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International Medical Graduates

Leadership in the U.S. Armed Forces: Experience of an International Medical Graduate

Capt. Angeline A. Lazarus, MD, FACP
Rockville, Maryland
Former ACP Governor
ACP Regent, 2003-2009

Leadership in the Armed Forces provides an unique opportunity to excel as it requires the leader to keep the organization/unit functioning at its best at all times and to carry out the mission at peace and war-time. The unit has to be cohesive, well-prepared, organized, competent, skillful and above all, understand the mission clearly and work together as team. At times, the unit has to carry out the mission regardless of circumstances and dangers, willing to accept the Commander's decisions and follow the directions diligently.

The basis of successful leadership lies in the leader. It has been said that good leaders inspire us to put our confidence in them; great leaders inspire us to put our confidence in ourselves. The foundation of Department of Defense is discipline. The structure, functionality and effectiveness of the organization depend on the leader. The accomplishment of the mission depends on the team.

To give you some background, I was born in Lalgudi, Tamil Nadu State in India and graduated from Madurai Medical College, University of Madras in 1969. After completion of internship, I worked in a Railway Hospital until I came to the United States of America in 1972. I did a rotating internship at St. John's Hospital in Cleveland, Ohio and residency and chief residency at the Veterans Administration Medical Center, Dayton, Ohio. After graduation, I joined the Veterans Hospital in Martinsburg, WV and had two rewarding years of practice as a staff internist. My experience in the Armed Forces began on 7 July 1978 when I joined the Navy to begin my fellowship in Pulmonary Medicine at the National Naval Medical Center, Bethesda, Maryland. This is a prestigious medical center where many presidents of the United States of America have received their medical care. Academically it is a sound institution. I was pleased with the program it had to offer. I had to sign a contract of serving two years after graduation and the assignment could be anywhere in the USA or overseas. I carefully considered the offer and accepted it. My husband, parents and siblings were supportive of my decision.

Training in the Navy was a new experience. I had to wear the uniform every day, learn all the rank structure of the Navy and other services, the types of ships, and observe proper military courtesy. In addition, I had to learn the Navy lingo, how to salute and how to polish my shoes. I must meet weight standards and complete physical readiness testing twice a year. Soon after I joined, I noticed that the training program met the Residency Review Committee's curriculum requirements and also prepared me as a military medical officer. I recognized the need for leadership skills during my fellowship.

In the twenty years of my naval career, I have held several leadership positions including Head of the Pulmonary Division, Program Director of Pulmonary, pulmonary and critical care fellowships at two naval hospitals, and Director of Medical Services. Currently I serve as the Chair, Department of Internal Medicine and Program Director of Internal Medicine Residency. I have gained valuable experience during these years. I would like to share just a few of my thoughts and experiences that have been helpful to me in my career. "Fear of God is the beginning of wisdom" says Proverbs in the Bible. With this in mind, I knew I can be a leader if I exercised good leadership skills. There are many leadership skills and styles. There are many books written on this subject. For me, I considered four skills that are critical for leadership. These are knowledge, attitude, fairness with caring, and communication. We need clear goals, well-defined strategies, adequate resources, and we need to work closely with the team to accomplish the mission. Remember there are no easy answers or cookbook solutions. The leader has to understand the cultural resistance of the department when change is called for.

Knowledge: Knowledge is power, and it is your vital asset. In service, you will find yourself in situations of discomfort and danger. You may not be able to predict or prevent these unwanted circumstances that cause fear, anxiety, and discouragement. Knowledge for a leader includes not only subject matter but also knowledge of personnel, their strengths, weaknesses, resources, choosing the right person for the right task. The leader should understand the mission of the Navy and the role of his team/unit to accomplish the mission. I realized during my first leadership role that the key is to study the unit's goals, assignments, resources and to evaluate the need for changes. If your goal is to accomplish the Navy's mission, you will receive the attention of your unit. When you demonstrate detailed and thorough knowledge of the unit's mission and the unit structure, you receive the respect of the unit. Knowledge and sound decisions are crucial for effective leadership that inspires loyalty. You have to be flexible and be able to utilize the available resources to accomplish the mission. During the Gulf War, I was assigned to the Fleet Hospital 5 in Al Jubail, Saudi Arabia about 80 miles south of Kuwait. I was the Director of ICU that had 80 beds. This was a tent hospital and the equipment was not comparable to what you have in the ICU in the USA. There were many limitations to traditional practice but we were able to provide the care that was necessary to help these wounded and ill military men and women to stay alive and to arrange transportation for them when stable. Knowledge and experience can overcome the obstacles.

