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The Value of Physician Leadership – Podcast #197

Podcast #197 Show Notes: The Value of Physician Leadership

For medicine and healthcare nationally, it is not good that, as physicians, we are tending to abdicate our leadership opportunities. If we refuse to do it, less qualified people are going to take on that role, with consequences which we don’t necessarily want. In this episode, we discuss physician leadership with Dr. Brent Lacey. We talk about how to overcome our reluctance to lead and be better leaders, how to run more efficient meetings, manage hiring and firing better, deal with crises, and have a vision and a mission for our practice that everyone buys into. In the day to day work as a doctor, leadership is required. Even if you don’t want it, you’re the leader of the team, and if things are going badly, every head in the room turns to you and expects you to solve the problem. Gain the leadership skills you need. Start with this episode.

 

Sponsor

This podcast is sponsored by Bob Bhayani at drdisabilityquotes.com. He is an independent provider of disability insurance planning solutions to the medical community in every state and a long-time White Coat Investor sponsor. He specializes in working with residents and fellows early in their careers to set up sound financial and insurance strategies. If you need to review your disability insurance coverage to make sure it meets your needs or if you just haven’t gotten around to getting this critical insurance in place, contact Bob today by email [email protected] or by calling (973) 771-9100.

Quote of the Day

Our quote of the day is from Tim Ferris, who said,

“Doing less meaningless work so that you can focus on things of greater personal importance is not laziness.”.

We love Tim’s focus on spending your time on that which only you can do and putting yourself to your best and highest possible use.

Fire Your Financial Advisor Course Upgrade Plus CME Option

If you missed Monday’s post, we have updated our course that helps you get a financial plan in place. As part of these updates, we have new material from me and other instructors. Those of you who have already purchased Fire Your Financial Advisor, you are automatically upgraded into all of this new material. We’re also putting in place a forum where students in the course can talk to one another, ask their questions to me or moderators and get them answered in a private way.

We also have a second course that’s called Financial Wellness and Burnout Prevention for Medical Professionals. This is an additional course basically added on to Fire Your Financial Advisor. You get all the stuff in Fire Your Financial Advisor plus eight hours of wellness material eligible for CME that basically doubles the size of the course.

This allows you to buy it using dedicated CME funds and also allows you to write it off as a business expense if you are self-employed. For those who purchased FYFA in the past, if you want to further upgrade to this CME course and get all the wellness material, all you have to do is pay the difference between the two courses.

Fire Your Financial Advisor is now $799. Financial Wellness and Burnout Prevention for Medical Professionals with CME is $1,099. But for the next two weeks, from now through February 22nd, you can get $100 off using coupon code WELLNESS100.

Buy the New Fire Your Financial Advisor Course Today for $799 $699!

Buy Financial Wellness and Burnout Prevention for Medical Professionals Today for $1099 $999!

Leading as a Physician

Dr. Brent Lacey blogs at The Scope of Practice.  Most physicians and dentists enter their profession with large amounts of student loan debt and little knowledge of how to actually run a practice. His site is a place where you can gain the knowledge you need to run your business successfully and master your personal finances. Everyone comes out of training knowing how to be a good physician and nothing else about what it takes to be a good physician leader or business manager. He wanted to come on the podcast to discuss physician leadership. We started with why it is important to him and why it should be important to you.

“It really is important. And not only that, I would say that it’s critical. I’m reminded of something that John Adams said of government. And I think this is true of business more generally. He said, “Public business must always be done by somebody. If wise men decline it, others will not. If honest men refuse it, others will not”. I think we see that. So, why is it important? I would say two things. First, it’s good for our patients. When you look at the national statistics, you’ll see hospitals that are run by physicians are safer. They have better customer service. And as a matter of fact, they’re actually more profitable. And I think that’s because we as physicians know what we need to run a successful healthcare delivery service for our patients. I mean, we know what it takes to care for our patients. So, I think we owe it to our patients to be leaders in our field.

The second thing is that burnout is a real and ever-growing threat. And if you look at it, the root causes of burnout really aren’t the number of hours worked or the reimbursement rate. Not really. I mean, if you look at polls and surveys, what you see is that physicians feel burned out when they don’t feel supported by their leadership, when they don’t feel appreciated, and, most importantly, when they don’t feel like they’re getting what they need to take care of their patients. So, like I said, we know what it takes to care for our patients. And I think that the best way for us to change the system is to participate in it and then lead it.”

Competence is Important to Establish Credibility as a Leader

Dr. Lacey has said before that competence is important to establish credibility as a leader. What does he mean by that?

“Credibility is the currency of leadership. At the end of the day, leadership is about influence. How can you as a leader influence a person or a group to do something? The only way that you can get them to follow your guidance is if they take you seriously.

I think that’s true generally of leadership more broadly. Your influence extends only as far as your credibility will reach. The more people take you seriously as a physician and as a person, the more likely they are to follow your lead. A critical component to this as a physician is to actually be a good physician. No one takes you seriously as a physician leader if you’re not a good doctor. We have to be good at our craft and we have to be good at leading. Otherwise, nobody will take us seriously.”

Improving as a Leader

Beyond being good at practicing medicine, how else do we become good at leading? Is it about taking courses or are some people just natural leaders? Should you read books on leadership? Let’s assume you buy into this and you say, “Yes, leadership is important. I should be a leader”. How do you become a good leader?

“I think it is important to recognize that leaders come in all shapes and sizes and with all kinds of different character traits. And so, I think that if you want to be a leader, you may have heard the saying “You should dress for the job that you want, not the job that you have”. And I think that you can extend that analogy to say, “You should train for the job that you want, not the job that you have”. And so, if you want to be a leader, you need to do all the things that you said – listen to leadership podcasts, read leadership books, go study at the feet of people who are in those positions. Learn what it takes, learn what the job of the leader is.”

Dr. Lacey suggests going to the person in the leadership position you want someday, like department head or chair in your university setting, and find out something that you can do that will help make their lives easier. Just go ask them, “what are some projects that you are working on?” Or “what are some things that we need to be doing in our department?” If you can find a way to lift a burden off of someone that will really help them, they’ll take you more seriously.

You can show people that you are able and willing to make their lives easier and help do a job better. Dr. Lacey said that is what leadership is – finding ways to help people do a job that they need to do, to excel in that role.

Leading When You Are Not in Charge

What are some ways you can lead when you’re not actually in charge? Dr. Lacey had two suggestions.

“Leadership is influence. And so, I think that it’s important to recognize that no matter what your station is, you are a leader to someone. If you’re an intern, you can lead your medical students. You can lead your nurses. If you’re an attending, but not leading your department, you can still lead your peers, your residents, your students. If you can demonstrate that you can lead when you’re not in charge of much, you’ll be put in charge of more. One of the ways that you can do that is just find a way to help someone else do their job better. I guarantee you if you just go around the hospital and ask people, “What’s the hardest thing about your job right now? What are the top three things that someone needs to fix in this hospital? What are the top three things you’re struggling with right now?” and just find a way to help them with that. If you can do that, people will take notice of that. That’s all that leadership is. It’s helping other people excel at their jobs.

But the second thing I would say that’s really important for people to recognize is, first off, you have to be outstanding at your own job. Work hard, be a team player, show up with a smile every day. You do that and you’re 90% of the way there.”

Managing Your Boss

A phrase that Dike Drummond used on the podcast, was about the importance of managing your boss. What recommendations does Dr. Lacey have for managing your boss?

“One of the things that I think is really helpful is to learn what the boss needs. And honestly, that just starts by asking them. And it can be in a formal setting, if you’re sitting down for a quarterly review or a semi-annual review or something, and they ask you if you have any questions, say, “Yeah, what’s something that I could be doing that would help us out here? What’s a problem that we’re struggling with that I could be doing something for?” And if you have a good boss, if you have someone who’s responsive and helpful, then they’ll just tell you straight out and they’ll give you some opportunities.”

Overcoming Your Reluctance to Lead

One of the criteria for medical school acceptance is some leadership experience. Certainly in our careers, there are a lot of situations, not just formal leadership positions, but just the day-to-day work as a physician, where leadership is required. You’re the captain of the ship. You’re the leader of the team, and if things are going badly, every head in the room turns to you and expects you to solve the problem.

