To K(err) is human

It is that time of year...the NBA playoffs are in full motion. Where the top teams with the top talent compete for the title. This year, the Warriors were eliminated from the playoffs for the 3rd time in 5 years, after their ascendancy into the ring of NBA champions. In fact, they earned 4 championship rings during their run at 5 consecutive NBA Finals between 2015-2019. Steve Kerr was the head coach during that stretch and he continues in that role today.

Steve owns 9 rings in total, though. How? As player he earned 5. That's right, readers, five. Before turning coach.

Kerr played college basketball for the Arizona Wildcats and set the NCAA single season 3-point FG % (57%). He was drafted to play for the Suns and played 15 seasons, winning 3 rings with the Bulls and 2 rings with the Spurs. And retired as the all-time NBA leader in single season 3-pt %. Accuracy as a player counts. But then he retired, ambled around as minority owner, president of operations, GM, and TV commentator before becoming coach.

Once upon a time, the NBA boasted player-coaches. These were players who were simultaneously coaches. The most known to today's fans would be Bill Russell of the Celtics and Lenny Wilkens who played/coached both in Seattle and Portland, but that was 40-50 years ago. Times have changed, haven't they?

There was also a time the House of Medicine boasted practicing-admins; physician leaders who were practicing docs AND in administrative roles. I am not talking about MEC roles or Faculty roles, but docs who ran clinics, medical groups, ASCs, etc., who were VPMAs, CMOs, (maybe CCOs, CPEs, CEOs??). The equivalent (?) of player-coaches.

But this is no longer true in the NBA. Why is that? Maybe because the game is more complex, the league is more complex, the roles are more demanding, or the athleticism is off the charts and as you age you simply cannot compete...

When you discuss the role of practicing-admins with folks, you will hear a variety of opinions re: being a CMO while still practicing medicine (at least in some fraction).

The most cogent position (that I have heard) was that being a physician administrator in today's healthcare ecosystem, especially if you wish to be a transformative leader, requires an entirely new set of skills than the doctoring ones and you disservice everyone around you if you are not 100% focused on excelling at those new skills. If you believe that you can excel at both, then you mathematically become a 1.5 or 2.0 FTE, by never giving less than 100% to either role. IN today's healthcare, that seems like a recipe for anything but success and will come at great individual cost. And exhaustion, and stress, and....well, you know the rest.

Once you move past an MEC role or medical directorship, and are considered a formal, titled officer of an organization (and have direct reports, matrixed bosses, forecasted budgets, KPIs, and other myriad bureaucratic requirements) then confront the brutal reality of the role. And lead. Fully.

Doctors, for the most part, have excellent critical thinking skills as they have been particularly trained in that art. Those same skills can also elevate the natural trait of self criticism, something that doctors are also very, very good at. In some ways that may be good for patient care, in a positive OCD-kind-of-way. Obsessing over one's skills and self imposed demands for ever better perfection. But self criticism can be malignant, too. That is a real challenge when practicing medicine and must be guarded against to avoid feelings of low self worth, imposter syndrome, and low self esteem.

Equally important is the need to check our filters when potentially inclined to be too harsh in criticism aimed at each other. Even in the midst of the creative introspection and healthy debate on the pros/cons of practicing while leading, there is an undercurrent that reflects a criticism full of loathing, bordering on hate, almost. In places where frontline physicians develop outright disgust for physician leaders and demand that in order to be trusted, the leader (you) must lead AND practice. So, our self-critical young aspiring leaders take that to heart, and try to do both. And at great personal cost. And, by the way, is trust really earned by virtue of using the EHR 3 shifts/month?? That does not feel like earning trust; more like shared punishment.

Bordering on the edge of this discomfort is a thoughtful article which makes reference to DINOs (Doctors in Name Only). In reference to doctors who are "healthcare leaders (department chiefs, local leaders) who rarely see patients or do clinical work because of their administrative titles or roles, or always get the “easy” shifts or the “easy” cases" and have become commonplace. I do not exactly know anyone who fits this description, but that is the authors claim regarding the term. They use language to suggest that DINOs have become administrators (like a player turned into a coach) and the piece attempts to articulate that "the problems lies with..." only to restate "the real problem is" and then state "the biggest problem" with these DINOs is that they no longer see patients and do not feel the workflow burdens that they, as administrators, create upon the frontline physicians. That problem is not worthy of labels or of name calling. That problem is a failure of leadership and a failure of governance. If a physician administrator overburdens a department with 5 more pages of documents in an already overtaxed workflow stream, that is a failure of listening/learning/governing, and ultimately leading. Or a failure of the system, itself. But not a fault of NOT practicing at the bedside. And sharing the pain of being subject to onerous workflows is NOT worthy of any valid argument.

