Lead from Ahead (For a Change)

Now that the mythical East Coast Bias has been unmasked, and one day to be destroyed, I find myself out of ideas. After all, isn’t it the Editor’s job to bring peace to the galaxy? Oh wait, that’s a job for the Emperor.

There has been a resurgence of interest in leadership…which is a prescription that dermatology needs every single day. Leadership in teaching, in advocacy, and in mentorship are essential to our survival and our strength. We see what happens when the house is divided, when we turn on each other and when philosophy becomes personal…not that I have ever said that our scope is under siege, so without leadership we will be lost. Just ask a few who I know will be reading this; some of the specialty’s biggest anarchists have risen to positions of power by discovering their inner leader and maximizing the chance to give back. Yes, you know who you are, and I’ll buy you drinks later.

Imagine leadership from behind by exclusion to create policy, to serve on committees or on a board, or in training students and residents—where would we be then? Imagine the declaration of leadership without the action behind the reaction, does that leave us at the starting line? Fortunately, there are many avenues for identifying our future leaders and cultivating their talents for taking the reins, but that in many ways is still a work in progress. But how do we get leaders to focus on global good instead of cultivating their “brand?” Ah yes, an editorial for another issue in the works.

So if leadership is reactive and not proactive? Is that leadership? And does leadership have to result in consensus, or can that backfire depending on the issue and groups involved? We have all been out to dinner with someone who neither can order off the menu and needs to tweak everything, or even worse, knows what he/she does NOT want but cannot figure out what to get. We have also been in conversations and deliberations that go sideways, regardless of topic, where real leadership skills are needed to bring the temperatures down and bring things back to the middle for resolution.

There are countless lessons and teaching points about what makes a good leader and what helps foster involvement so as to reduce groupthink and partisanship. However, there are also misconceptions among emerging leaders that being aggressive and assertive is a sign of strength. That’s an easy misstep since politics is built on who yells the loudest and points the most fingers gets the attention, but the concept of quality over quantity has to be emphasized and taught to our future leaders to undo this damage. Many of our best leaders in medicine are measured, are good listeners, and are often the last to speak instead of the first and loudest. With society seemingly mandating that being seen and heard is valued over accuracy, how do leaders in dermatology, and corporate America for that matter, teach the fundamentals of leadership by example and not leadership by bulldozing?

With the endless onslaught of dermatology conferences and meetings, some of which are run by academicians with only professors as faculty, there are now mentorship and leadership sessions that should capture the attention of our future leaders. Despite some of the rinse-and-repeat of curriculum, young dermatologists in the first 5 years out of training are the best target audience for not only learning how to lead early in their careers, but also how to be effective leaders. Fortunately, the best advice coming from these sessions is: learn how to listen. One of the best analogies I heard was, “real steamrollers don’t make a lot of noise, they just do their jobs without acting like steamrollers, unlike bulldozers that make noise and move things around but accomplish nothing.” Not bad for construction site metaphors 101.

The AAD has a Leadership Forum every year which is a must for anyone interested in moving in the direction of leadership positions on committees and in governance, including dermatologists from all parts of the specialty (yes, private practice dermatologists can be leaders too…just ask the current trend of presidents). Leadership skills, and how to navigate structures and organizational ladders, are definitely worth learning if that is the next step, and it definitely trumps the sense of entitlement of announcing that it is “my time” when maybe it is not.

My advice to the future leaders of dermatology who will be driving the bus soon (similar to what I tell the bride and babies) is this: listen before you speak, and speak less and effectively, but have the passion to keep your foot on the gas while watching the brake. Don’t forget the mantra of the board meeting, “does it need to be said…by me…and right now?” The best leaders will lead without acknowledgment, often from behind the curtain instead of in the mirror.