Yet many physicians are not really interested in leadership. They want to punch the clock and go home. They want to give good patient care, but they have no interest in managing other physicians, much less other staff members. What advice does he have for them? Is this a problem? Are those people just not cut out for leadership or should they be doing something different than what they’re doing? Dr. Lacey broke his answer into two parts. Is that good for medicine as a general concept? And is it good for that person?

“As a general concept for medicine and for healthcare nationally, it is not good that, as physicians, we are tending to abdicate our leadership opportunities. If we refuse to do it, less qualified people are going to take on that role. That is unfortunately what we’ve seen over time, a lot of administrators that are not good at running hospitals, that are trying to teach us how to do patient care, and they’re not very good at it.

So, I think it’s a problem on a systemic level, but on an individual level, is everyone cut out to be a leader? Well, not everyone’s necessarily geared for leadership in a formal sense. Maybe they’re not ready for a department chair or a directorship role or something like that, but, like I said, leadership is influence. You can be a leader anywhere you are. You can lead the nurses to do better at their job. You can lead your staff. You can lead your peers.”

He stresses that leadership is first excelling at your job and then helping other people do the same. He doesn’t think that everyone necessarily needs to go for leadership roles, but feels, a lot of times, people choose not to do that because they feel unqualified or unprepared.

“If you’re thinking along those lines, then there are ways that you can prepare yourself. You can read books, listen to podcasts, go to conferences, learn from mentors. But find ways to prepare yourself for those kinds of things. There’s no end to the amount of content that’s out there to absorb. And so, if you can take on some of that content and learn and grow, then a lot of times you find that you actually do develop an interest. Sometimes it’s just a matter of jumping into the deep end and learning how to swim.”

Running Effective Meetings

I’m not a huge fan of meetings.  Part of that is because I’ve been in a lot of meetings that are less than effective. What does it take to run an effective meeting? What are the “dos” and “don’ts”? Brent said running a meeting is a learned skill. It’s not natural. You get better with practice and time. He had some specific suggestions for running a meeting.

  1. Decide the purpose of the meeting ahead of time. Is it for delivering information? Is it a brainstorming session? Get everyone on the same page from the start or you risk having the entire meeting just completely derailed by irrelevant interruptions. “This is why we’re here. If there’s something else, we’ll talk about it elsewhere.”
  2. Be prepared to run the meeting. Have a written agenda and stick to it. Don’t let people derail the meeting with non-agenda items. Save it for later. This will help you start and end the meeting on time and people will tend to stay tuned in more when they know that you’re going to actually end the meeting on time.
  3. Embrace the phrase, “Let’s take that conversation offline.” Many times in a meeting people will say is, “Yes, I agree with that. Let me say this” and then they basically say the exact same thing the other person just said. If you find yourself going in an endless stream of circles, or if it becomes obvious that there are two really strong opposing viewpoints, and you’re not going to reach a specific decision or a definite course of action, say, “let’s take that conversation offline.” Then you can assign some team members or people on the committee to address it outside of the meeting and report on it later.
  4. Limit the conversation. One of the hardest things to do is prevent meetings from devolving into just endless conversation. It is not important that everyone says something if they’re just restating what someone else said. You can coach your team members on this. You can tell them everyone’s opinion is valuable, but speak up when you have something new to contribute or an alternative perspective to offer.
  5. Get to a call to action. Get to a specific decision. Discussion is fine, but it only is valuable if it’s going to lead to some kind of an action. There kind of a subtle art for pulling up for action at the right time. You don’t want to quash the discussion by calling for action too early. But on the other hand, you don’t want to just let the conversation go on forever and never actually lead to anything purposeful. Allow the conversation to unfold naturally. Once you think you’ve got some consensus, some of this is just by reading the body language and just getting some head nods from the people in the room, or if you feel like all the relevant viewpoints have been discussed, call for a vote, make a decision to set some specific course of action and end it.

Hiring

Hiring is difficult. We get no training in medical school or residency on hiring other people. We have never spent any time in the HR world, and it becomes intimidating because you’re worried you’re going to hire the wrong person. How do you make sure you’re hiring the right people? Dr. Lacey suggested reading The Ideal Team Player by Patrick Lencioni.

Lencioni’s thesis is that the ideal team member has three characteristics.

  1. They need to be humble.
  2. They need to be hungry
  3. They need to be people-smart.

Ideally, you have someone who is good at all three of those. That’s the ideal team player. If they are good at two and okay at the third, they can develop the third.  But if you have someone who is only really good with one, you’re really not going to do well.

Beyond those characteristics, Dr. Lacey said,

“First thing is to define who you want. Then the second question is how do you actually find those people. Start by getting referrals from your current team members. If you already have great team members, then they are going to want to work with other people who are also great. If you look at national statistics, a large percentage of hires in any company from any industry comes from internal referrals. Those referrals also tend to have the lowest turnover. If you don’t like firing people, then you need to hire the people that your current team members like.”

Second is have an in-depth hiring process. This is one of the things that is maybe problematic or challenging for a lot of companies. It’s the idea of having a really long and complex and in-depth hiring process. I think most places you’ll have a 30-minute interview or an hour interview, but it’s very hard to gauge someone’s true character and work ethic in a 30-minute interview.”

An in-depth hiring process would be a slow and very deliberate process and would benefit you by having a lot less employee turnover, because you’ll hire the right people and you won’t end up having to fire them later.

He also suggests having a probationary period for someone when they’re first hired. During that 90 days, that person can quit for any reason, and you can fire them for absolutely any reason.

Firing

We talked about firing your team members, not someone that is embezzling, sexually harassing your staff, or just not meeting the basic requirements of the job, but someone who is checking the boxes but not humble, hungry, or people-smart and you wonder if you should fire them. How do you know when you should fire someone and what is the best way to do it?

Brent called it sanctioned incompetence. They just are not up to the level of everyone else. He suggested two other books Good to Great and Built to Last by Jim Collins. In one of the books, Jim said to ask yourself this question,

“If I had to hire someone for this position today, is this the person that I would be excited to hire?”

If that answer isn’t an enthusiastic “yes,” it is time to start thinking about letting them go. Dr. Lacey said the best way is to do that is decisively and with extreme clarity.

“First off, you have to start by just deciding that someone isn’t meeting your expectations. And I think one of the places that we’ve failed to do this is by not examining our role as their leader. So, you need to consider whether or not you’ve made your expectations crystal clear to them. And if they’re not doing well because they don’t know what your expectations are, then that’s our fault as leaders. And so, we need to own up to that.

But whether it’s that they’re not meeting expectations or they don’t know your expectations, sit down with them and tell them very clearly the specific ways in which they are not living up to your expectations for their job and write it down. Write down the very specific shortfalls and be clear.

Explain to them that, in order to stay, give them say like 30 days or some defined period of time for them to be able to make some changes, and then, at the end of each week, meet with them and review the week’s performance and work with them. A lot of times what you’ll find is that if you’ve got an employee that is just not meeting expectations at all, every week, the same conversation happens. Like “You’re still not doing it. You’re still not bringing it. You’re still not where we want you to be”. A lot of times they see the writing is on the wall and they just end up quitting. But if they don’t do that by the end of the month, then you’ve given them very clear metrics. You’ve worked with them to try to rehab them and then you decisively let them go. Hire slow and fire fast.”

Dealing with Crises

What special tips does Dr. Lacey have for leading in a crisis?

  1. Don’t panic. Keep calm. The first pulse you check is your own.
  2. Use extremely effective communication. He mentioned groups having leadership meetings every day at the height of the COVID crisis, or even a few times a day. It is important to have everyone on the same page and working together at all times.
  3. Distill your problems down to the big, key issues, because, when you’re in a crisis, there are always fires that you’re putting out, but you have to focus on what the key issues are. How will you care for your patients safely? How will you make enough money to keep the business afloat? What do we need to sacrifice to meet our goals? Are there things that we need to be doing differently in order to achieve all of this? You focus on the big issues and then the smaller issues will start to fall in around those. But don’t let the urgent crowd out the important. Focus on those big things.

He also mentioned that, before hitting a crisis, it is really important to clearly define your company’s values.

“What are the principles on which your company is built? What’s your mission? Because a crisis will test those to the limit. Decide what your values are ahead of time and then anchor to those during the crisis. If you have a decision to make, and you have an option that goes against your company’s values, that’s a bad decision. It is crucial to have that to guide you when you’re in a crisis.”

