Knowledge technicians differ from physician managers who are different from physician leaders. In addition, not all physician leaders are entrepreneurs and few physician entrepreneurs are innovators.

The ” change impact funnel” looks something like this:

It starts at the top with a wide base of physician knowledge technicians. Most doctors are trained to do three things and to do them well: make decisions, perform technical procedures and communicate. In other words, they are expected to be a first class diagnostician and technician and have a pleasing bedside manner. Few are triple threats and many of these skills are being replaced or supplemented by deep learning, AI and robotic technologies. Consequently, we have redefined what it means to be a triple threat.

The second level of impact is the physician manager, someone who is expected to optimize the efficiency and effectiveness of business, marketing and clinical policies, procedures and processes. They are agents of the existing clinical care and business models. Their entire focus is on the now and not the new. They do the thing right, not necessarily the right thing.

Physician leaders occupy the next level and are expected to provide vision, direction and inspiration and drive the change process. Some see their role as incremental tweekers, leading the painful and difficult process of changing the existing model. Others see their role as making the model obsolete. They typically try to follow John Kotter’s 8 step change paradigm: unfreeze by creating a sense of urgency, changing behavior, and then refreezing the new behaviors to engraft them on to the culture and make them sustainable.

Physician entrepreneurs take it one step further, taking advantage of opportunity with scarce, uncontrolled resources with the goal of creating user defined value through the deployment of biomedical and clinical innovation. Often times, their outcomes will be in conflict with physician managers who are there to protect, not disrupt, the status quo, or leaders who don’t have the same vision.

Some physican entrepreneurs are innovators, occupying a space in the upper right hand corner of the novelty-value matrix

Where you sit on the matrix is dependent on how much time your spending on the now (lower left), the next (right lower) or the new (upper right quadrant). The upper left quadrant is the place in hell reserved for shiny new objects that create little or no user defined value at significant multiples when compared to the competition or the status quo.

Finally, there is that rare combination of physician innovator who leads and inspires other physician innovators, the leaderpreneur. They are hard to find, highly valued and difficult to retain. They lead innovators, not manage innovation systems.

In his classic HBR article, John Kotter notes that leadership is different from management, but not for the reasons most people think. Leadership isn’t mystical and mysterious. It has nothing to do with having “charisma” or other exotic personality traits. It is not the province of a chosen few. Nor is leadership necessarily better than management or a replacement for it. Rather, leadership and management are two distinctive and complementary systems of action. Each has its own function and characteristic activities. Both are necessary for success in today’s business environment. Management is about coping with complexity. Its practices and procedures are largely a response to the emergence of large, complex organizations in the twentieth century. Leadership, by contrast, is about coping with change, requiring vision, direction and inspiration. 

COVID has forced changes in how we work that are likely to last and that will challenge leaderpreneurs. They will be part of the hybrid economy moving forward with both intended and unintended consequences, including its impact on innovation and the high performance teams necessary to create it.

Here is a recent list of healthcare entrepreneurs recognized by their peers. Some are physician entrepreneurs who span the change impact funnel. It remains to be seen whether they will make the cut next year.

Beatrice was Dante’s muse in the Inferno. Fortunately, we are seeing more and more physicians serve as role models for others who want to navigate the innovation inferno.