A sour relationship with your immediate superior can ruin an otherwise fulfilling job. When you report to someone you continually disagree with or simply don’t understand, just showing up for work can become a misery. If you’re in a situation like this, don’t despair; there is a possible solution.
Whether the conflict you feel with your boss is over care decisions, personal style, or scope of work, it really boils down to who gets control over your time and your patients.
“For physicians especially, autonomy is very important,” says Tosha B. Wetterneck, MD, associate professor of medicine at University of Wisconsin Hospital/Clinics in Madison. “Physicians are people who work hard, are very smart, and like to control what they do. There is obviously a lot of complexity and variation to the job, which adds to the workload. Plus, decision-making processes need to be happening all the time. This creates stress—and the way to control that stress is to have control over what they do.”
—Russell L. Holman, MD, chief operating officer, Cogent Healthcare, and immediate past president of SHM
A hospitalist who continually butts heads with a superior over issues—or one who subjugates his or her opinion and decisions to the boss’s—is not likely to be satisfied with their job.
“Certainly, an individual’s autonomy is influenced by what they want to have control over and they’re allowed to have control over,” says Dr. Wetterneck. “If there’s a discrepancy between the two, that’s definitely going to have a negative effect on that hospitalist. If there’s a mismatch between what they want control over and what their boss wants, that’s going to be a problem.”
Russell L. Holman, MD, chief operating officer for Brentwood, Tenn.-based Cogent Healthcare and immediate past president of SHM, has worked his way through problems like this—both as the reportee and the boss. He worked out some particularly valuable lessons in a past job where, as medical director, he had trouble connecting with his boss.
“There seemed to be a tremendous communication gap, and there was a mismatch between what I felt was important and what my superior felt was important,” he recalls. “It seemed really hard to get on the same page.”
So he set out to solve the problem: “What I learned was that it’s not sufficient in a leadership role to just focus on who is reporting to you and manage in that direction,” says Dr. Holman. “No one ever tells you this, but you need to spend time managing up.”
Managing up primarily means initiating conversations to get information you need to better work with your boss.
“You need a clear understanding about the priorities and hot buttons of the person you’re reporting to, what they’re personally invested in, how they’re being managed, and what their incentives are,” advises Dr. Holman. “In my situation, I felt that I needed to understand my superior’s background—his career progression, areas of interest, things he felt were important in the organization.”
How do you uncover these facts? It’s simple: Request a one-on-one meeting with your superior and have a direct conversation where you ask those questions.
Next, continues Dr. Holman: “Have what I would call a translational conversation … ‘How do your priorities translate to me and my daily work?’ Again, ask this directly.”
But be warned. “This can be a very productive conversation, but it’s not an easy one to have,” he says. “The reason it’s hard is because whether you’re a frontline hospitalist or a group leader of some kind, you’re a highly educated, highly paid professional. Why would you want to redirect yourself to someone else’s priorities?”