Attitude: We have the freedom to choose the attitude. Embrace a positive and rewarding attitude. Having a healthy, positive attitude consumes less mental energy with high productivity. It is also contagious. Your hopeful outlook through difficulties, trials and discouraging situations can energize your team and keep the mission on focus. It will create innovative ideas, paradigm changes and opportunities to excel. Good attitude toward life begins with gratitude towards God. A positive attitude in times of crisis, chaos and calamity will determine your strength. My attitude at home and work is very important to me. I learnt the secret that talking of positive things that happened in your life and in others' life instill positive feelings and create a positive attitude within you and in those surrounding you. Well, we all get into the trap of sharing negative things at times - some days more often than others. I realized, often it is an expression of self pity and other times, it is a forewarning to your colleagues to prevent them from facing unwanted end-results. Remember, when you engage in negative talk, do not share it with your junior colleagues or with your superiors. Choose your friends wisely and they can be your sounding boards. Recognize and reward your staff. I actively seek out opportunities to recognize and reward my trainees and staff for their accomplishments and contributions to the department. All champions have seen failures. Failure is not an end. There are plenty of good footprints that need accolades.

Caring with Fairness: I strongly feel you cannot care unless you are fair. You have to be a good listener to be fair and to care. Listening is an art and it has a broader dimension than you think. In the last twenty years, I have met a few colleagues who have the art of listening. With increasing demands on productivity and time constraints, this valuable tool for strong leadership is often ignored or underutilized. Listening with sincerity followed by guidance and mentoring will make you a strong leader. Your caring and fairness will earn the loyalty and respect of your unit. Your unit will seek your advice and appreciate your feedback if you demonstrate fairness in your actions.

Communication: This is a crucial skill you need to lead your team. In the military, we diligently follow the chain of command in communication, a discipline that is critical for smooth operation of our mission. Communication is considered to be effective when the mission is accomplished successfully. It travels through many tiers of leadership and therefore has the potential to break down. An efficient leader considers proactively all the possible avenues of miscommunication and prepares in advance to prevent them. An effective communication requires the ingredients of articulating precisely, listening carefully and understanding clearly. Now we know why communication can fail. I learnt early on that you must do a careful follow-up on your communication to reap a successful outcome of your mission.

Over the years, I have tried to capitalize on my strengths. I have become very aware of my skills that need extra attention. Successful leadership at higher levels calls for personal introspection, education and commitment. I have learnt to prioritize, receive training, teach others, be prepared and try not to be defensive. I have the following quotes in my office. "Wisdom is knowing when to speak your mind and when to mind your speech", "Wisdom is knowing what to do, skill is knowing how to do, and virtue is doing it". Leadership is an ongoing challenge. In the military, approximately one fourth to one-fifth of the staff in a team change every year and consequently, the training and cumulative knowledge of your team changes. You may be deployed or transferred. You may be called for a humanitarian or combat mission at a moment's notice. Discipline, details and dedication are cornerstone to sound decisions. Sound decisions and strategies earn respect and loyalty that are pivotal for successful mission. A cohesive unit can face the challenges and obstacles with courage and commitment.

The core values of the Navy are commitment, honor, integrity and loyalty. These are the essentials of a role-model leader. I do not expect every one and every action to be perfect. After a few years in the Navy, I began to understand the different leadership styles and personality traits. I got my skills analyzed so I know how to maximize my style in working with others of different leadership skills. I also read books to get better grip on leadership styles of men and women. Not having too many women in leadership in Navy medicine in my early career, I am keenly aware of the value of mentoring.

In summary, I have sailed through calm and stormy seas. There are only a handful of international medical graduates in the military. Most of the international medical graduates in the military have demonstrated exemplary leadership and have received awards of recognition. The basic skills of knowledge, attitude, caring with fairness and communication have helped me to lead my team to accomplish the mission. I have enjoyed the collegiality of my comrades, shared mutual trust and respect and have received loyal support. Personally for me, the team includes patients and health care providers, military and civilian, officers and enlisted staff. I am glad that I did not leave the Navy after my two years of obligated time but chose to pursue my naval medical career. I was chosen as the Governor for the Navy Chapter of ACP in 1999. My husband and family have always been my encouragers and sounding boards. With God's protection and guidance, I enjoy serving the country both during peace and war times.

This article was prepared for the ACP IMG Web site in 2000.

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