings of Thaler and others like him as a leadership and marketing model for years.

[Editor Note: physician leadership is a complex skillset. This post is part of a series produced by physician advocates LLC and Medical Success Central discussing physician professional and business skills– the things you weren’t taught in medical school, but define your career success. Please sign up for our newsletter to be kept informed.]

Second- I hear about a disappointing interaction from one of my colleagues with the upper leadership at their institution. My friend tells me they are implementing a new Antibiotic Use policy. There is mandated educational class prior to implementation.  An email goes out to the staff, “Everyone must sign up for a class. So far, only 15% have signed up. If you don’t sign up, you’ll be suspended, etc.” Knowing the findings of Thaler, my friend sent an email recommending that everyone be assigned a date for training with the option to reschedule. That will get everyone past the first step and have 100% assigned. After a professional exchange discussing Thaler’s work in education, finance, and medicine she got a disheartening response: “I’ve launched five Antibiotic Programs. How many have you launched? We’ll ask you for advice when we want it.” Can you believe it? And yet, so typical of the poor leadership that dominates the field of medicine, even at the highest levels.

Third- This article on candor in the workplace is published in the WSJ. Being able to be honest without being penalty is one of the most pressing problems in medicine. Jack Welch, the former CEO of GE was one of the leading proponents. What do we mean by candor? The ability to honestly discuss failures, problems, and even personality issues- in a professional manner- without facing backlash or career harm.   In medicine, it’s often the case that the we are silent over the big glaring problems and verbose about the meaningless ones. The honest are usually “whacked”, while the meek get promoted. Physician leaders are especially guilty of this- the people below you are discussing problems they have with current policies. Since the leaders set the policies, they are in the firing line. If their egos are bruised easily, they respond with oppression rather than discussion.

Which gets me to my point. How you deal with your thought leaders and change agents defines your success.  Maybe, you weren’t interested in an idea sent your way. The smart reply would be along the lines of “Thanks for your input. You raise some great ideas. It’s too late to use them now, but I could really use somebody with your interests on the Antibiotic stewardship committee.”  Now the ball is in my court. If I was talented and motivated, this would be a big break for me and the leadership could add an interested and vested team player. If I’m not competent, I’d screen myself out. Instead, I have now gone silent. I will not offer any new innovations, even if directly asked. I ‘ve learned the penalty of giving advice- I get “whacked”.  When your best people go silent, you’re in trouble. My friend called me looking for a reference- she knows that she is smarter, works harder, and can get treated better somewhere else, all with a bigger paycheck. The administrator who sent the email reply described above probably thought himself witty, but it was a very costly response. Chance are, if you lose a top-performing employee it’s because of poor leadership.

In part two, I’ll discuss what I call my Physician Leadership Credo.  Certainly, there are a lot of excellent books, courses, and seminars on Physician Leadership- I’ll just share my own style. In the meanwhile, consider the role of employee silence in the harm of your healthcare organization’s success, how well your organization encourages candor, and consider joining us for the Negotiation and Professional Skills for Physician Seminar.

What do you think? Have you left a good job because of poor leadership? Do you work someplace where you can be honest without fear of reprisal? What is your leadership credo? Share your thoughts in the comment section below.


Physician Conflict Management- How You Deal with Conflict Matters

Take a guess how many google entries there are for the search term “disruptive doctor”? Did you guess 21.2 MILLION in 0.7 seconds?  Sounds crazy, right?

Author: Robert A Felberg MD

Topic: Conflict Management, Physician Leadership

Keywords: conflict resolution in medicine examples, conflict management in healthcare setting, Disruptive physician program

We’ve all seen the rude doctor who responds like an immature child or abuses the staff, but did you realize that the issue is this widespread?  Maybe, just maybe, we’ve all been a little (or a lot) guilty of this offense as well… But who can blame us?   We’re working crazy hours on no sleep, we get abused every day from all angles, everyone else gets to treat us poorly, but the second we even raise our voice to complain about the 22nd peer-to-peer call that afternoon, we get labeled “disruptive”.     Sometimes it’s seems like everyone else is making my environment hostile, but we’re the only ones who get in trouble for it!

[Introduction: This is part of a series delving into complicated professional and medical business skills that are vital to physician success, but are not covered as part of your training. Presented by physician advocates and medical success central, this is not intended to replace legal advice. Please sign up for our newsletter to keep informed. Please consider joining us for our upcoming CME approved seminar.]

Ok. You’ve had your chance to vent… Remember- It’s OK to have emotions, it’s not OK to allow emotions to have you. Especially when you are in an asymmetrical relationship and hold more power.

Conflict Defined: Conflict is a disagreement about the use of shared resources, between interdependent parties, and involving negative emotions. 

Delving into this definition of reveals a lot  about how conflict occurs and how it can be addressed.

  • You can only really be in conflict about shared “resources”- the term resources can be used loosely here. These resources can include obvious things like finances, materials, staff, or time. It can also involve “relationships” or “persons” if you think of relationship in the strictly economic sense- you can easily enter a conflict about the treatment of another person or groups of people. The closer that person is to you or your identity, the stronger the pull to jump in.
    • Consider this- The other party may not truly understand the nature of your concern. Sometimes you aren’t even aware why you are getting emotionally charged. We’ve all experienced a person “blowing-up” over something seemingly minor and not understanding why they are so upset.  Before you escalate a conflict- are you aware of why they are upset and have you calmly let the other party express their concerns? Maybe the resource has little value to you and you can readily concede it, once you understand the issue.
      • For instance, your nurse must pick up his son at soccer practice in twenty minutes.  You need him to assist in a procedure.   He starts to get visibly upset.   Rather than responding like you often do at the end of a rough day by escalating the conflict, you ask him to take a break, calm down, and explain why he is upset.   After you learn the reason, you offer to pay for a taxi for his son if he can supply the receipt.


