I want to share a message with the physicians who retain advanced practitioners. If you are a doctor and you hire nurse practitioners or physician assistants, this message is directly for you. I’m speaking for your employees.

I know a number of docs concerned about hiring new graduates. Your concern is that you spend time hiring them, training them, and then they move on to other jobs. As a doctor, you feel this situation would be frustrating and upsetting, and you’d lose revenue as well.

I’d like to challenge you with something. One of the things I found with a number of physicians, is that doctors think they’re good at the things they weren’t trained in, like business and leadership. Just because you’re a physician, it doesn’t mean you’re great at leadership. Med school doesn’t necessarily prepare you for leadership in the same way that entrepreneurs or business owners or CEOs are prepared.

At CEO conferences a lot of time is spent on leadership. I once heard something I really needed to hear from a business coach, his name was Tony DeSimone, at one of these conferences. He said to me, “John, what part of your leadership style led to that result?” That was pretty powerful.

If you’re a doctor, you need to ask yourself the same question. “What part of my leadership style led to my advanced practitioner moving on?” Maybe you’re not the reason they left. Maybe you are. Any good leader takes full responsibility for their actions. Being proactive is the first habit of highly effective people. You’re proactive. So if you’re a physician concerned about retaining advanced practitioners, ask yourself, “What part of my leadership style led to this result?”

You have to remember that advanced practitioners aren’t residents. We can easily get other jobs in other places; we don’t really need you. But what we want, so badly, is to be part of your team. We want to be a valued team member and we’re looking for support. I’m telling you, show sincere appreciation for your advanced practitioners and they will love you. I’m not talking about showing superficial appreciation. Value what they bring to the table.

I worked in a cardiothoracic team. Cardiothoracic surgery is badass; I have tremendous respect for these surgeons. However, the surgeon who ran this team didn’t allow input. People were leaving left and right because they didn’t feel appreciated.

As a physician, showing appreciation to your advanced practitioners doesn’t cost you anything. Us PAs and NPs are used to being abused when something goes wrong. When you add positive feedback, it goes a long way. For every chart with negative feedback, give 10 or 20 with positive feedback. “You did a great job there.” “The nurses really like you.” “I got a great compliment from a patient on your behavior.” That’s important.

Psychological safety is important in medicine. There needs to be an environment where people can make mistakes and learn from them. My first boss loved when I made a mistake. She would rub my nose in it. I became so fragile in that environment. My next boss would ask me questions when I made a mistake to help me learn from it. I would have gone through a brick wall for that man. How are you giving feedback as a supervising doc? Are you giving feedback punitively or are you acting like a coach, a mentor? Do you want to help your clinicians grow? That’s really important.

To build a strong team, every person has to feel important, like a part of the bigger mission of the unit. As the leader, you set the barometer for what’s acceptable. If you made negative or derogatory comments about patients, I wouldn’t want to work with you.

Unless you’re a principle-based leader advanced practitioners can respect, you’re going to turn over PAs and NPs your whole life. I need to know what’s important to you. I need to know that my growth is important to you, that my family is important to you. You don’t have to give me a raise. I just need to know my role in the mission is critical to you and your patients. I need clear goals and objectives. A good leader communicates these things. Once again, it’s all about psychological safety. Let me know you’re going to protect me, nurture me.

You have to be brutally honest with me about my performance. If it’s bad, tell me and give me corrective action. Don’t get me wrong; some attitudes and egos will not fit well in your team. But I’m telling you, CEO conferences will tell you, when they say ego is a chokehold on performance, they mean you too. What’s bigger, your desire to care for patients and the team, or you feeling important within the team?

If it’s all about you and you know it, we know it too. We can see how you talk, how you treat us and how you treat your patients. This might be a good time to check yourself. Ask, “How am I as a leader? What part of my leadership style led to this result?”

I hope you can hear that. I get to go to a lot of PA conferences and meet my PA and NP colleagues. We love our job. We love being accepted and appreciated and contributing to the team. The more you support that feeling, the more we will stay faithful to you. If you don’t provide that environment, someone else will. Then, you’re just a commodity doc, not truly a leader.

I hope this helps you. If I can be of any help, reach out to me. I love leadership. Jim Collins, in his book Good to Great, talks about what makes a level five leader. It’s a fierce dedication to the cause (the patients) and humility. If you’re fiercely dedicated, but not so humble, you’re a level four leader. That’s still pretty good. A level five leader is someone who is fiercely dedicated to the mission, but also humble at the same time.

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