moneyball posterVery rare to come upon a young man like Billy. Who can run, who can field, who can throw, who can hit and who can hit with power. Those five tools you don’t see that very often….we’re looking at a guy who is a potential superstar.” (Moneyball, 2011)


In the movie MoneyBall they refer to the lead character (played by Brad Pitt) as being a five tool player when he was being recruited out of high school. Being a 5-tool player mean being able to (for both average (1) and power(2) ), throw with speed and accuracy (3), field (4), and is fast with great base running skills (5). It is acknowledged that most players only have 2 or 3 of these and that a true “five tool baseball player” is rare.

All physicians are leaders. We lead clinically every day. We provide leadership as we care for patients, supervise residents and medical students, and interact with all the other allied health providers. the concept of the 5-Tools of Physician Leadership is geared to those that provide leadership to other physicians.

I believe that there are also five vital tools that Physician Leaders in the 21st Century need to have. They address the fundamental thing we need….the ability to lead change in chaotic times.  The more they hone these skills the more successful they will be. Like in baseball very few will be perfect in all five .

The tools that physician leaders need to  have are:

  • Solid and respected clinical skills (1)
  • Comprehensive communication skills (2)
  • The abilities to Create (3), Execute (4) and Sustain (5)

While the first two are hardly “new”, the emphasis on creating, initiating and sustaining change are a 21st century phenomenon.

Clinical Skills:

tt-positions-greenNo matter how much the practice of medicine changes or will change it is ultimately a conservative and somewhat insular discipline. While we practice many specialties there are commonalities: The experience of medical school and residency and the focus on patient care. Without a solid clinical base recognized either from years of clinical practice or possession of coveted knowledge it is unlikely other physicians will follow you. Furthermore the perception that you are no longer sufficiently clinical (ie swinging a hammer) can also reduce your value on clinical matters. Simply put physician leaders must stay grounded somehow in the clinical world no matter how difficult that could be time-wise.


email picThis is perhaps the most difficult of the 5-Tools to define. It takes some courage to get up in front of your distinguished peers and tell them to do something.
It is even harder to get them to listen. We are used to communicating with each other clinically. But this is different. You have to find both universal messages that work for all physicians but also appeal to the differences within and between specialties.

Communication also requires mastering different media. In an average sized hospital it would almost be impossible to communicate only in person. Most physicians (40ish and above) can be reached reliably through emails. Very few physicians under 30 these days ever open email and prefer texting and other mobile app based venues.

Create, Execute and Sustain:

technologyMedicine is becoming more integrated, more coordinated and requires cooperation across not only specialties but also disciplines (nursing, allied health, etc). If physicians are to lead they must be able to influence the way care is provided. Physicians should be well suited for these tasks. From 3rd year of medical school on we have been creating differential diagnosis, initiating treatment plans and sustaining the attention required to complete our rigorous training.

These three tools though are separate and unique. We have all met physicians who have great complex ideas that they expound upon at every staff meeting. They have vision and passion (to create) but are unable to translate that into action or sustained results.

On the opposite end is the physician who is frequently belittled by colleagues but loved by chairs. She or he is always the first one to turn in their required paperwork, is never late with their charts, and carries forward the protocols and policies of their department (the Sustainer).

The Executor is like the shock troop of change management. Able to rally their medical staff or department and charge full force into the unknown. They are able to translate the creative ideas into action and start the ball rolling. They understand the pros and cons of the change and provide the energy to get the initial job done. Like the Creators however they frequently lose interest after a while and sustained change is threatened.


As stated earlier it is rare to find a truly 5-Tool Physician Leader. Some of the most successful I have known only possessed 2 or 3 but were smart enough to surround themselves with others who possessed the other tools. It is important to remember that while these tools are vital to a physician leader they are not the only skills needed. Comfort with data and analytics (both Big and Little Data) along with a fundamental understanding of finances and budgeting are crucial as well.

David J. Adinaro MD, M.Eng., FACEP