Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / The Expertise Tax: Moving From Hero to Host Leader
Transcript
- Santina Wheat: Welcome back to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. Now today, I want you to think back to the very first time that you clipped an ID badge to your scrubs or your white coat or just that dress outfit. Maybe it was the third year of medical school. Or maybe it was day one of intern year. Or maybe it was day one of nursing school, your first day in the clinic. Do you remember the physical weight of that badge? For most of us, that badge was not just a piece of plastic that got us through locked doors, though it certainly did that. It was also a suit of armor. Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. That badge was the physical proof that we belonged in that room or on that floor and caring for patients. It said, I am an expert. It said, I have the answers and I am safe to trust. This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. Now in medicine, we are socialized to believe that our credentials are our identity. We spend decades accumulating titles, fellowships, and accolades, all of this while operating under the silent assumption that the more letters we have after our name, You can find information on how to reach me in the show notes. the more of a leader we become. don't forget to hit subscribe so that never miss an episode ⁓ and leave me a rating so that others can find too. I'm sure that many of you have the feeling of, just need to learn more. just need to finish that fellowship. I just need to finish that degree. and take care of yourself because you deserve to be held up too. And I'll see you next time. But here is the hidden load that comes with this that we don't always discuss in our leadership retreats. That badge that we wear, it eventually can become a barrier. We start to feel like we lead from our credentials rather than leading from our character. We often feel this immense crushing pressure to be the all-knowing expert and to be that expert at all times. And so today I want to talk about the expertise tax, that weight of trying to prove that we belong in the room and how that leads to a leadership style that doesn't just burn us out. but it actually suffocates the very teams that we are trying to inspire. And so we are going to look beyond the badge and look at what leadership looks like when we are finally able to take off that armor. Now, I would like to share with you a chapter of my own journey that I am not particularly proud of, but it is one that I think many of you will recognize. Many years ago, I transitioned into a major leadership role. On paper, I was ready. On paper, I had the training, the clinical skill, And for me in the moment, most importantly, I had the title. But inside, I was a mess. I was relatively young for the position, and I was hyper aware of the hierarchy. I could feel the invisible eyes of those who were senior to me. And I could hear the internal murmurs, the ones telling me that I was a diversity hire. or that I was too green, or that I hadn't paid my dues in the traditional way, or that I was being chosen because it was going to be easier for someone else. Now, because I was listening to those things and the other thoughts running through my head, I was suffering from massive imposter syndrome. And I fell into the most common leadership trap in healthcare. I tried to outperform my insecurity. I decided that to prove I was a real leader, I had to be the most knowledgeable person in every single meeting. and really in every single room. At the time, I thought leadership meant total control. I was not just directing projects. I was in the weeds of every single spreadsheet. And nobody needs to be in the weeds of every single spreadsheet. I was proofreading every draft. I was CC'd on every email thread. and I was effectively trying to be a one-person department. I wasn't doing this because I didn't necessarily trust other people. I was doing this because I thought I had to prove myself. And improving myself, I was forgetting how that looked. Now, in reflecting back, I told myself that I was just being thorough and that as a good leader, I was supporting my team. But when I look back now on it honestly, I can name it for what it actually was. I was micromanaging. My need to prove my worth through my badge or credentials meant that I was not allowing anyone else to lead. In reality, I was the bottleneck. I was frustrating my team because I was signaling every single day that I did not trust their expertise as much as I trusted my own. I was carrying the load of five people, not because the work required it, but because my ego was trying to protect the authority of that new badge. And what that felt like was driving through a snowstorm where you were holding on ⁓ so tight and just hoping that you don't go sliding. Now I'm glad that I can say today what that actually was and I can watch out for it a little bit more as I continue to lead. And this reflection brings us to what I want to talk about today, what I'm going to call the expertise tax. In the exam room, being the expert is absolutely necessary. If a patient comes in with acute coronary syndrome, they don't really want a collaborative discussion about their options. They want to know the expert knows the protocol. And so we are trained to be the hero of that clinical encounter. And of course, there are times that we are collaborative. I think that's crucial as a good family physician. And I think it's crucial in many other specialties as well. But that is my bread and butter. But there are still those times that we accept that we're the expert in the room ⁓ But when we're not talking about our patients, when we move into leadership, whether that is running a residency program, leading a clinic or a department or being an educator, that hero identity can actually become a massive hidden load. because now we feel like we have to perform as that leader. I want you to think about the ways that you potentially are performing as a leader. Thinking about the energy that you spend on invisible tasks every single day. Maybe it's an email audit, spending 15 minutes drafting an email that is really only three sentences long so that you don't sound too soft or too aggressive and making sure that you're absolutely clear. Or maybe it's the decision