When I travel the country and listen to CMOs, this subject comes up every time. They feel lumped into the same mindset as lower "leaders" who are also still seeing patients (which is probably appropriate in those frontline roles, but not of the CMO). They are threatened to continue to see patients.

I don't see CFOs going back to former accountant roles and filing tax returns for old clients. I don't see COOs going back to facilities management and getting on the phone to procure items or punching in order entries for supply chains.

Nor should a CMO go back to seeing patients (unless they really want to AND have a support structure to do so). If they seek it for joy of teaching, satisfaction of patient care, being part of the team, no one should stop them, but someone should also point out that it is NOT a requirement. Worse, if their Boss says that it PAYS part of the CMO administrative salary and the CMO is required to see patients, that is pure B*llshit. A double flagrant technical foul. If that were true, then ask the boss why his CEO job is 100% overhead, but your CMO job has to have widget making to offset some of your % overhead to the organization.

You earned your degree, just like everyone else. You should be proud to introduce yourself as "Doctor." No one gave you the title. You earned it. And how you use it has no unworthiness once you stop seeing patients. Nor should you be forced to see patients to offset the economics of your role simply because you have MD/DO after your name. Exploitation has no place here. If you were hired to be a CMO and "fix the docs," then demand to be the coach, not the player-coach. The leader, not the person with 3 feet in 7 canoes.

Many organizations seek a CMO to manage the distrust of the medical staff. Just being honest, here. But that does not mean that you have to be punished by both the administration and the physician staff. And seeing patients should NOT be the litmus of trust. Changing the burdens doctors face should be just one standard for earning trust. And you can do that without taking a shift. And without paying down some of your overhead.

Most physician leaders that I have met (and worked with) are quite excellent at their job as evidenced by their achievements, accreditations, accomplishments, and endorsements. And not because they saw 18-20 patients on a shift last week and toiled in the EHR. But because they chose to become 100% leader. If they did provide patient care, it was of their own volition, and many times on nights and weekends so as to avoid conflicts with their "day job."

If you are a practicing physician and see the tribe of CMOs as simply the mouthpiece of administration, have you had the crucial conversation? Shared that perspective and asked for an explanation about the things that come out of the CMOs mouth? An understanding of their why? Demanded better leadership of them and their C suite colleagues? You certainly have that right. And if you claim to be in fear of your job if you speak up, I understand that occurs in many places nowadays. Shame on those organizations.

But if you have more workspace freedom to speak your mind, before you call someone a DINO (whether behind your back or in front of them, but with intent to criticize), have you followed in their shadows? Observed them? Taken a "shift" for them? Carried their phone for a day? Understand their pains, frustrations, burdens, challenges??? If not, and you DINO them anyway, shame on you, too, for name calling and adding to workplace toxicity.

If there is any reasonable hope at all (and, yes, hope is not a strategy) that healthcare can and will change, it will require many more physician leaders. To step into demanding roles, to learn new skills, to accept new challenges. Doing many hard and difficult tasks along the way.

Not everyone can do this, and there will always be the bad apples who spoil the bunch (Ralph DLT, anyone?) and in unforgiveable ways, but let's not dissuade folks from trying to make a difference with name calling and ill-conceived tribal thinking.

The NBA is way better off since letting go of the player-coach concept. It is to be emulated, in fact, since it enables pathways for strong players to become great coaches. 9 rings is simply math to some folks, but it is also uncontestable evidence that Steve Kerr is a Champion.

I understand why folks hold on to the past. I do. There is great comfort in recalling days gone by (and purposefully ignoring the many bad days, too).

But instead of demoting someone, consider changing your position and discerning that DINO should now be sought as a coveted title, and one that denotes a talented physician who no longer sees patients and has now become a transformational leader at a totally new level. If you can do that, then call us DINOs. Its ok to make a mistake.

As they say, to err is human. To forgive is divine.