Vision and Formal Mission Statement for your Business

How do you cast a vision? Should you have a formal mission statement? How small of an organization needs a mission statement? This is what Dr. Lacey will be talking about at our conference next month. He thinks everyone needs a formal mission statement. You need a guiding mission to focus the company around.

“But let’s start by how do you actually cast the vision. Well, the first thing you want to do is determine what do you want your company to look like in the future? So, let’s say you’re casting a vision for your company for the next five years. So, what do you want that to look like in five years? Figure out what you want and be specific about it. Have a specific goal in mind and then assess the gap between where you are now and where you’ll be at that time. Then you can break those down into smaller, bite-sized chunks on like a quarterly or an annual basis. But have an idea. This is where you get to imagine things. What would it look like? What would be your dream scenario for 5 years from now, 10 years from now?”

As far as a mission statement, he suggested creating a one-liner. Your mission statement doesn’t need to be a three-page document.

“Create a one-liner, two or three sentences that tells the story of your company. And the one-liners should succinctly tell people three things. Part one, what is the problem that you’re trying to overcome? Who are you serving? Part two, what skills, what talents, what abilities do you have and how do you use them to help solve that problem or serve those people? And part three is how do you help those people whom you serve to achieve success for themselves?”

It should be something short in story format that is memorable and that team members can repeat. “They can learn it. It’ll start to infuse into the DNA of your company.”

Ending

Leaders are not born, leaders are made. Dr. Lacey suggests it is time that we take back the leadership of our professions from the people who are leading it now.

“Instead of just complaining about it, instead of posting on social media endlessly, go join a hospital committee, go apply for a leadership role, go talk to your department chair and find out something that you can do to make the company better. Look for some way to get involved in your business. The best way to ensure the best future for your company is to participate in shaping it. If you decline to do it, less qualified people will take that responsibility from you.”

Read more about Dr. Lacey at The Scope of Practice. He put together a free guide for WCI podcast listeners called Five Critical Tools for the Physician Leader. It has ideas for how to celebrate your team members, how to put together a mission statement, how to create the one-liner for your business, a list of books that all leaders should read, and a 10-day clinic make-over challenge. So check that out.

Full Transcription

Intro:
This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We’ve been helping doctors and other high-income professionals stop doing dumb things with their money since 2011. Here’s your host, Dr. Jim Dahle.
Dr. Jim Dahle:

This is White Coat Investor podcast number 197 – Leading as a physician. Welcome back to the podcast. I hope you’re having a great time in your practice with your family as we start seeing some of the COVID restrictions start to loosen up a little bit as more and more people get vaccinated and thankfully cases are starting to fall.
Dr. Jim Dahle:
But thanks for what you do. Those of you who have been on the front lines, thanks for taking those risks. Even those of you who just had a lot of hassle in your work due to COVID, I appreciate what you do as well.
Dr. Jim Dahle:
By the way, Valentine’s Day is coming up in a few days. Don’t forget that for those of you who have a sweetheart, don’t let that pass you by. It’s a great opportunity to show them how much you care about them. For those of you who don’t, find something special for Singles Awareness Day. I think there’s a lot of us at some point in our life that have celebrated Singles Awareness Day and let’s have a great time with that in a COVID safe way of course.
Dr. Jim Dahle:
All right. Our podcast today is sponsored by Bob Bhayani at drdisabilityquotes.com. He is an independent provider of disability insurance planning solutions to the medical community in every state and a long-time White Coat Investor sponsor.
Dr. Jim Dahle:
He specializes in working with residents and fellows early in their careers to set up sound financial and insurance strategies. If you need to review your disability insurance coverage or get this critical insurance in place, contact Bob at drdisabilityquotes.com today. You can email him at [email protected] or you can call him at (973) 771-9100.

Dr. Jim Dahle:
Our quote of the day to day comes from Tim Ferris, who said, “Doing less meaningless work so that you can focus on things of greater personal importance is not laziness”. And I love Tim’s focus on spending your time on that which only you can do and putting yourself to your best and highest possible use.
Dr. Jim Dahle:
I also want to announce that our flagship premier course Fire Your Financial Advisor has been redone. We have updated it. We have upgraded it. It is ready for prime time here in 2021. This is a great course that’s been put together that helps you go from “zero to hero” in your finances. It will teach you the basics of financial literacy. Heck it’ll spoon-feed the basics of financial literacy to you. And most importantly, you will leave the course with a written financial plan in place that you can follow to financial success and to your own financial independence.
Dr. Jim Dahle:
Now we’ve had this course around for three years. It’s provocatively called Fire Your Financial Advisor, even though it doesn’t necessarily tell you to fire your financial advisor. It does teach you what financial advisors do and help you learn to do that on your own if you want. But if you don’t want to, it also teaches you how to make sure you’re getting good advice at a fair price from your advisor.
Dr. Jim Dahle:
As part of these updates, we have new material from me in there. We also have new material from other instructors. We’ve added material from Bill Bernstein, Jonathan Clements, Sarah Catherine Gutierrez, Mike Piper, Larry Keller, and others into the course. And you get all that in addition to what was in there before. Those of you who have already purchased Fire Your Financial Advisor, you are automatically upgraded into all of this new material.
Dr. Jim Dahle:
We’re also putting in place a forum where students in the course can talk to one another where they can ask their questions to me or to moderators and get their questions answered in a private way. And so, that’s also a significant upgrade to the course compared to what we had before.
Dr. Jim Dahle:
However, we are also putting in place a second course that we’re calling The Financial Wellness Course for Doctors. This is an additional course, a base that basically is added on to Fire Your Financial Advisor. So, you get all the stuff you get in Fire Your Financial Advisor, in addition, you get eight hours of wellness material eligible for CME that basically doubles the size of the course.
Dr. Jim Dahle:
This allows you to buy it using dedicated CME funds using your CME dollars, and also allows you to write it off as a business expense if you are self-employed. So, it provides either a CME or dental continuing education credit for that. So, that is a great new addition we have to Fire Your Financial Advisor this year. those who have purchased in the past are upgraded to the new Fire Your Financial Advisor course. If you want to further upgrade to The Financial Wellness Course for Doctors and get all that wellness material in there as well, all you have to do is pay the difference between the two courses.

Dr. Jim Dahle:
So, Fire Your Financial Advisor, yes, with all this new stuff, we’ve raised the price. It is now $799. The Financial Wellness Course for Doctors is $1,099. But for the next two weeks, from now through February 22nd, we’re selling these for $100 off. So, we’re giving you a hundred dollars discount and you can get that for an even better deal than what you normally get.
Dr. Jim Dahle:
Now, is that a lot of money? Yes, it’s a lot of money, but I think provides a lot of value. It saves you a lot of time of learning this stuff the same way I did going through books, internet forums, reading blogs, et cetera. Can you learn this stuff on your own? Yes, you can. Can we teach it to you faster than you can learn on your own? Absolutely we can. And that’s the real value of the course.
Dr. Jim Dahle:
Since we came out with Fire Your Financial Advisor, you see all these other courses being sold by physicians for $1,500 – $2,000, even $3,000 for some of the real estate courses out there. Some doctors are paying $5,000 or $15,000 for life coaching. This course is still a great deal for the price of just two or three hours with a financial advisor, you are getting a course that is going to teach you how to write your own financial plan. So, it’s a hundred dollars off until February 22nd. You can get more information at the website, or you can just go to whitecoatinvestor.com/fyfa to get more information on that.
Dr. Jim Dahle:
All right, we have a special guest today we’re bringing on the podcast. Brent Lacey is a blogger, a podcaster, a public speaker, a coach, a veteran, and a gastroenterologist. You may know him from WCICon20 in Las Vegas. He was a speaker there, and he’s also going to have a part in the White Coat Investor conference coming up. If you want, you can still sign up for that – whitecoatinvestor.com/conference.

Dr. Jim Dahle:
He blogs at thescopeofpractice.com. And he’s a big fan of not only taking control of your practice and your life, but also a physician showing leadership and he applied to come on the podcast to talk about that. So, let’s get him on the podcast.
Dr. Jim Dahle:
All right, Dr. Brent Lacey, welcome to the White Coat Investor podcast.