silo, where you feel like you just cannot ask for help because a real leader should already know all of the answers. Or maybe it's the perfectionism shield, where you are double checking a junior faculty's members work until midnight because you are afraid that if they make a mistake, it will reflect poorly on you. Or maybe it's the conversations running through your head, where you spend tons of time ⁓ thinking through what you did say, what you say, what you should have said, and if it came across how you were hoping. Why do we all do this? Well, we do it in part because medicine is a shame-based culture. From day one of medical school, the not knowing ⁓ is treated almost as a failing. We get pimped on rounds. We are all ranked against our peers. ⁓ And that is before we have our first job By the time we reach leadership, the idea of being wrong, well, it feels like an existential threat. So we carry the load of perfectionism a defense mechanism. But perfectionism, that just isn't leadership. Perfectionism ⁓ is a high-end version of fear. So how do we move past that? How do we put this down? Well, we have to shift our identity from the hero leader over to the host leader. And there's a few ways we can think about doing this. First, let's talk about the I don't know power move. One of the most liberating things you can do for your team is to sit in a meeting, listen to a complex problem, and say, I actually don't know. I don't have the solution for this yet. But I trust the expertise in this room to find it. Those can be really hard words to say and require a lot of trust. But when you say, don't know, you aren't showing weakness. You are creating a vacuum intentionally that your team will be able to fill with their own brilliance. You are moving the load from your shoulders to the collective strength of the group. you're a lightning-filled vote. There is also the strategy of relinquishing the Now, as clinical leaders, we are all obsessed with process. But to lighten your load, you have to define the what and the why, and then you have to get out of the way of the how. If you give a project to a junior faculty member, you have to let them do it their way. And you have to do it that way even if it is only 80 % as perfect as what you think. would be your way. That 20 % gap is the price of their growth and it's the price of your freedom. And it might surprise you. There might be amazing innovation that comes through that is even better than what you planned on. And then the last strategy that I want to talk about is having a professional standard of care. We have a legal standard of care for patients. And so we also need a standard of care for our own internal monologues. And so here is the standard that I want you to use. If you would not talk to a struggling intern the way that you talk to yourself when you quote unquote fail as a leader, then you are violating your own professional standard of care. I want you to have self-compassion. This is the only thing that makes leadership sustainable. And so I want you to talk to yourself in the same way that you would talk to a loved one, a friend, or a struggling learner on one of their most difficult days. That's really hard to do. because we are often our own harshest critics, but with practice, this can really help you grow and feel like your work is so much more sustainable. Now, before we end, I want to spend a few moments talking about the shadow that we cast. Our learners, whether they be medical students or residents or fellows, our teammates, the young attendings, our clinical support staff, whoever it is that is surrounding us, they are all watching us. And that means that they are taking our cue from us. If they see us white-knuckling our leadership roles. Maybe that's them seeing us stressed or controlling and unable to disconnect and unable to say that we don't know. Well, then they are going to look at our lives and say, well, I might want to be the clinician, but I certainly don't want that leadership job. Or I certainly don't want that educator job. When we do that, we are inadvertently killing the pathway of future leaders. We're doing that by making leadership look like a life sentence of misery. And I don't believe that it has to be. I think you can have so much joy in leadership. Because when we lead beyond the badge, when we show up as human beings who make mistakes, who delegate with trust, who admit that they don't know everything, also, ⁓ who have lives outside of the hospital or the clinic, then we are performing a radical act of mentorship. We are showing those who are watching us, those who are surrounding us, that leadership is actually a team sport. It is not a solo marathon. So I want to give you a challenge. On Monday morning, I want you to take off your badge for five minutes before you walk into that first meeting. And if you don't have a meeting on Monday, that's okay. Whenever your next one is, I want you both literally and figuratively take off that badge. I want you look at it. I want you to be aware that it gets you in the door and that that's where it stops. I want you to remember that your humanity is why people follow you. So before you walk into that meeting on Monday morning, I want you to reflect on this and think about how it is that you are showing that humanity. And then I have a second challenge for you. This week, I want you to find one thing that you are micromanaging out of fear. And once you identify it, I want you to give it away. I want you to delegate not just the task, but the authority that goes along with it. And then I want you to watch what happens to the energy of your team when you delegate strategically and finally stop trying to be the hero. And then I would love for you to send me an email or send me a message on social media and tell me what you chose to give away and tell me how it felt. It might be scary. It might bring you joy, but you won't know until you try. I am so happy that you joined me today for this episode of The Hidden Load. If it has helped you put down a small part of your armor today, then I hope that you will share this with a colleague as a reminder that it's not all about the badge And I hope that you remember that we are stronger when we lead together because that can help us lighten our hidden loads. Thank you for joining me today. I look forward to seeing you next time.