Building blocks or connecting dots: steps toward physician leadership

Abraham (Rami) Rudnick, M


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The path to leadership may take a long-term planning approach or an opportunistic route, but I believe that it is often a combination in different proportions depending on the individual and the stage of their career. Effective physician leadership development may also benefit from an occasional look back at past choices to learn from the past, optimize the present, and prepare for the future.


Editor’s note: We asked CCPL members who have qualified as Canadian Certified Physician Leaders to tell us something about their “path” to leadership: what inspired them, how they succeeded, what they’ve learned. We hope their thoughts help you in your similar journey.


Currently, the route to leadership for physicians is not based on evidence.1 For this and other reasons, it is helpful to share our experience and relevant reflections, with the aim of informing the pathways to leadership of other physicians. My “critical rationalist” preference leads me to start with reflections.2 The few references I cite are intended to illustrate my own physician leadership development to date. Top




Like most trajectories in life, physician leadership development may be robustly planned in advance (the building block approach) or it may take advantage of unexpected — as well as expected — opportunities (the connecting dots approach). In practice, most if not all development combines these two routes in what I term the stepping stones approach. The proportions of building blocks and connected dots may vary among individuals and at different times along one’s path. Top


It is not clear to what extent the choice of one approach over another is intentional or whether such choices depend on personal or other factors. What seems clear is that, in retrospect, one can be more or less satisfied with these choices and learn from them for the future, not only about particular stepping stones, but also about one’s development trajectory more generally.


For example, if one’s long-term planning has led to success and satisfaction, it may make sense to continue with a building blocks weighted approach. Yet, some flexibility may still be needed if an unexpected opportunity arises that fits the general outline of the long-term plan. In this article, I share some of my experience in planning and flexibility, as from early on I focused on long-term general goals, such as developing creatively, intellectually, and interpersonally. Top




During my childhood and youth, I was focused on a career as a classical pianist; this training developed some of my cognitive skills, such as the ability to pay prolonged attention to detail, and expressive skills, such as balancing content and style to achieve successful communication, artistic, in this case, but transferable to other contexts. Immediately after medical school, I worked as a military general practitioner, and this training developed some of my crisis management skills, such as remaining calm in hostile territory, and administrative skills, such as organizing large sets of health data in a user-friendly way. During my military service and immediately after that during my residency in psychiatry, I started and completed a doctorate in philosophy; this training developed some of my intellectual skills, such as critical thinking, and creative skills, such putting together facts and arguments as a reasoned narrative. Top


From early on in my medical career, I chose to and learned to improve health care systems collaboratively (with service users and other stakeholders), using applied research, clinical leadership opportunities, and, later, also academic leadership opportunities. To guide myself and others in this work, I developed a principled leadership values-based approach, focused on being person-centred, evidence-informed, and socially responsible.3 As part of that, I have involved service users, such as people with mental health challenges and other stakeholders, in health systems improvement and related research. I have also provided needed guidance in health research, for example by publishing a comprehensive collection of articles on social science methods in this field.4 Top




In retrospect, I see a clear — if not straight — path in my development as a physician leader. It has combined, or rather integrated, creative expression with intellectual inquiry and human service, leading to a dynamic balance among physician leadership, clinical practice, health research, and medical education. It seems that I have mostly used, and still use, a building blocks approach, but when unexpected yet relevant opportunities, such as research administration, arise, I have been able to take advantage of them, satisfactorily and successfully. Top


Other physician leaders may have different paths and face different choices. It seems to me that effective physician leadership development, perhaps similar to effective physician leadership,5 can benefit occasionally looking back and learning from past choices, to both optimize the present and prepare for the future (planned or not). Perhaps this life lesson can be structured and studied as a next step in my leadership development. Top



1.Pallaveshi L, Rudnick A. Development of physician leadership: a scoping review. Can J Physician Leadersh 2016;3(2):57-63. Available:

2.Rudnick A. A philosophical analysis of the general methodology of qualitative research: a critical rationalist perspective. Health Care Anal 2014;22(3):245-54.

3.Rudnick A. Principled physician (and other health care) leadership: introducing a value-based approach. Can J Physician Leadersh 2014;1(1):7-10. Available:

4.Rudnick A, Forchuk C (editors). Social science methods in health research. New Delhi: Sage; 2017.

5.Taylor B. Effective medical leadership. Toronto: University of Toronto; 2011.



Abraham (Rami) Rudnick, BMedSc, MD, MPsych, PhD, CPRP, FRCPC, CCPE, FCPA, is vice-president of research and chief of psychiatry, Thunder Bay Regional Health Sciences Centre; chief scientist, Thunder Bay Regional Health Research Institute; and professor of psychiatry, Northern Ontario School of Medicine, Canada.


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