  • You are interdependent or rely on the other party. That means, that even if there is a power difference– think you and a nurse or you and the president of the hospital- there is more to be lost than just the direct disagreement. You also risk souring the relationship.  In most health care related conflicts, the relationship is worth 75% percent of the final agreement.  (note: I’ll cover the role of relationship in another post.   Please sign up to the newsletter to be kept up-to-date) You need to keep a few things in mind when you enter a conflict
    • You are rarely just at odds about the immediate issue at hand. You are also conflicted about the nature of the relationship. If the relationship breaks down the harm can be considerable, far worse than you initially believe, and can harm more than just the parties involved.
    • Because of the interdependence of the two parties, the role of power gets magnified. If a physician gets into a conflict with a lab tech, the perceived power difference- real or not- gives you the appearance of a 6’4” football linebacker picking on a kid in a wheelchair.  You will always be the bad guy, even if you think your response was appropriate. The counter argument will always be, “you are a doctor, you are not permitted to lose your cool at any time.”  Unfortunately, it doesn’t work the other way- The president of the hospital may have more power, but if you respond poorly to his abuse, as a physician have little recourse because your power is considerably higher than the average person. Think of the world’s smallest violin joke as the common reply when you complain.


  • Conflict is associated with negative emotions. This is the most important defining characteristic of conflict. We interact with people all day long about the use of resources and different behaviors, without getting overly emotional. If we both want pizza for lunch, we get along swimmingly.  If you want pizza and I want Chinese take-out, and I accuse you of always making demands and never caring about what I want, suddenly we have a problem.
    • Conflict minus Emotions equals Negotiation.  As a physician, negotiation is the single most vital professional skillset you can learn. If you can avoid or defuse the emotional aspect of the disagreement, focus on the actual issue at hand, be honest with each other, and keep the relationship in mind, you’ll find most work conflicts can be managed- sometimes more easily than you can imagine.
    • Emotions are internal “facts”. The emotional state of yourself or the other party is as real as any other “fact” of the negotiation. The price of a dozen oranges is $3.25 is just as relevant as “I am worried” when it comes to resolving a conflict. Keep this in mind as you move forward.
      1. Do not belittle the other’s persons emotional state. Doctors do this often. They hear that OR nurse is tearful after you humiliate her and you respond, “They need to toughen up. This is medicine, not a beauty pageant!” Instead, you should consider saying, “Wow. I had no idea they were so upset. I’d really like a chance to apologize when she feels better.” You don’t need to “give in” on the disagreement, but rather apologize for worsening the harmful emotional state. Or at the very least recognize it – “I see you are very upset. That wasn’t my intention. I hope you’ll see that I am interested in working this problem out.”
      2. Consider your emotional state and the emotional state of the other party. If you are too angry to discuss an issue, say so- call a “time out”.  When someone else is too emotional to negotiate, call for a break and reconvene when they’ve had a chance to cool down.   If the other person is getting abusive, tell them you will not negotiate with someone who is acting this way, that you will return to the table when they can behave professionally, and walk out.  Don’t just threaten to walk out- do it.
      3. Don’t make the error of fundamental attribution the tendency to allow your perception of another person’s actions or beliefs reflect on who they are.  You overhear someone arguing against a raise for the nursing staff and label them as “greedy” and “selfish”.   This attribution to their character is based on your perception of how they acted and taints your relationship and dealings with them. What you don’t know is that the hospital is facing a reduction in revenue and a review of the bond issue.   A cash crunch from a nursing raise would bankrupt the hospital.
      4. Fundamental attribution errors can be made worse when people who have trouble communicating their reasons behind their actions or the need to keep information confidential.Your ancestors had to make snap judgements to survive- is that a shadow or a tiger? A delayed choice could be fatal. The same tendency to judge others rapidly leads to conflict.Before you judge a persons’ character based on their actions, try to understand their reasons.

Everyone will face conflict in their medical career. Whether it’s fair or not, as a physician you will be constantly under the microscope. If you respond to conflict poorly it may harm your reputation and career irreparably.  The good news is that conflict, like other physician professional and business skills are straightforward to learn and most doctors can master them with study and practice.   Much like learning to break bad news, there are techniques that can help you get through an emotionally charged situation and conclude a satisfying solution.  Doctors who have mastered conflict management are often considered “sages”, “wise”, or “peacemakers”.   This is a very positive association and can only help your career.   Being branded “immature”, “disruptive” or “a jerk” is the opposite.

Future posts will explore techniques and style of conflict management including how to “vaccinate” yourself against career destroying conflict before it happens. In the interim, think about the conflicts you’ve had in the past and how you might approach them differently, practice techniques to help you call a “time out” before the real damage occurs, and consider a formal CME approved course designed for physicians to help master the conflicts you will inevitably face.   With the proper skillset and training you will be able to reach your dreams and succeed… really succeed.


What do you think? Are the JC disruptive physician requirements helpful or harmful? Are doctors the bad guys or the scapegoats? Have you ever had a conflict where you responded to so poorly that you’d give anything to take it back? Do you have any advice for avoiding unnecessary conflict? Let us know your thoughts in the comment section below.