The New Doctor Triple Threat

Like most doctors, I attend several medical conferences and Grand Rounds during the week to keep up on the latest advances and new thinking in medicine. Inevitably, the moderator will introduce the speaker incanting, "Dr. ____ is the ultimate example of the triple threat. She is an exemplary clinician, an excellent teacher, and has just received multimillion dollar funding to continue her award winning research". Among her many awards and leadership positions are _____________________"

By this time the introduction will last longer than her presentation.

Then, when the Powerpoint show begins, there is the title slide and the mandatory financial disclosure slide, which, in most instances declares, almost proudly, that are none, implying that any collaboration with industry or revenue producing side gigs are verboten and would taint what the speaker is going to say, like any other crass infomercial.

There is never a failure slide.

The Peter Principle, formulated by Laurence J Peter in 1969, postulates that an individual’s promotion within an organizational hierarchy is predicated on their performance in their current role rather than their skills/abilities in their intended role. In other words, people are promoted until they are no longer qualified for the position they currently hold, and “managers rise to the level of their incompetence".

Unfortunately, the game has changed and we need a new plan, leadership, and team skills. Here are 5 issues facing medical schools. Does the chairperson of your department have the knowledge, skills, attitudes, and competencies to solve them?

Instead of research, teaching, and patient care, we should be recruiting for leadership, biomedical entrepreneurship, edupreneurship and innovation. But, before we can, the search committees need to understand the differences between one and the other.

In other words, we need leaderpreneurs.

Leadership is the process of providing vision, direction, and inspiration.

Entrepreneurship is the pursuit of opportunity with scarce, uncontrolled resources under conditions of uncertainty with the goal of the creating user defined value through the deployment of innovation using a VAST business model with the goal of achieving the sextuple aim.

Innovation is the process of creating something new or using it in a new way that results in at least 10x the customer defined value when compared to the competitive offering or the status quo.

Can physician-technologists-entrepreneurs and engineers transform sick care into healthcare, the Triple Threat 3.0?

Putting all these together requires 3 things.

Another version is the doctor/technologist/entrepreneur. Take a look at what that person looks like. Or, how about this one who is trying to save private practice.

First, you need personality traits that are high in domains associated with entrepreneurial success, such as a high locus of control and an acceptable risk profile.

According to recent research, what companies are really seeking today are leaders who can motivate diverse, technologically savvy, and global workforces; those who can play the role of corporate statesperson, dealing effectively with all constituents; and those who can rapidly and effectively apply their skills in a new company, in what may be an unfamiliar industry.?The bottom line: companies want leaders who are good with people, good communicators, good relationship builders, and people-oriented problem solvers.

Second, you need the proper mindset to evolve from a a knowledge technician with deep domain expertise to a leaderpreneur.

Finally, you need the knowledge, skills, abilities, and competencies to do the job that needs to be done.

While personalities are primarily fixed or slowly change as we get older, mindsets and KSAs can be developed with practice and training. In addition, while there are important differences, the clinical mindset has a lot in common with the innovator's, leader's and entrepreneur's mindset.

What will it take to create new triple threats?

1. An academic entrepreneurial mindset creating entrepreneurial universities where every graduate adopts a state of mind that stresses the pursuit of opportunity through the deployment of innovation.

2. A change in how we educate medical students and residents.

3. Leadership, vision, strategy, and alignment.

4. Integration of the disparate units in a complex academic health environment

5. A change in the business model from a cash based pay as you go one to an investment, equity building one.

6. Better academic-industry integration.

7. Hospital and health system-based incubators and accelerators

8. A different seed stage funding model

9. Resolving when and how we protect but share health data

10. Changing the academic culture of innovation.

11. Rethink the ethics of physician entrepreneurship and how we disclose conflict of interest.

12. Rethink how we build leadership capacity.

M: Mindset. The foundational level of the MSK Leader Development Framework pyramid targets a leader’s mindset, in particular, the beliefs that orient the way we handle situations and sort out what is going on. To assess what a leader can do and build additional capacity, the organization must create the space for the leader to gain clarity about conscious and unconscious beliefs they hold. An understanding of those beliefs and how they inform actions is critical to understanding different perspectives and thinking more broadly.

S: Skills. The middle tier of the pyramid addresses a leader’s skills. Conventional thinking considers skills merely a person’s abilities. In the MSK Framework, the skills level seeks to answer the question: Who are you as a leader? Emotional intelligence reigns supreme here. Leader development work around skills presents both the leader and the organization the opportunity to assess whether the leader is flexible, resilient, adaptable, empathetic, and self-aware, among other qualities. The results of those assessments can shape the actions that grow the leader’s capacity. Investment in this tier empowers leaders to engage in critical conversations and develop their direct reports.

K: Knowledge. The top tier of the Framework considers a leader’s knowledge. Knowledge includes the leader’s technical training, socialization, and executing abilities. Some organizations focus on this tier at the expense of the previous ones, but a shift in perspective can produce significant results, particularly for middle managers. Whereas the T-shaped model emphasizes technical competencies in the vertical and horizontal axes, the MSK Leader Development Framework assumes that leaders are technically competent and will continue to grow. Investment in the mindset and skills tiers, however, is not a given. Making that investment enables leaders to fully bring to bear their knowledge on behalf of the organization. The self-awareness created by the exploration of their mindset and the ability to self-regulate that comes from examining their skills puts leaders in a place of greater agency that allows them to more fully deliver their Knowledge.

What the moderator failed to say was that traditional triple threats are a vanishing breed. NIH funding is dropping and science is getting more and more complex and specialized and increasingly unfundable for those who don't dedicate their careers to it full time. Teaching is an increasingly unfunded mandate and state support is no where to be found. Clinicians are the academic cash cows and drive the other two wheels. But, reimbursements are dropping and academic docs are feeling the same pressures to produce as their non-academic colleagues in the community. Just like them, if they don't make the numbers, they are benched.

College or NFL mobile quarterbacks who can audible at the scrimmage line, are a running threat in or out of the pocket and can throw for 300 yards per game are a regular part of Saturday and Sunday afternoons. Academic medicine needs a new playbook as well and people in the skill positions who can execute.

Here are some entrepreneurial competencies.

Here are some digital health competencies

Here are some data analytics and artificial intelligence competencies

Here are the ACGME clinical competencies

While there are exceptions, few people can have all the competencies listed above. However, since most doctors' core competence is clinical care, i.e. their major, they can certainly develop the other competencies or use transferable skills to supplement the jobs they are doing now or want to do in the future, their minors.

The biggest challenge is not suffering from the Dunning-Kruger effect-a cognitive?bias?in which people wrongly overestimate their knowledge or ability in a specific area.?This tends to occur because a lack of self-awareness prevents them from accurately assessing their own skills.

We need, instead, entrepreneurial universitites and medical schools.

Of course, the other option is to just fire the coach and run the same offense.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship