If You Want to Go Up (Part One): You’ll Need to Get Up.

If You Want to Go Up (Part One): You’ll Need to Get Up.

“Let him who would move the world first move himself” -Socrates

Author: Robert A Felberg MD

Topics: Physician leadership, Career Advancement, Office Politics

Keywords: Doctor opportunities, effective time management skills for doctors, advancement for a doctor

“1. You have get up to go up.      2. You have to give up to go up.      3. You have to grow up to go up.”

John Maxwell


John Maxwell is one of the best resources available for anyone interested in self-improvement and leadership. It’s amazing how little his work has percolated through the medical field where it could be well applied. I have listened to nearly every audio-book he has put out and have found each one to be valuable. There is no financial relationship between us. I’ve never met the man- I’m just an admirer of his work.


In “The 21 Irrefutable Laws of Leadership”, Maxwell laid out some of the simplest advice I have ever read about “making it to the top” or “going up”. This involves Initiative– “getting up”, Sacrifice– “giving up”, and Maturity– “growing up”. Although it’s been several years since I first read that book, this has always stuck with me as powerful advice. There’s not much I could add other than a leader needs be able to be Vulnerable– “You have to open up to go up.”

I’m going to explore each of these concepts- Initiative, Sacrifice, Maturity, and Vulnerability as it related to medical leadership and success. In this post I going to discuss Initiative. In future posts, I’ll review Sacrifice, Maturity, and Vulnerability as it relates to medical leadership.  After reading the series, please consider an honest assessment of your personality traits. There is a great amount of information and mentorship available, but first you need to “know yourself” before you can really benefit.

Initiative amongst physician really takes two forms, Energy and Innovation. I will focus on Energy for the rest of this post.  Energy is one of the “4 E’s and one P” of leadership often discussed by Jack Welch. To succeed and move forward, you need to be energetic- you need to have a high level of enthusiasm, stamina, and personal fortitude. You also need to avoid the opposite of “energetic”, i.e.; laziness, apathy, and a tendency to shirk work and responsibility.

Energy as it relates to medical leadership has a few characteristics. The first is embracing challenges and accepting the work that needs to be done. When your business partner calls in sick do you spend 40 minutes whining to whoever will listen about the unfairness of it all? Do you internally seethe in anger at the injustice? Or do you quickly get over the change in plans and rally your team to get the work done? Although, you may feel like acting the first way, the second course of action is clearly the role of a leader and will lead to personal success.

“Action creates opportunity”- Unattributed

A bias towards action characterizes energetic people. When given two choices, they will choose the one that leads to increased value and mutual benefit over the one that defends the current status quo. They are willing to take the risk to grow the business over protective policies designed to just hang on to a shrinking share.

Another, often overlooked characteristic of Initiative is personal fortitude or “grit”. This is the quality that leads to perseverance and an optimistic outlook when faced with adversity. It’s my belief that this personality trait is learned through experience. How else is it possible for a doctor to learn to cover a 36 hour shift or see 27 patients in a day? Clearly, it’s not something you can do the first day of internship. You slowly gain the experience and confidence facing continued challenge and triumphing over it. This leads to a personal sense of accomplishment and a reservoir of fortitude. Your dad was right- mowing the lawn in the rain does build character.

Many physicians lack personal energy for many different causes. The most common manifestations are laziness and shirking of responsibility. Often physicians express the combination of sarcasm, insult, and blaming best defined as “snarky”- a defensive mechanism consisting of low-level attacks with the hope that the requesting person avoid the unpleasantness in the future. It’s sort of the personality equivalent of porcupine quills.

All of these low energy traits have one attribute in common- they are geared towards short term benefit. They all trade immediate gain against long-term relationship, future program development, or care delivery improvement. Leadership is primarily focused on the future, often at the cost of the immediate. It’s easy to see why low-energy physicians are considered to have poor advancement and leadership potential.

Here are some tips to help you “Go up by Getting Up”:

  • “I wasted time and now doth time waste me.”- Shakespeare. Learn the difference between “restorative rest” and “dawdling”. I love surfing the net and posting cat pictures to facebook as much as everyone else. But, I do those activities after I get my important work done. At the same time, learn to take useful breaks during the day- whether that involves meditation, pleasure reading, or contemplative walking.
  • Pomodoro is more than fancy talk for tomato. It’s amazing how much you can accomplish if you just focus. The Pomodoro technique leverages this idea. You set aside 25 minutes of uninterrupted, highly-focused work. Then you do it. Then you take a short break and do it again. After a while, your task is done, but it’s done so much more quickly than you ever imagined possible. As a neurologist, I could lecture for several hours about how this method ideally harmonizes brain function and neurotransmitter regeneration, but suffice it to say- it works and is the “secret sauce” to my success (tomato pun intended).
  • “As a man thinketh in his heart, so is he”- Proverbs 23:7. Much can be said about how your inner thoughts influence your life. Try to pay attention to your “inner dialogue”. If your thoughts turn negative or start to move towards the “snarky” beliefs mentioned above, try to get a handle on them. Change your inner dialogue to one of action, teamwork, success, and triumph. This may take practice, but will lead to solid personal fortitude. Consider “As a Man Thinketh” by James Allen. Be aware that J. Allen was a man of his times and several of his characterizations would be considered outdated by modern criteria. Nonetheless, it’s an excellent read.
  • Develop an Internal Locus of Control. People with an external locus of control believe that they have very little power over what happens to them and that external forces- the hospital, the government, fate, luck, karma, vast hidden conspiracies- have ultimate control over their lives. Those with an internal locus believe that, although unable to regulate every circumstance, they have considerable influence over the events in their life. Work to achieve an internal locus of control. This will give you a sense of leverage when facing difficult times and the motivation that will give you the energy to achieve.
  • Dedication trumps motivation every time. We all have passions. Many of us attempt to turn these passions into businesses or careers. Yet, despite being passionate, many of us fail. Not because the idea is poor, but rather we lack the energy to follow through. The reason is that passion relies on motivation and motivation is an uphill battle. You are fighting entropy, laziness, and 2 million years of human evolution trying to convince yourself to do something out of love when there are other activities that lead to actual gains.

Rely on dedication instead.  This blog is a great example –   I am tremendously passionate about teaching and helping the next generation of doctors succeed.  But, when I first started, I could barely convince myself to complete one post monthly. Finally, I stopped treating the blog like a hobby and approached it like a business. I set a goal of 4 blog posts weekly. Now I rely on dedication rather than waiting for the proper mood to strike with much better results.

 Initiative is one of the personality traits that characterize successful physicians. By embracing change, challenges, and action you will quickly become a physician leader.  Like all physician professional and medical business skills, changing your approach to obstacles and building personal fortitude can be difficult at first and is something you can master with practice and experience.  Having a solid skillset will give you the tools you need to implement the changes you desire.  Up your skillset and consider taking a CME approved course designed for physicians. Through study, practice, and hard work you’ll be able to achieve your dreams and succeed… really succeed.

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What do you think? Is there a formula to physician success? Do you have any advice? How have you overcome procrastination? Share your thoughts in the comment section below.



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