Dr. Brent Lacey:
Thanks for having me, Jim. I’m excited to be here.

Dr. Jim Dahle:
Awesome. Well, let’s start at the beginning. That’s where I start most of my podcast guests at. Tell us about your early life and how that influenced your views on medicine and money.

Dr. Brent Lacey:
Well, I knew for sure when I graduated high school that I definitely, definitely did not want to be a physician and I didn’t want to be a lawyer. I had only rolled out those two careers with absolute certainty. And I think the main reason is that my father was a physician and he and I had been best friends for really since I was a little kid.
Dr. Brent Lacey:
But I always got asked, “Are you going to be a doctor like your dad?” and decided “You know what? No, I’m going to be my own man”. And then ended up just deciding that medicine was the calling for me. And then I decided, “Well, I won’t do internal medicine because that’s what dad did”, but no, I loved internal medicine. Then I decided, “Well, at least I won’t do GI because that’s what dad did”. And now I ended up as a gastroenterologist anyway.
Dr. Brent Lacey:
But as far as money goes, that really started when I was very young. My parents were really good about teaching me about money. I remember when I was 14, there was a week one summer when I was away at camp and my brother and sister were both away for something else. And we were all gone for the same week. And we learned never to do that again because that’s when your parents start to conspire to do things. And so that week they invented something they called The Lacey Family Financial Plan.
Dr. Brent Lacey:
And what they did is they raised everybody’s allowances fairly substantially, and then told us we’re never allowed to ask for money ever again. So, they said, you can have room and board and we’ll pay for your car insurance. But if you want to buy a car, that’s on you. If you want to buy your lunch at school, that’s on you. You buy your own clothes, you buy your own entertainment, you buy everything.
Dr. Brent Lacey:
But they taught me how to budget. They taught me how to open up a checking account, how to balance a checkbook, how to invest, what’s a mutual fund. And I soak that up and it was great. It was phenomenal education. It wasn’t until I got to college and med school and I realized that nobody else got that benefit.

Dr. Jim Dahle:
It’s interesting. I just got a text from my daughter this morning. You know what she texted me? I’ll tell you here. She texted me, “Dude, have you seen this crazy Game Stop stock stuff?”
Dr. Brent Lacey:
Yeah. I’ve been checking on that today.
Dr. Jim Dahle:
And I said, yeah, that’s funny. The high schoolers are talking about. And she says, “I had a contest with some friends as to what day it would drop. Guess who won?”
Dr. Brent Lacey:
I love it. Future day trader there.
Dr. Jim Dahle:
They certainly do pick up some lessons from you. I’m not sure mine are picking up the right lessons, but at least she’s not buying it, she’s just following the news. But it’s interesting what we learn when we’re young, huh?
Dr. Jim Dahle:
So, you get out of the house, you already know how to budget your money. That’s good. And then you head off to college and med school and residency and fellowship. Tell us about your education. Where did you train?

Dr. Brent Lacey:
Well, I went to undergraduate at Texas A&M and one of the great benefits that I got there is that I was involved in the student union there. One of the things that we prized at Texas A&M was something we call the other education and that’s basically all your extracurriculars. And so, they really tout that as being seriously important. And so, I got involved in the student union first through just a leadership organization and then started to go deeper and deeper. And then by my senior year, I was actually selected to be the chief operating officer for the student union, which was an amazing experience. So, it was me and two other students and three staff, that were formed from the board of directors for the student union. And it was 1,800 students and a $6 million budget. It was just phenomenal.
Dr. Brent Lacey:
That leadership laboratory experience that I got was phenomenally valuable. And so, I think that’s what really got me inspired for some of the stuff that I do now. And so, when I went into med school, I was really grateful that I learned all that stuff because now I use it every day. And certainly, I didn’t learn it in med school. I don’t know about you, but this is not formally taught in med school or residency or anything like that. But I went to San Antonio, University of Texas in San Antonio for med school and then did all my training through the Navy, and spent my first 11 years as a Navy doc.
Dr. Jim Dahle:
Did you do a general medical officer tour?

Dr. Brent Lacey:
No, I ended up not. I was going to, but then I ended up getting selected to go straight through for internal medicine residency, which I got kind of lucky, only four people got to go through that year and ended up going straight through residency and fellowship and then off to my tours.
Dr. Jim Dahle:
Straight through into fellowship as well.
Dr. Brent Lacey:
Yeah, it was unusual, but I guess I must’ve said something during the interview that they liked, so, it ended up working out.
Dr. Jim Dahle:
They just really needed gastroenterologists. You never know.
Dr. Brent Lacey:
Yeah.
Dr. Jim Dahle:
Okay. So, tell us about that career that you’ve had so far, both in the military and out of it, as well as this new side gig you’ve got – The Scope of Practice. Bring us up to speed with what you’ve been doing since you got out of your GI fellowship.

Dr. Brent Lacey:
Yeah. So, I did all my training through the Navy and then did my tours in Pensacola, Florida, and with the Marines at Camp Lejeune. And I feel like we need a whole another podcast to tell you all the great stories about working with the Marines. I mean, I loved the Marines, but you can hear some crazy stories from them. And so, now I’m actually out of the military in a full-time private GI practice, and just loving it.
Dr. Brent Lacey:
But what I discovered about five years ago when I got out of fellowship is I just was dismayed at how we learn personal finance and leadership and business management strategies in med school. I mean, everyone comes out of training knowing how to be a good physician and we know nothing else about what it takes to be a good physician leader or business manager. And we got to know that stuff if we’re going to be in practice.
Dr. Brent Lacey:
And so, I started doing some teaching for just the residents and the students, and started getting asked to speak to groups of docs and nurses and medical staff. And I remember especially when I would give my personal finance talks, I’m sure you get the same thing is that I get asked the same 8 or 10 questions every time. And I remember thinking “It’d be nice if I just had a blog or something somewhere where I could just refer people to it”. And I thought, “Well, why don’t I just do that?” So, I started writing a blog and started picking up some traction with it and eventually started a podcast. And so, that’s what I do now.

Dr. Jim Dahle:
Now, when you applied to be a guest on this podcast, you said you wanted to talk about leadership. Why is that important to you? And why should it be important to listeners, particularly physician listeners?

Dr. Brent Lacey:
Well, first let’s establish that it really is important. I mean, it’s not just important to me. It really is important. And not only that, I would say that it’s critical. So, if you look at the last year as just an example, 2020 showed us that a lot of hospitals and healthcare organizations are just frankly really terrible at managing themselves. I saw a lot of physicians lose their jobs, find themselves replaced by NPs and PAs. And a lot of people saw the hospitals just completely go under.
Dr. Brent Lacey:
And so, I’ve got reminded of something that John Adams said of government. And I think this is true of business more generally. He said, “Public business must always be done by somebody. If wise man decline it, others will not. If honest man refuse it, others will not”. And I think we see that. So, why is it important? I would say two things. First, it’s good for our patients. When you look at the national statistics, you’ll see hospitals that are run by physicians are safer. They have better customer service. And as a matter of fact, they’re actually more profitable if you look at it. And I think that’s because we as physicians know what we need to run a successful healthcare delivery service for our patients. I mean, we know what it takes to care for our patients. So, I think we owe it to our patients to be leaders in our field.
Dr. Brent Lacey:
And I would say the second thing is that burnout is a real and ever-growing threat. And if you look at it, the root causes of burnout really aren’t the number of hours work or reimbursement rate. Not really. I mean, if you look at polls and surveys, what you see is that physicians feel burned out when they don’t feel supported by their leadership, when they don’t feel appreciated and most importantly, when they don’t feel like they’re getting what they need to take care of their patients. So, as I said, we know what it takes to care for our patients. And I think that the best way for us to change the system is to participate in it and then lead it.

Dr. Jim Dahle:
So, you have said before that competence is important to establish credibility as a leader. What did you mean by that?
Dr. Brent Lacey:
Oh, this is so critical. Credibility is the currency of leadership. At the end of the day, leadership is about influence. How can you as a leader influence a person or a group to do something? The only way that you can get them to follow your guidance is if they take you seriously.
Dr. Brent Lacey:
I remember when I was a kid, I had a friend that was incredibly disrespectful to and dismissive of his mother. And I remember we’d be hanging out in his room and she’d come up to tell him to turn the music down or something. And he just rolls his eyes and just say no. And that would not have gone well in my house. I don’t know about you, but I mean, for sure that would not have ended well with my mom. But instead of her dealing with that in a more direct way, she would say something like, “Well, just wait until your father gets home”. And I think it was problematic because she just had no credibility with him. She didn’t establish herself as a leader in the home. She just let him walk all over her.

