Follow the Leader: How to Build and Retain Great Clinical Teams

When physician turnover starts to climb, hospitals employ their doctors, bringing the group in-house and hoping they’ll stay loyal.

Then two years pass, and the same health system is back on the phone with a locums agency, paying premium rates to rent the engagement it thought it had purchased. I’ve seen this cycle more times than I can count, and it always starts with the same mistake. What it bought was a contract. What it needed was a leader. 

Engagement is built, not bought

When you ask a clinician why they stay, they rarely say their employer. They talk about the person they report to. In hospital-based medicine, that’s the local medical director, the physician who runs the group on the floor and sets the tone for everyone around them. That’s not just my take. Gallup has spent decades studying what drives engagement across industries, and the biggest factor they’ve found is the quality of the manager, which accounts for 70% of the variance from one team to the next.

A good one holds the group to a real standard when everyone is slammed, and doesn’t put off the hard conversations. More than anyone else, that person decides whether a new hire is still there in eighteen months. And when the medical director leads, the loyalty the system was trying to buy appears naturally. Recruiting gets easier, because a clinician can walk in for a day and know whether a place is well run. Retention takes care of itself, because people don’t leave a team they feel good about.

You can put every physician in the building on the payroll, but if the medical director hasn’t been developed to lead them, all you’ve changed is who signs the checks. Engagement gets built on the ground, by someone the team follows.

The skill no one taught us

Here’s the part we don’t like to say out loud. We spend more than a decade training physicians and teach them almost nothing about leading people. You can spend twelve years learning to manage septic shock at three in the morning and never be shown how to run a meeting or coach a colleague through a bad stretch. So, what do we do? We take the best clinician in the group, hand them the title, and assume that leadership comes with it. But clinical excellence and leadership are different skills, which I learned the hard way. For years I thought of myself as a physician and a teacher. It wasn’t until a hospital asked me to train as a Six Sigma black belt that I saw how much about leading people I didn’t understand.

Let me give you an example. A directive comes down that sepsis bundle compliance is low, and we have to get the numbers up. Delivered that way, it’s just another box to check, one more top-down demand nobody explains. The metric becomes the goal, and the patient drops out of the conversation. 

Now picture a medical director who stops and explains the “why.” Finishing a one-hour sepsis bundle is associated with a 25% lower chance of dying within 90 days. Simon Sinek made this case to the business world years ago, that great leaders start with why. It turns out, it works just as well at the bedside. Explaining why something matters is the real work of leadership.

Who steadies the team

Hospital-based medicine isn’t getting simpler. The pressure from regulators and payers keeps stacking up, and the public’s expectations are climbing right alongside it. A new quality measure shows up one year and a new documentation rule the next. In that environment, it’s easy to treat leadership development as a nice-to-have, the workshop you squeeze in when you can.

But the programs that keep their people build it in, and they treat it as seriously as the call schedule or the EHR. Over time, that investment compounds. Every medical director you develop becomes someone who develops the next one, until the program grows its own leaders. When the next hard stretch arrives, and it will, no contract is going to walk onto the unit and steady your team. A leader will. That’s who we should have been building all along.

Photo: daizuoxin, Getty Images

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