It’s a question every CEO must answer for him- or herself: When should A CEO stop working in the trenches, if ever?
There is a fantastic scene in the movie Margin Call, where the steely CEO of a fictional Bear Stearns-type company on the verge of implosion, played by Jeremy Irons, asks a low-level analyst to explain why his company is suddenly about to go bankrupt.
“Maybe you could tell me what you think is going on here–and please, speak as you might to a young child, or a golden retriever.”
In short, he has no idea what’s going on in the trenches of his company. He is the epitome of the detached CEO. He swoops in on a helicopter in the dark of night to make a fateful decision about the future of his company.
For my part, I’ve chosen a considerably more involved path, though not without a great deal of contemplation. The amount of time I spend working in the trenches, that is, working clinical shifts in the ER, as the CEO of a company that employs over 250 physicians, nurses, PAs, and support staff, was particularly on my mind the other day as I drove two hours home from one of our partner hospitals after a shift.
It wasn’t the furthest hospital away from my house by any stretch (that one would be nearly 500 miles away), but it was enough away that I had time to think about the amount of time I had just taken away from the duties of leading the company.
Working clinically takes me away from a number of crucial responsibilities. It takes me away from executing on the strategic vision of our company; it takes me away from meeting with our hospital partners to ensure we continue to provide the kind of service that got us this far; and it takes me away from continuing to develop the current and future leaders of the company.
People generally don’t criticize the CEO of any company for not working “on the floor,” whether that floor is a manufacturing company, a hotel chain, or a hospital. In fact, much advice on leadership and management would seem to discourage that sort of CEO behavior. A successful leader’s time is too valuable to be working in the business, we’re told; they should be working on the business.
At the very least, as a company grows and becomes more complex, job roles become more defined and specific. A job which needs to be done by you and can’t be performed by someone else is an appropriate reality for a high-functioning organization. It is a perfectly legitimate argument to say that I should be spending all my time leading the company.
But there are three main reasons that I won’t do that.
Having trained for so many years to become a physician, it is almost impossible for me to walk away from it. I still love stepping into a patient’s room, introducing myself as an ER doc, and starting the conversation about what ails them and how I can help them today. There is almost something magical about the interaction to me. It is a privilege to care for patients and I still find great satisfaction in it, period.
There is no better way to “ground truth” than to walk in the shoes of a clinician. You get a sense of the health of a company by how it functions under stress, and there are few more stressful environments than a busy emergency department.
In the ER I can get a sense of how coverage is matched, whether there needs to be more support in certain areas, how flow is working, and how well the department is interacting with other parts of the hospital. Sure, the information could be conveyed in a memo or an incident report, but it loses some of its fullness. There are things that can only be seen in the moment, and as the leader of the company I continue to believe that witnessing those moments is crucial.
Finally, it gives me a certain amount of “street cred” if I can still hold my own as a provider and then talk to people as a leader. That is understandable, and, from my viewpoint, very appreciated.
Knowing that your CEO is willing to put a stethoscope around their neck and show up on time for a shift makes a statement unlike any email or policy ever could.
This is all not to say that there aren’t trade-offs. There are and they need to be weighed appropriately. I clearly cannot work a full complement of clinical shifts, nor can I work at every one of our locations, which are now spread across three states. That is a reality I had to face as our company grew.
In some ways I do miss the days when I just worked at one location, knew every person with whom I worked in detail, was on a first name basis with our consultants, and could walk into most areas of the hospital and people would know who I am.
A 2012 CareerBuilder survey reported that 40% of workers have never met their CEO, and an amazing 21% of workers did not even know what their CEO looks like. Those are some sad numbers.
So, when should a CEO stop working in the trenches? For me, the answer to that is probably never. Being the leader of a growing company has taught me more lessons about life than I could ever have imagined–and, it has also made me a better clinician, just as working clinically makes me a better leader. That’s why I will continue to try and find that balance of clinical time and leadership as long as I am able.
—Dr. Angelo Falcone is a founding partner and the CEO of MEP Health an outpatient care partner to hospitals in the Mid-Atlantic and New England. Dr. Falcone also blogs for The Shift and in his spare time runs triathlons.