Dr. Brent Lacey:
I think that’s true generally of leadership more broadly. Your influence extends only as far as your credibility will reach. The more people take you seriously as a physician and as a person, the more likely they are to follow your lead. A critical component to this as a physician is to actually be a good physician. No one takes you seriously as a physician leader if you’re not a good doctor. Everyone just dismisses you.
Dr. Brent Lacey:
You probably have people like this in your own hospital. People that you knew them when they were just a physician and not as a leader and you remember them being a fairly terrible doctor. So, what makes them think that that you would take them seriously as a leader? No one does. So, we have to be good at our craft and we have to be good at leading. Otherwise, nobody will take us seriously.

Dr. Jim Dahle:
So, how do you become good at leading? Is it about taking courses or are some people just natural leaders? Should you read books on leadership? Let’s assume you buy into this and you say, “Yes, leadership is important. I should be a leader”. How do you become a good leader?

Dr. Brent Lacey:
Well, I think all of the above. I think it’s important to recognize that leaders come in all shapes and sizes and with all kinds of different character traits. And so, I think that if you want to be a leader, you may have heard the saying “You should dress for the job that you want, not the job that you have”. And I think that you can extend that analogy to say, “You should train for the job that you want, not the job that you have”. And so, if you want to be a leader, you need to do all the things that you said – Listen to leadership podcast, read leadership books, go study at the feet of people who are in those positions. Learn what it takes, learn what the job of the leader is.
Dr. Brent Lacey:
So, let’s say that you want to be a department head someday, or you want to be a chair in your university setting. Well, what does that person actually do? That’s a good place to start. Just go ask them or even better go find out something that you can do that will help make their lives easier. Just go ask him, “Hey, what are some projects that you guys are working on? Or what are some things that we need to be doing in our department?” And if you can find a way to lift a burden off of somebody that will really help them, they’ll take you more seriously.

Dr. Brent Lacey:
So, if you can show someone that you are able and willing to make their lives easier and help them do a job better than that’s really all leadership is, is just finding ways to help people do a job that they need to do and to excel in that role.

Dr. Jim Dahle:
Can you talk about some ways that you can lead when you’re not actually in charge?

Dr. Brent Lacey:
Okay. Yes, I love this question. Because this is us for most of our careers, right? We basically spend all of our…

Dr. Jim Dahle:
Especially in the military, right? Especially in the military.
Dr. Brent Lacey:
Yeah, absolutely. Well, like I said, leadership is influence. And so, I think that it’s important to recognize that no matter what your station is, you are a leader to someone. And so, if you’re out there and you’re listening if you’re an intern, if you’re a medical student, you can lead someone. If you’re an intern, you can lead your medical students. You can lead your nurses. If you’re an attending, but not leading your department, you can still lead your peers, your residents, your students.
Dr. Brent Lacey:
One of my favorite stories that I think will illustrate this comes from the Bible. It’s the parable of the talents. And Jesus tells the story of a master who had three servants and he went away for a while and he gave each of them a certain amount of money to manage for them. And so, one that was given a lot of money, made a lot of money for the master. And then another one that was given less, was able to make some money, but less. And then one that was given a little bit to manage, did nothing and made no money at all. And so, then when the master returned, he rewarded the servants who actually did something and made the money and they were put in charge of more.
Dr. Brent Lacey:
And so, the point there is that if you can demonstrate that you can lead when you’re not in charge of much, you’ll be put in charge of more. And so, like I said, one of the ways that you can do that is just find a way to help someone else do their job better. Because I guarantee you if you just go around the hospital and just ask people, “What’s the hardest thing about your job right now? What are the top three things that someone needs to fix in this hospital?”
Dr. Brent Lacey:
Just go ask the charge nurse on the hospital ward where you’re at, go ask your office manager what are the top three things you’re struggling with right now. And just find a way to help them with that. And if you can do that, some people will take notice of that. That’s all that leadership is. It’s helping other people excel at their jobs. And that’s the first thing I would say.
Dr. Brent Lacey:
But the second thing I would say that’s really important for people to recognize is first off, you have to be outstanding at your own job. Work hard, be a team player, show up with a smile every day. You do that and you’re 90% of the way there.
Dr. Brent Lacey:
One of the things I always tell my interns, it’s July and the interns are coming on for the first session and I always tell them, okay, the best thing that you can do this month is be excellent at your job. Don’t make me have to chase you down. Just come to work with a smile, be on time, be prepared to take good care of the patients, care about the nurses, help each other out, be a team player. You do that and that reputation will carry you forward. And eventually, you do that enough and people start to notice, you’ll start to be put in charge of more things.

Dr. Jim Dahle:
A phrase that Dike Drummond used, he was on here a few weeks ago on the podcast, was about the importance of managing your boss. What recommendations do you have for managing your boss?

Dr. Brent Lacey:
That is a really tricky situation. So, first of all, you have to know your boss. Just like if you’re a speaker, you have to know your audience, you have to know your boss. And some bosses are very approachable and some you kind of have to learn how to work with them.
Dr. Brent Lacey:
But one of the things that I think is really helpful is to learn what the boss needs. And honestly, that just starts by asking them. And it can be in a formal setting, if you’re sitting down for a quarterly review or a semi-annual review or something, and they asked you if you have any questions, say, “Yeah, what’s something that I could be doing that would help us out here? What’s a problem that we’re struggling with that I could be doing something for?” And if you have a good boss, if you have someone who’s responsive and helpful then they’ll just tell you straight out and they’ll give you some opportunities.

Dr. Brent Lacey:
The other thing that I think can be very helpful is to recognize that not all bosses are capable of being managed. And so, if you want to thrive, if you want to do well, one of the things that you need to recognize is when it’s time to just stay in your own lane and just do your job very effectively.
Dr. Brent Lacey:
And very oftentimes what I find is that just by doing that, and just by showing that you are extremely competent at your own role, that over time, your boss will start to notice things and they’ll start to give you opportunities to start to have some influence. They’ll start to notice, “Okay, you know what? He’s doing a really good job at this. Let me give him a project to work on”. And so, it just comes back to just doing very, very good at what you were being called to do, and then looking for ways to try to help out.

Dr. Jim Dahle:
It’s interesting. One of the criteria for a lot of medical schools to get in is to have some leadership experience. We’re actually required to have it to get into medical school. And certainly, there’ve been a lot of situations, not just formal hospital leadership positions being on the MEC and being a department chair and being in charge of the emergency department, those sorts of things where you are thrust into position of leadership, but just the day-to-day work as a physician. You’re the captain of the ship. You’re the leader of the team and things are going badly every head in the room turns to you and expects you to solve the problem.
Dr. Jim Dahle:
And yet I meet so many physicians who are really not interested in leadership. They want to punch the clock and go home. And they’re very much wanting to give good patient care. They want to treat their patients well, but they have no interest in managing other physicians, much less other staff members. What advice do you have for them? Do you think that is a problem? Do you think that those people just aren’t cut out for leadership or should they be doing something different than what they’re doing? Do they need an attitude change for instance?

