Rules for Dictators—Serve Your True Boss

I once got lost in Rome using an English language digital map. No matter how much I turned the damned thing, no matter how much I tried to match the names, I couldn’t find that damned Coliseum.



Then I realized I had pulled up a map of Rome—Texas.



Practicing medicine within a large organization is the same.



The roadmap I had created as a resident in an academic medical center was useless when I tried to find my way in a large healthcare organization.



I wasted a lot of time and suffered much frustration trying to make my way—until I came across “The Dictator’s Handbook.”



It’s a peer-reviewed, reproducible roadmap with a high predictive power that will allow you to navigate your way to success in any large organization.



It will teach you everything your residency should have taught you about thriving in the real world, but didn’t.



We’ve already reviewed a general summary.



Now let’s look at the tactics.



In my first corpmed experience, I was having trouble figuring out who my boss was.



I was closing in on a patient panel that was effectively 3000 patients strong—far too many to care for effectively, or even enjoyably.



I wanted to see under what conditions I could close my practice to new patients.



In response to my inquiries, every administrator and Medical Director I worked with walked on eggshells, as if fearful of telling me too much or too little information.



It was very frustrating trying to get a straight answer out of anyone.



Even my former partners who were trying to advance into administration were having problems looking me in the eye.



So I took a more direct approach.



I sent an email up the entire hierarchy announcing I was closing my practice to new patients.



I immediately received a reply stating I could not do that.



I had found my boss.



He was three levels above me. I had only met him a few times before. But now I knew where the real authority lay.



And thus I started my campaign of finding out what value he needed me to supply to him.



Some, like volume and metrics, I could. Some like, clinician leadership, I elected not to.



Interestingly, revenue generation never came up, though cost-control certainly did.



Eventually, I wearied of spending my time generating value that was meaningless to my personal and professional fulfillment. But I still left with a reputation as a generator of great value.



And being a “generator” served me very well—as long as I met my boss’ needs, he absolutely left me alone.




You don’t have to take my direct approach to find your boss.




You can take a more systematic approach.




Stay with me now, this is a bit involved but will pay off big time in satisfaction, fulfillment and a sense of control.




Start with who you perceive as your immediate supervisor. Ask who they report to in the organizational chart. Ask them what that person expects of them.  Make clear your interest in helping them succeed.  Set up a meeting in a few months to evaluate your progress.




Then work hard deliver what your supervisor values




It could be patient numbers, customer satisfaction, mammogram rates—anything




As much as it is in your power, get it done.




Then, decide about a modification in your work environment which you desire. It should be something pretty straightforward with an obvious benefit. For me, it was a cap on patients. For you, it could be a slightly later start time, or a perhaps a scribe.




Nothing too major, something doable but also a challenge.




Then, at the follow-up meeting with your supervisor, demonstrate how well you generated the value your supervisor told you she needed—and then ask for the work modification you decided upon. If she cannot accede to your request, ask for a meeting with her and her immediate supervisor. It’s important to meet all together so your supervisor doesn’t think you’re going to do them professional harm behind their back.




Frame the meeting as a collaboration to improve your performance.




At that meeting do the same thing that you did at the first meeting with your immediate supervisor—find out what your supervisor’s supervisor needs to impress her own superior in turn and how you can deliver it for them. Then outline what you’re prepared to do to meet their needs and set up a follow-up meeting to assess your progress a few months later.




At that meeting, push again for your desired clinical change.




If there’s no progress, repeat the process up the organizational chart.




Until you get the person who can give you a straight answer—yes or no.




Congratulations, you’ve found your true boss.




The one for whom you ultimately generate value and from whom you can garner benefits.




You are one of their constituents.




And now your relationship will be explicit— to the benefit of both.



Find out what they need, set up periodic meetings outside the normal employee review channels to check on your progress in delivering it.



And then deliver.




The administrators and Medical Directors in between?  Well, they’re dead wood.




Treat them with respect, but direct your efforts toward generating value for your real boss.




It will pay off.




Your true boss will know that you understand how the game is played, and you won’t waste time playing the game with the wrong person.




Sound like a pain?  Sound like “kissing ass?”




Welcome to the corporate world.




You don’t have to do this. You can just keep your head down, see patients and take what comes.




But the frustration and powerlessness you experience will eventually pay its dividends in burnout, disengagement, and loss of Joy Time.





So find out who your real boss is, serve them well, and enjoy the benefits.




And thrive in the corporate world.




Need unbiased guidance finding and succeeding within your ideal medical practice, contact me, no obligation just help and value.