Lessons Learned from a Half Century of Physician Leadership

Blake Waterhouse, MD, MBA has had a 50 year career as a physician and physician leader, including service as President and CEO of Straub Clinic & Hospital, the largest integrated health system in Hawaii; as President and CEO of  Physicians Plus Medical Group,  a 300 physician medical group in south central Wisconsin; and as medical director of the Jackson Clinic in Madison, Wisconsin.

 Following are some of the key lessons learned from a half century of leadership in provider organizations.

    The more responsibility we assume as a physician leader ….


  1.  The more we need to know about:
  • the basics of cost and financial management, continuous quality improvement, strategic leadership, and mediation and conflict management.
  • the day-to-day details of our own organization. Most organizational knowledge resides with our front-line colleagues, including nurses and first-line administrators. We need to take the initiative to continuously interact with them and listen to what they have to say.
  • the strategic plans and likely responses of our current and prospective competitors, what they are presently doing and how they’re likely to respond to our own initiatives.


  1. The more difficult the job becomes because:
  • the issues and problems we face become increasingly ambiguous and complex.
  • we are not able to “fix” every—or even most—problems. Often the best we can hope for is to substitute a more manageable problem for the one we presently face.
  • there is frequently more than one appropriate response to an issue or problem. We have to try to sort them out and choose the one that most effectively moves the organization forward.


  1. The more important our words, actions and behaviors become because:
  • we live in a fishbowl. Our actions and everything we say and do is observed and interpreted by the people in the organization.
  • for better or worse, our staff will usually “mirror” our example.
  • if we want an organization that has integrity, compassion, transparency and focus on quality, as leaders we have to consistently model these desired qualities.


  1. The more we need to prioritize and protect our time and energy by:
  • not losing control of our calendar.
  • insisting that every internal meeting has an advance agenda.
  • handling every email and piece of paper just once.
  • accepting the fact that we will have more and more meetings, both inside our organization and within our community.


  1. The more unsure we will become in our decision making because:
  • leading others becomes exponentially more difficult and demanding as the number of people for which we are responsible grows larger.
  • we can NOT please everyone all of the time—or even most of the time—nor should we try. There will always be conflict within the organization; our job is to manage it. 
  • physicians are resistant to being managed, but they are receptive to being led by another physician whom they respect.
  • our decisions must be both transparent and in alignment with the mission, values and strategic plan of the organization.


  1. The more rewarding the job can be, because:
  • the most rewarding accomplishments in life are usually those that were the most challenging.
  • helping our organization and colleagues grow better and stronger can be enormously fulfilling.

     Blake E. Waterhouse, MD, MBA