Dr. Brent Lacey:
Well, it’s a great question. And I think that it breaks down in two ways. One is, is that good for medicine as a general concept? And the second is, is it good for that person? I would say as a general concept for medicine and for healthcare nationally, it is not good that as physicians, we are tending to advocate our leadership opportunities. I think that like what I was saying earlier, if we refuse to do it, less qualified people are going to take on that role. And that’s unfortunately what we’ve seen over time is that there’s just a lot of administrators that are not good at running hospitals that are trying to teach us how to do patient care and they’re not very good at it.
Dr. Brent Lacey:
So, I think it’s a problem on a systemic level, but on an individual level, is everyone cut out to be a leader? Well, not everyone’s necessarily geared for leadership in a formal sense. Maybe they’re not ready for a department chair or a directorship role or something like that. But like I said, leadership is influenced. You can be a leader anywhere you are. You can lead the nurses to do better at their job. You can lead your staff. You can lead your peers.
Dr. Brent Lacey:
So, I think leadership is first and foremost about excelling in the job that you’re doing and then helping other people to do the same. Now, again, I don’t think that everyone necessarily needs to go for leadership role, but I think that a lot of times, I think people choose not to do that because they feel unqualified or they feel unprepared, or they feel like they have the imposter syndrome. They feel like, “Well, who would listen to me? Who would follow me?”
Dr. Brent Lacey:
And I think if you’re thinking along those lines, then there are ways that you can prepare yourself. Like I said, you can read books, listen to podcasts, go to conferences, learn from mentors. But find ways to prepare yourself for those kinds of things. There’s no end to the amount of content that’s out there to absorb. And so, if you can take on some of that content and learn and grow, then a lot of times you find that you actually do develop an interest.
Dr. Brent Lacey:
I find that a lot of times people that thought they weren’t interested, if I give them a project or I have a role for them to play and offer them a chance to do something, they find that it’s something they really enjoy. They find that they actually excel. So, sometimes it’s just a matter of jumping into the deep end and learning how to swim.

Dr. Jim Dahle:
Let’s get into some of the nitty-gritty. One of the things I’m not a huge fan of is meetings. And part of that is because I’ve been in a lot of meetings that are less than effective, for instance. I don’t even like going to my own meetings sometimes. But you wrote a blog post a couple of years ago about running effective meetings. Can you briefly summarize the “dos” and “do nots” to have effective meetings?

Dr. Brent Lacey:
Sure. So, this was something that I learned when I was the chief operating officer at the student union at Texas A&M. And this was something that was very hard for me actually. That is one of the most helpful skills that I think I picked up during my years there. And I think the thing that is important for people to recognize is that running a meeting is a learned skill. It’s not natural. And so, you get better with practice and with time.
Dr. Brent Lacey:
But let me give you a few specific ways that you can run an effective meeting. The first thing to do is decide the purpose of the meeting ahead of time. Is it for delivering information? Is it a brainstorming session? Is it the day before your major project is getting ready to start and you’re trying to make sure all of the courses of action are all in line?
Dr. Brent Lacey:
So, what is the actual purpose of the meeting? Get everyone on the same page from the start or you risk having the entire meeting just completely derailed by irrelevant interruptions. Someone will say, “Oh, I have a question since we’re all here”, right? It’s that phrase. “Since we’re all here anyway” – That needs to not be part of the meeting. Establish upfront at the very beginning of the meeting, “This is why we’re here. If there’s something else we’ll talk about it elsewhere”.
Dr. Brent Lacey:
The second thing is to be prepared to run the meeting. And by that, I mean, specifically have an agenda. It’s kind of like baking a cake. If you’re going to bake a cake, you don’t just wander through the kitchen randomly grabbing an assortment of ingredients and tools and just sort of thinking, Okay, well, I think I got everything I need”. You use a recipe, right? You’ve got very specific things that you’re going for. So same thing with the meeting – Have a written agenda and stick to it and don’t let people derail the meeting with non-agenda items. Save it for later. If you’re running a meeting with a lot of physicians especially, I would keep it to maybe three or four items per hour. If you do too many more things than that, people can’t really stay focused that long.
Dr. Brent Lacey:
The other thing I’ll say with that is that will help you start and end the meetings on time and people will tend to stay tuned in more when they know that you’re going to actually end the meeting on time.
Dr. Brent Lacey:
The third thing I would say is to embrace the phrase, “Let’s take that conversation offline”. Because how many times have you sat in a meeting and just endless conversation, people are just talking? My favorite thing that people will say is, “Yes, I agree with that. Let me say this” and then they basically say the exact same thing the other person just said. And so, if you find yourself going in an endless stream of circles, or if it becomes obvious that there’s two really strong opposing viewpoints and so, you’re not going to reach a specific decision or a definite course of action. Let’s say, let’s take that conversation offline. And then you can assign some team members or people on the committee or whatever the situation is to address it outside of the meeting and then they can report on it later.
Dr. Brent Lacey:
The fourth thing you can do is limit the conversation. And this is one of the hardest things to do is to prevent meetings from devolving into just endless conversation. I mean, you’ll have the fourth person that starts to make this diatribe, and then everyone just goes to their phones. So, everyone wants to contribute something, but it’s not important that everyone says something if they’re just restating what someone else said. You can coach your team members on this. You can tell them everyone’s opinion is valuable, but speak up when you have something new to contribute or an alternative perspective to offer. Don’t just say the same thing that everyone else has said.
Dr. Brent Lacey:
And the final thing that I say with this that’s I think probably the most important is get to a call to action. In the military we talk about course of action, right? So, get to a specific decision. Discussion is fine, but it only is valuable if it’s going to lead to some kind of an action. And this is kind of a subtle art for pulling up for action at the right time. You don’t want to quash the discussion by calling fraction too early. But on the other hand, you don’t want to just let the conversation go on forever and never actually lead to anything purposeful.
Dr. Brent Lacey:
So, you can kind of allow the conversation to unfold naturally. And once you think you’ve got some consensus and some of this is just by reading the body language and just getting some head nods from the people in the room, or if you feel like all the relevant viewpoints have been discussed, call for a vote, make a decisive action to clear some specific course of action and end it but get to a call to action of some kind.

Dr. Jim Dahle:
Another thing that’s difficult for me and I think most physicians is hiring. We got no training in medical school or residency on hiring other people. We’ve never spent any time in the HR world and it becomes intimidating because you’re worried, you’re going to hire the wrong person. You’re worried you’re going to turn on a fire them, which is really awkward and you’ll feel bad because now they’re unemployed so on and so forth. How do you make sure you’re hiring the right people?

Dr. Brent Lacey:
Yeah, that’s a great question. And this is probably the most important question to ask in a company and the one that we screw up the most honestly. So, first thing I would say is that you have to define what you’re looking for. The book that shaped my opinion on this the most is one of my favorite books on business and leadership is called “The Ideal Team Player”. And it’s by a guy named Patrick Lencioni.
Dr. Brent Lacey:
His thesis is that the ideal team member has three characteristics. They need to be humble. They need to be hungry and they need to be people-smart. So, let’s break that down a little bit. So, first is humble. You want someone with the humility to know when they need help with something and someone who just won’t hog the glory for themselves. They’re helpful. They’re helping their team members. The humble team member is going to give credit where it’s due and they promote their coworkers as much as themselves. So that’s first.
Dr. Brent Lacey:
Second is hungry. Someone who’s hungry is passionate about their work. They’re always looking for ways to make something safer, more efficient or better experience. They’re just like, “This could be 5% better. This could be 3% better. We could make this 10-minutes faster. We could cut down one set of emails from this email string”. The hungry team member is someone who drives your team to succeed.
Dr. Brent Lacey:
And then the third thing is people-smart. So, someone who’s people-smart is someone that you like to be around. They build other people up. They work to bring harmony to the team. So, the people-smart team member promotes community with their colleagues. Ideally, you have someone who is good at all three of those. That’s the ideal team player. I’m really a fan of this analogy. And I think you can have someone who’s really great at two of those and okay at a third, but you can develop the third. But if you have someone who’s only really good with one, you’re really not going to do well.
Dr. Brent Lacey:
So, humble, hungry and people-smart. So, first thing is to define who do you want. And then the second question there is how do you actually find those people. Well, one way I think that’s really helpful is to start by getting referrals from your current team members. So, if you already have great team members, well, let’s assume that you have good team members. If not, you probably need to ask them different questions. But if you already have great team members, then they are going to want to work with other people who are also great. And if you look at national statistics, a large percentage of hires in any company from any industry come from internal referrals. And those referrals also tend to have the lowest turnover. If you don’t like firing people, then you need to hire the people that you already hired like. So, you can really use that.
Dr. Brent Lacey:
Second is have an in-depth hiring process. This is one of the things that is maybe problematic or challenging for a lot of companies. It’s the idea of having a really long and complex and in-depth hiring process. I think most places you’ll have a 30-minute interview or an hour interview or a couple of one-hour interviews or something like that. But it’s very hard to gauge someone’s true character and work ethic in a 30-minute interview. It’s just really hard.
Dr. Brent Lacey:
If you hire someone after just one 30-minute interview, I kind of think of it like asking someone to marry you after going on one dinner date. I mean, maybe you get lucky, but a lot of times you end up with the wrong choice. So, I think that if you can learn to create a process that allows you to hire very slowly and very deliberately, the other benefit from that is you’ll have a lot less employee turnover, because you’ll hire the right people and you won’t end up having to fire them later, and then you don’t have as much churn.

