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Monday Mar 10, 2014

Leading While Learning

When I first was approached about contributing to the Fresh Perspectives blog, I was nervous about signing up because I had finished residency only six months earlier. What could I possibly know that would benefit other physicians who have just finished residency? Honestly, I still feel that way.

However, I decided to participate in this blog with the hope that we can discuss the challenges facing us as new-to-practice physicians and find solutions through advice from each other and our more seasoned colleagues.


Here I am with my daughter on graduation day. My first assignment after residency: medical director of a patient-centered medical home with a staff of more than 25 health care professionals and more than 8,000 patients.

The challenge I'm facing now is leading while learning, and I'm probably not the only one. As soon as we graduate from residency, we are viewed as leaders. But we still have a lot to learn. How do we balance that?

During my Army residency training, I thought I would finish and go work as a junior physician. During this time, I would develop my ability to influence by improving my competency, character and compassion. As an Army officer, I am expected to lead, and I thought after a few smaller roles, I would be ready.

My first assignment after residency, however, is medical director of a National Committee for Quality Assurance Level 3 patient-centered medical home (PCMH) with one other family physician, four nurse practitioners, 19 nurses, one physician assistant, one clinical psychologist and more than 8,000 enrolled patients. We also have a lab and pharmacy on site. Obviously, it is not the small role I was expecting.

I thought I was ready for the challenge. I savored it, and then it smacked me in the face. I feel competent with the care I provide, but I struggle with making the transition from resident to leader.

The AAFP promotes team-based care in a physician-led PCMH as the future of primary care, but I fear that we are not addressing the development of these leaders. I am living the promise, straight out of residency leading a PCMH with seasoned nurse practitioners and nurses. Some days I am successful, and other days I fail. How do I address the days I fail?

How do I set the standard for my nurses while becoming comfortable with PCMH principles myself?

How do I explain the importance of Healthcare Effectiveness Data and Information Set (HEDIS) measures to health care professionals who have been practicing longer than I have been alive?

How do I elevate everyone’s scope of practice in a way that allows the nurses to function at their highest level without making the physicians feel like their scope of practice is being invaded?

These are the challenges I face each day. I don’t think I am alone in this struggle, or at least I hope not. How do we develop the future team leaders of family medicine?

I am open to comments. I crave them actually -- positive or negative -- if they lead to discussion and improvement. For now, I will keep putting my boots on, showing up and meeting the challenges head on.

It’s what we do as family physicians.

Michael Brackman D.O., is a captain in the United States Army, and is the medical director of a patient-centered medical home at Fort Hood, Texas. The views expressed in this blog are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense or the U.S. government.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.