Intended for healthcare professionals


Doctors must see themselves as managers as well as leaders

BMJ 2016; 352 doi: (Published 01 March 2016) Cite this as: BMJ 2016;352:cf_limbharddecisions
  1. Matthew Limb
  1. BMJ Careers
  1. Limb{at}


Doctors need to change their attitude towards management roles, senior medical and health service leaders tell Matthew Limb

Medical management has an image problem that needs to be tackled if more doctors are to be encouraged into leadership roles, senior medical and health service figures say.

For one thing, doctors’ tendency to see themselves as leaders but not managers needs to change, says Jonathan Fielden, medical director at University College London Hospital. “One of the difficulties, particularly in the healthcare sector, is there is more kudos related to leadership and more criticism related to management,” he says. “When was the last time you saw a positive headline about healthcare management?”

Fielden says he is managerially held accountable, say for targets and performance, but he also leads a change agenda. “I think sometimes the medical profession hides behind this being different from avoid filling the vacuum for leadership or management, if there is one,” he says.

Stephen Gillam, a general practitioner and lecturer at Cambridge University’s Institute of Public Health, believes that one of the difficulties for clinical leaders is often they may have to “be awkward” and challenge their colleagues to bring about changes. “You have to be a certain sort of individual to take that on,” he says. “You have to have a detachment and toughness I think very often to be an effective leader.”

Simon Bird, who leads Hay Group consultants’ UK healthcare practice, says he associates leadership with “role modelling good behaviour” and enabling people to “do the right thing, in its broadest sense.”

Management, he says, “is about ensuring the organisation is in good shape to enable people to do the right thing.” This, he suggests, includes making the right decisions about which clinical areas and pathways need investment and marshalling resources, staffing, and budgets.

Bird believes that the term “clinical leader” has itself become “unhelpful” for doctors wishing to develop their careers. It has been “overused” by employing organisations, who often fail to define it or spell out accountabilities, leaving doctors without the support or resources to perform effectively, he argues. “At worst, doctors can then feel hoodwinked or caught out for being asked to do an impossible job.”

Bird, a former NHS manager who works with NHS organisations on leadership and organisational development, says trusts should be more “thoughtful and serious” about what they mean by clinical leader roles. He suggests that senior doctors in leadership roles who seem reluctant to accept management-type duties, are almost behaving like teenagers.

“It’s almost naive to expect to be able to have the benefits of a leadership role without having to take on some of the other stuff that might be less attractive that comes your way with it,” he says. “I think it’s now impossible to separate the two.”

Leadership might be defined as taking on those more “unsexy” or “tedious” tasks “without complaining about it all the time,” he suggests. Those heard to say, “I can’t wait till I finish my clinical director job so I can go back to being a proper doctor” should be aware of the negative impact this has on those who see them as role models, he says. “When will we start telling different stories about the management/leadership dynamic?”

Chris Hewitt, chief executive of the local medical committee for Leicester, Leicestershire and Rutland, says that short term priorities to meet financial and quality targets and “risk averse” processes that allow excessive scrutiny, regulation, and bureaucracy to flourish can combine to create a “toxic environment.”

Clinical leaders will challenge managers and politicians who may be tempted to resort to quick fix solutions, but all too often those “who stick to their principles end up resigning or moving on,” he says.

“When people see medical chief executives getting sacked or resigning it’s another nail in the coffin for medical students and training doctors thinking perhaps I’ll go into leadership roles.”


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