Dr. Brent Lacey:
And so, the third thing that I think is really helpful that not a lot of companies do, but I think is really valuable is to have some kind of probationary period for someone when they’re first hired. Like 60 days or 90 days. And so, let’s say it’s 90-day probationary period. During that 90 days that persons can quit for any reason and you can fire them for absolutely any reason. Now that sounds maybe a little bit crazy, a little bit harsh, but this is actually a great backstop to the hiring process.
Dr. Brent Lacey:
So, if someone snakes through the hiring process and it just turns out they’re not a good fit for the company for one reason or another. Maybe they’re not bad at their job. Maybe they’re not stealing from you, but they’re just not a good fit. Then it’ll be a lot harder for them to be able to maintain that facade if you will, for three months. And so, if you get someone that just isn’t a good fit or their true character is shining through, and you’re seeing that, “Oh, this is not a good person to work with” then you’ve got the opportunity to let them go and to let them just move on.

Dr. Jim Dahle:
Let’s talk about letting people go. I’m not talking about someone that’s embezzling or sexually harassing your staff or just not meeting the basic requirements of the job. This is someone that’s checking the boxes, but maybe they’re not humble, they’re not hungry, they’re not people-smart, whatever. And it’s time that you’re thinking, “Well, should I fire them?” How do you know when you should fire someone? And what’s the best way to do it?

Dr. Brent Lacey:
Yeah. This is a great question. Well, if it’s for fraud or something obvious like sexual harassment, just show them the door. That one’s easy. But what if you have the person who I call this sanctioned incompetence. So, what if you’ve got someone who is just not quite bringing it or they’re just not up to the level of everyone else. It’s actually still very simple. And I got this concept from… Oh, I forget which of the two books. There are two books by a guy named James Collins. One is a “Good to Great”. And the other one is called “Built to Last”. They’re probably the two most important books on business, I think ever written and everyone needs to go read those immediately.
Dr. Brent Lacey:
But in one of those two books, he says, ask yourself this question about any team member at any time. Here’s the question. “If I had to hire someone for this position today, is this the person that I would be excited to hire?” And if that answer isn’t an enthusiastic “yes” it’s time to start thinking about letting them go. And I think the best way to do this is decisively, which we tend to waffle, we tend to put this off, we tend to not want to confront the difficult conversation. But to do it decisively and with extreme clarity.
Dr. Brent Lacey:
So, let me unpack that for a second here. First off, you’ve got to start by just deciding that someone isn’t meeting your expectations. And I think one of the places that we’ve failed to do this is by not examining our role as their leader. So, you need to consider whether or not you’ve made your expectations crystal clear to them. And if they’re not doing well because they don’t know what your expectations are, then that’s our fault as leaders. And so, we need own up to that.
Dr. Brent Lacey:
But whether it’s that they’re not meeting expectations or they don’t know your expectations, sit down with them and tell them very clearly the specific ways in which they are not living up to your expectations for their job and write it down. Write down the very specific shortfalls and be clear.
Dr. Brent Lacey:
And so, explain to them that in order to stay, give them say like 30 days or some defined period of time for them to be able to make some changes. And then at the end of each week, meet with them and review the week’s performance and work with them, rehab. And a lot of times what you’ll find is that if you’ve got an employee that is just not meeting expectations at all, every week. Every week, the same conversation happens. Like “You’re still not doing it. You’re still not bringing it. You’re still not where we want you to be”. A lot of times they see the writings on the wall and they just end up quitting, honestly.
Dr. Brent Lacey:
So, sometimes it can save you from a painful conversation, but if they don’t do that by the end of the month, then you’ve given them very clear metrics. You’ve worked with them to try to rehab them and then you decisively let them go. Fire them. Hire slow and fire fast.

Dr. Jim Dahle:
That’s good advice. So, there’ve been a lot of crises in the last year. Do you have any special tips for leading in a crisis?

Dr. Brent Lacey:
Yes. First off don’t panic. So, you think about like a code blue situation, right? When you’re in a code blue and as an ER doc you know this of course. I mean, the first thing you got to do is keep calm.

Dr. Jim Dahle:
Check your own pulse, right?
Dr. Brent Lacey:
Yeah, exactly. Exactly. The first pulse you check is your own. And I think that that’s really, really important. Just to use the code blue analogy, we talk about closed loop communication, right? If everyone’s done, if you’re having some flashbacks to your last day STLs training, I’m sorry. But one key is extremely effective communication. So that closed loop communication we talk about in BLS and ACLS training.
Dr. Brent Lacey:
For example, I know that a lot of companies, a lot of groups were having leadership meetings every day at the height of the COVID crisis, or even a few times a day. But it’s having everyone on the same page and working together at all times is critical.
Dr. Brent Lacey:
The second thing I would say is distill your problems down to the big key issues, because when you’re in a crisis, things come hot and fast and there’s always fires that you’re putting out. But you got to focus on what the key issues are. How will you care for your patients safely? How will you make enough money to keep the business afloat? What do we need to sacrifice to meet our goals? Are there things that we need to be doing differently in order to achieve all of this? You focus on the big issues and then the smaller issues will start to fall in around those. But don’t let the urgent crowd out the important. Focus on those big things.
Dr. Brent Lacey:
One thing is really important to mention here. This is actually before you even get to the crisis stage. This is something that I think we don’t often take time to do in a lot of companies, but it is really important to do. And that is to very clearly define your company’s values before you get to a crisis. What are the principles on which your company is built? What’s your mission? Because a crisis will test those to the limit. You think about all this stuff that happened during COVID last year. People are starting to ask questions they never thought they would ask.
Dr. Brent Lacey:
Decide what your values are ahead of time and then anchor to those during the crisis. If you have a decision to make, and you’ve got an option that it goes against your company’s values, that’s a bad decision. And it’s crucial to have that to guide you when you’re in a crisis.

Dr. Jim Dahle:
You bring up vision and you bring up mission. How do you cast a vision? And should you have a formal mission statement? How small of an organization needs a mission statement?
Dr. Brent Lacey:
Yeah. This is a great question. Well, this is actually one of the talks that I’m giving it at the White Coat Investor conference this year. A shameless plug, everyone go register for the conference, please.
Dr. Jim Dahle:
That’s at whitecoatinvestor.com/conference where you register for that.
Dr. Brent Lacey:
Yeah, there you go. Everyone, come out. But a couple of thoughts. So, I do think that everybody needs to have a formal mission statement for their company, even if your is small. But it doesn’t have to be this formal legalese that no one’s ever going to read. In fact, you don’t want that.
Dr. Brent Lacey:
But let’s start by how do you actually cast the vision. Well, the first thing you want to do is determine what do you want your company to look like in the future? So, let’s say you’re casting a vision for your company for the next, let’s say five years. So, what do you want that to look like in five years? Let’s say you’re doing it for your clinical practice. How many physicians are you going to have? What service lines do you want to be able to offer? What’s your goal top line revenue? Are you expanding to new locations?
Dr. Brent Lacey:
So, figure out what you want and be specific about it. Have a specific goal in mind and then assess the gap between where you are now and where you’ll be at that time. And then you can break those down into smaller bite-sized chunks on like a quarterly or an annual basis. But have an idea. This is where you get to imagine things. What would it look like? What would be your dream scenario for 5 years from now, 10 years from now? And do you need a formal mission statement? My opinion is that yes, you do. And I think it goes back to the values question I was mentioning a second ago. You need a guiding mission to focus the company around.
Dr. Brent Lacey:
Formal mission statements are valuable, but they often get done wrong. What happens is that the company leaders go off for a weekend and they have this great brainstorming session. They’re like “We’re so excited, and this is going to be wonderful and kumbaya, and this is fantastic”. And then they write it out and then they come back on Monday and then they send it in an email to the company and nobody ever reads it. That is really unhelpful. So, it needs to be something that people can easily remember.
Dr. Brent Lacey:
Here’s an exercise that you can do that I recommend. It’s actually super easy. Create a one-liner. This doesn’t need to be a three-page thing. Create a one-liner, two or three sentences that tells the story of your company. And the one-liners should succinctly tell people three things. Part one, what is the problem that you’re trying to overcome? Who are you serving? Part two, what skills, what talents, what abilities do you have and how do you use them to help solve that problem or serve those people? And part three is how do you help those people whom you serve to achieve success for themselves?
Dr. Brent Lacey:
So, let me give an example. When I started The Scope of Practice, for example, this is what I put together as my one-liner. “Most physicians enter their profession with large amounts of personal debt and little to no knowledge of how to run a clinical practice. And as someone who’s successfully managed a multi-million-dollar company, I created The Scope of Practice to be the place where physicians can get the knowledge and resources, they need to lead their businesses successfully and master their personal finances”.
Dr. Brent Lacey:
That’s it. It’s not a 12-page thing. It’s not something you come up with at a weekend retreat. It is really short. It is in story format. And if you can tell it in story format like that, it’ll be much more memorable. And then your team members can repeat it. They can learn it. It’ll start to infuse into the DNA of your company.

