Letter from the Editor: Opportunities Arise When Leading Through Disruption

by Alexander G. Chiu, MD •

Each one of us is a leader. Whether we manage an academic department of 300 employees or are in solo practice with a nurse and a biller, we make daily decisions that directly affect our patients and indirectly impact our employees. Some days are harder than others, and with the constant upheaval of the COVID-19 pandemic, I’ve begun to think more about what it means to lead in a time of disruption.

I can think of two recent examples from the business world that highlight how important it is to be agile and forward- thinking during disruption. Netflix launched in 1997, the same year I started my internship. In those days, 100-hour work weeks were the norm, and any weekend day off was a perfect excuse to lie on the couch and watch DVDs all day. I didn’t have the time or patience to go to Blockbuster to rent and return my movies. When Netflix offered a service to order a DVD and return it at my leisure, I jumped at the opportunity. By 2005, Netflix was shipping over 1 million DVDs a day. Blockbuster failed to pivot from the brick-and-mortar model and quickly went out of business. Netflix recognized the disruption, successfully pivoted to a streaming rental business, and expanded its portfolio to content development.

Contrast this with General Electric. I grew up in Schenectady, N.Y., where GE had a large turbine manufacturing plant where my parents worked for 30-plus years. GE was one of the original 12 companies listed in 1896 on the newly formed Dow Jones Industrial Average (DJIA). In the late 1990s, led by legendary CEO Jack Walsh, GE’s market value stood at a massive $600 billion. In 2001, Walsh retired, and, over the next 16 years, the company’s value plummeted from $600 to $53 billion; despite being an original DJIA member, GE was unceremoniously removed from the stock exchange in 2020. There are many reasons for its downfall, but most will point to the company becoming too big to manage while not being agile enough to pivot with the 2008 financial crisis.

So where does medicine fit in? The pandemic has caused a record number of people to leave the workforce, and we’ll be faced with provider shortages in the very near-term future. Health inequities persist, we sometimes face a difficult philosophical divide with patients who choose not to vaccinate or mask, and physician burnout rates are at an all-time high. But there are still tremendous opportunities.