Servant leadership: I’m concerned it’s dead.  It’s been suffering a deep malignancy for years, and it seems to be reaching the terminal phase.  The profession of medicine is dying along with it, because of the indivisible link between the two.  What happened?  Greed? Arrogance? Apathy? A decline in responsibility and ownership?

One possibility is that it was never alive to begin with, but merely an illusion.  I can’t name one doctor or leader I’ve met or been mentored by over the past 25 years I would like to be like.  There are those who have attributes I admire, and those who have attributes that I share, but none who I aspire to be.  Thus, I can only conclude that servant as physician and leader has always been and remains a rare anomaly.

Another possibility is that there is no energy or time to acquire the knowledge and skills or for the reflective listening needed to expand the awareness required to be a servant as leader and physician.  The lack of time has many contributing factors: the increasing complexity of practicing medicine, the immense breadth and depth of knowledge required, and the increasing amount of time required for EHR documentation, insurance-related administrative tasks, and various regulatory and licensing requirements.  A more positive reason for the lack of time is the shift to valuing wellness and balance if not synergy in one’s life, as well as the importance of being present with one’s family if you’ve decided to raise children.  Thus, some things had to go and among them were taking the time to learn the skills and behaviors to be a servant physician leader, and executing them on a regular basis.

A common root cause of both possibilities may be the lack of value individuals and society as a whole give to the concept of servant leadership or servant as physician.  Today there are conflicting priorities. One is forced to choose, often choosing with a natural self-centered bias.

Physicians often complain about RVUs, work hours and compensation; many want to make more money then complain about the focus on RVUs, which is how physicians get reimbursed.  Almost universally money eventually wins in this generative tension. What happens is that the physicians drive (perhaps unknowingly in some cases) an increasingly more efficient system designed to optimize revenue.  The resulting culture is: if a physician isn’t going to get paid for doing it, they won’t do it as much, or as well, or even at all.  Servant leadership often takes time and energy that has no RVUs attached to it.

I don’t have a cure, and it may already be dead.  I fear this lonely dream of servant as physician and leader will forever be securely stuck in the corners of my imagination.