Dr. Jim Dahle:
Awesome. Well, thank you for sharing that. Well, we need to wrap up here, but you’ve got the ear of, by the time this is listened to 30,000 to 40,000 high-income professionals, mostly doctors. What have we not talked about today that you think they should know?

Dr. Brent Lacey:
Well, the thing I would say is that leaders are not born, leaders are made. And if you’re listening to this podcast, you’re a leader. Congratulations. You’ve just been deputized. I think it’s time that we take back the leadership of our professions and for me that’s medicine and if you’re in law, then it’s law, but it’s time that we take back leadership from the people who are leading it now.
Dr. Brent Lacey:
And so, instead of just complaining about it, instead of posting on social media endlessly, go join a hospital committee, go apply for a leadership role, go talk to your department chair and find out something that you can do to make the company better. Look for some way to get involved in your business.
Dr. Brent Lacey:
Like I said, the best way to ensure the best future for your company is to participate in shaping it. And if you declined to do it, less qualified people will take that responsibility from you.

Dr. Jim Dahle:
Good tips. Where can listeners go if they want to learn more about you, or hire you to speak, write or coach them?
Dr. Brent Lacey:
The website is thescopeofpractice.com and they can contact me through there or and get access to the blog and the podcast and one-on-one coaching for career and personal finances. I also put together a free guide for the podcast listeners called Five Critical Tools for the Physician Leader. And it’s got ideas for how to celebrate your team members, how to put together a mission statement, how to create the one-liner for your business like we talked about, a list of books that all leaders should read and a 10-day clinic make-over challenge. So that’s free to download at thescopeofpractice.com/wci.

Dr. Jim Dahle:
Awesome. Dr. Brent Lacey, thank you for coming on the White Coat Investor podcast.

Dr. Brent Lacey:
Thanks so much for having me. I’m happy to be here.

Dr. Jim Dahle:
I hope you enjoyed that interview with Dr. Lacey. I think leadership is pretty important and something that a lot of us as physicians try to avoid sometimes. And there’s obviously consequences to that that maybe we don’t necessarily want.
Dr. Jim Dahle:
I want to talk very briefly about another topic that I think has been in the news, on the forums, on the subreddit and the Facebook group that has really become very prominent in the last few months. And it’s really about speculation in the markets and there’s a lot of it going on right now. You can see it in cryptocurrency, particularly with the big rise of Bitcoin at the end of 2020. And you can see it in a lot of talk on individual stocks and particularly more recently, the Wall Street Bets subreddit effects on some of the hedge funds that were trying to short some companies that were in a lot of trouble like GameStop and Blackberry and American Airlines and those sorts of companies.
Dr. Jim Dahle:
But it’s really interesting in that you’re starting to see people that don’t normally talk at all about markets, talking about stocks and talking about cryptocurrency. And so, it’s suggestion that maybe it’s time to be a little bit careful about it, number one, and number two, remember why you’re investing. I’m not saying you should sell all your stocks and go to cash by any means. I think you ought to follow your written investment plan. That’s what I’m doing. But realize that with all this speculation comes a lot of froth in the markets.
Dr. Jim Dahle:
I think it was Benjamin Graham who said, “In the short run, the market is a voting machine and in the long run, it is a weighing machine”. Well in the very, very short run, it certainly has elements of being a casino as you’ve seen most recently in the markets. Don’t get sucked into that. Remember why you’re investing, it’s all about your goals and your long-term goals. It’s a one player game. It’s you against your goals. Don’t get fear of missing out when you see other people making gobs of money because they shorted the right stock at the right time or bought the right options at the right time, et cetera.

Dr. Jim Dahle:
Now, we’re doing the best we can here at the White Coat Investor to help you to do the right thing. It got a little bit carried away in the Facebook group toward the end of 2020, and we actually put a new, more aggressive moderation policy in place there. We basically started closing threads that were primarily encouraging people to speculate whether it was in individual stocks or whether it was in cryptocurrency or whatever, and started closing those threats.
Dr. Jim Dahle:
Now, we haven’t had to do that on the subreddit or on the forum but certainly, we warn people there and we have a culture there where it doesn’t get overrun quite so easily like it does in a Facebook group. And part of that is just the way Facebook software works and the way the topics are continually regurgitated and so people are talking about the same thing in multiple different threads and drowning out the forum.
Dr. Jim Dahle:
But part of that is simply the sheer number of people in that Facebook group. It’s interesting when the GME thing really blew up and 3 million people went to this subreddit to start talking about shorting GME and shorting other stocks there on the Wall Street Bets subreddit. It really blew up to the point where 3 million people joined it in a day or two and the moderators basically just threw up their hands and said, “We can’t even read all this, much less moderated”.
Dr. Jim Dahle:
Well, that’s not the sort of environment we want people to have in their experiences with the White Coat Investor communities. And so, we’re doing the best we can to while not necessarily being against free speech or trying to keep people from talking about what they want to talk about. We also want them to be guided and those who are new to the community to come in and know that the community is not Wall Street Bets. It’s not about speculation. It’s not about trying to make a quick buck. It’s about meeting your long-term goals so that you can be a better parent, a better partner and a better physician. So, keep that in mind that those are efforts on our communities and be careful in your own personal financial life to not get sucked into that speculation.
Dr. Jim Dahle:
This podcast was sponsored by Bob Bhayani at drdisabilityquotes.com. He’s been a long-time sponsor of the White Coat Investor. One listener recently sent us this review. “Bob and his team were organized, patient, unerringly professional and honest. I was completely disarmed by his time and care. I’m indebted to Bob’s advocacy on my behalf and on behalf of other physicians and to you for recommending him”.

Dr. Jim Dahle:
You can contact Bob at drdisabilityquotes.com today. You can email him at [email protected] or by calling (973) 771-9100 to get your disability insurance in place today, or to evaluate a policy you may already have to see if it’s right for you.
Dr. Jim Dahle:
Don’t forget about our new revamped Fire Your Financial Advisor, and about our new course through with CME. This is Fire Your Financial Advisor, plus eight hours of wellness content eligible for CME, The Financial Wellness Course for Doctors. You can get that at whitecoatinvestor.com/fyfa.
Dr. Jim Dahle:
Obviously, we also have our conference coming up. That’s at whitecoatinvestor.com/conference. You can hear from people like Brent Lacey and others, and learn more about that.

Dr. Jim Dahle:
Thanks to those of you who are telling your friends about the podcast and leaving us a five-star review. Our most recent one came in from doctorcici, who said, “Thank you. Dr. Jim Dahle is here to educate the high earner in financial literacy. For some reason doctors are easy targets of being financially scammed. We must care for our money. Thank you, Jim, for giving me the tools!” You’re very welcome. Thanks for the five-star review.
Dr. Jim Dahle:
Head up, shoulders back. You’ve got this and we can help. Stay safe out there and we’ll see you next time on the White Coat Investor podcast.

Disclaimer:
My dad, your host, Dr. Dahle, is a practicing emergency physician, blogger, author, and podcaster. He’s not a licensed accountant, attorney or financial advisor. So, this podcast is for your entertainment and information only and should not be considered official personalized financial advice.

The post The Value of Physician Leadership – Podcast #197 appeared first on The White Coat Investor – Investing & Personal Finance for Doctors.

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