The model of physician leader as expert relates directly to the roles played by physicians in a professional culture. Those engaged in medical, clinical and scientific services populate the Professional Culture in healthcare communities. We have effective systems, and successful treatment programs because patients have always come first in the Professional Culture—clinical excellence is the key focus. Members of the Professional Culture look for strategies that promise to increase their control over and opportunity to influence the quality of health care they provide. We have effective systems, and successful treatment programs because patients have always come first in the Professional Culture. The patient comes first because it is through the patient that professional healthcare providers receive repeated reassurance and all kinds of support for the good job they do. This becomes the central ingredient in the provider’s sense of life’s purpose.
Those in the Professional Culture often find identity (and meaning) primarily through their affiliation with professional associations. As noted by McKenna and Pugno, members of this culture value technical expertise. They also are inclined to value specialized technical language. They are fully committed to preservation of professional autonomy and have established quasi-political governance processes to ensure this autonomy. These processes have enabled healthcare professionals, over the past hundred years, to strongly influence or even dictate the policies, procedures, and missions of healthcare systems. Members of this culture hold assumptions about the dominance of rationality and technically based procedures in hospitals and other health institutions.
The Professional Culture has been dominant in health care since early in the history of North American health care. Virtually all physicians were aligned with this culture for many years. As McKenna and Pugno (2006, p. 65) note, the display of clinical expertise was the ticket to becoming a “leader”:
“Conventional wisdom among clinicians holds that to attain a “position of leadership.” Physicians must first “prove themselves” through demonstrated clinical excellence. People who hold this traditional viewpoint believe that only upon being recognized as a clinical expert can physicians gain the respect of peers that is vital for earning the right to lead.”
This traditional viewpoint and dominance of the Professional Culture is now being attacked from all sides. Those in the Professional Culture must now share power with the other three cultures of contemporary health care—especially the Managerial Culture. Now, there are additional pathways to leadership among physicians. One of these pathways is serving in an executive position as the formal manager of people and resources in a healthcare system.
