Success and Leadership: What Is the 'Right Stuff'?

Vascular surgery exists today in a complex, competitive, resource-poor medical world in which dollars are scarce, other specialties are seeking to care for vascular patients, and hospital administrators' primary concern is their bottom line. To be successful in this environment, vascular surgeons must have the right stuff to succeed as individuals.

Dr. Frank J. Veith

More importantly, they must be able to work as groups or teams to compete effectively and to be successful. To do so, they need leaders who must also have the right stuff to motivate their teams to outperform the competition in practice and scholarly activity.

So what is the right stuff for individual vascular surgeons and for leaders of vascular surgery services, groups, or organizations to succeed in today's difficult medical environment?

Certain character traits are important to achieving individual success in vascular surgery. These include intelligence, commitment, dependability, persistence, adaptability, equanimity, patience, and the initiative and courage to try new techniques and learn new skills. In addition, the successful vascular surgeon must possess physical and mental stamina, effective communication skills, and the ability to work hard. A final requirement to reach academic success is creativity, which may be characterized as the ability to perceive new developmental opportunities, to engage in them, and to popularize them, thereby advancing the field.

While all these traits, skills, and abilities ensure individual prominence and success, it must be recognized that in the current complex medical environment most scholarly achievement and the best clinical care in vascular surgery come not from individuals working alone but from groups or teams of individuals. These groups are made up of vascular surgeons (often with diverse interests and skills), other health care professionals, administrators, and clerical staff members. To be successful, they must all function well as a cohesive team. To organize and administer such a team requires a leader who can orchestrate these diverse individuals to work smoothly and effectively together.

The effective leader recognizes that all team members are important, and makes them all feel that they are. All individuals must feel gratified and must feel that their own individual goals are being advanced and their needs are being met.

Only when this happens will they be willing to work fully to advance group interests and goals; only then will group and individual morale be high; and only then will the group interrelate in a unified fashion with institutional administrators and other groups, services, or departments within the hospital or medical center complex.

To determine what makes a good leader today in vascular surgery, we should first consider how such leaders are chosen and what characterizes a poor leader. Interestingly, most leaders are chosen because they have achieved individual success and possess the traits, skills, and abilities to do so. While some of these may be important, others are far more important for the successful group leader to have.

Perhaps that explains why so many vascular surgery leaders who were highly successful as individuals are failures in their leadership roles.

No longer can the effective leader function in the mode of the old fashioned "Professor" or "Geheimrat." In such systems, all under the professor's leadership worked entirely for the success of the dictatorial boss who totally controlled their destiny. Movement to other jobs without his approval was impossible. In such circumstances, all the financial rewards accrued to the professor. All the patients were cared for by him. All scholarly productivity was credited to him. Competition for his favor led to destructive behavior and "every man for himself" attitudes. Although some current vascular surgery leaders function in this way, it does not work effectively. Staff unrest is rife, productivity is limited, and personnel, who can easily move to other jobs, do so.

In contrast, the successful and good leader of today must work and fight for his team members. Unselfishness is a key trait of leadership. The successful leader must share financial and academic recognition rewards with individual team members in keeping with their contributions.

Everyone must be treated fairly, and the leader must devote the time and effort to make that determination accurately. The leader must put the team members' welfare above his own. He must gain his rewards in the collective output of the team and in the success and reflected glory of the individuals under his direction.

The situation is analogous to that of the military leader who is concerned primarily with his soldiers' welfare in and out of battle. If he cares about his troops' bivouac, he will never have to worry about his own.

More importantly, those under his command will then fight and die for him in battle.

It is not just at the local level that such unselfish, group-oriented leadership is required in vascular surgery. The specialty needs this form of leadership in its regional and national organizations to meet the many challenges ahead. No longer can becoming an officer in a society be considered just an honor and a way of advancing one's own career and prestige.

Society officers also have a responsibility. Those elected to these positions must represent, and act to support, the needs of society members and our specialty. This requires forethought and hard work, and sometimes courage. However, only when leaders act responsibly and have their organizations take actions that further the well-being of the specialty will vascular surgery reach its optimal position in today's medical community. Such group actions include public education about the specialty, maintenance of databases, support of multicentered cooperative research, preparation of valid practice guidelines, and, importantly, maintaining effective relationships with government, reimbursement sources, other specialties, and medicine as a whole.

Our specialty needs a voice coupled with an effective action arm. Only our societies can provide these, and their leaders, who must serve as the leaders of our specialty as well, should make these functions the responsibility of the society they lead.

Thus, to succeed as a leader in vascular surgery requires a different mind-set and some traits and goals that differ from those needed to succeed as an individual vascular surgeon.

Whereas the latter can have "me-centered" goals and can justifiably care mainly about his own achievements, rewards, and career advancement, the former must have "we-centered" goals and must act accordingly. Genuine care and concern for the well-being and interests of individuals under their leadership must become paramount for today's leaders in vascular surgery.

Only in that way will their groups prosper and be strong entities. Only in that way will the leaders be doing their job optimally. And only then will vascular surgery enjoy full success as a specialty.