A week ago, a business school professor named Chris Marquis started a fight.
He wrote in The New York Times that business schools should be shut down. He’s taught at Harvard, Cornell, and Cambridge. So he understands what he’s criticizing.
People responded quickly. Sachin Jain, a physician who runs a health plan and once sat in Marquis’s classroom at Harvard, pushed back. Don’t burn the schools down, he said. Fill them with people who have actually led. And get serious about ethics.
Shivaram Rajgopal from Columbia said the real problems don’t start in the classroom. They show up later, inside companies, where hierarchy and incentives shape behavior.
Marquis then shared something that stayed with me. He once asked first-term MBA students to write down their goals. The goals were inspiring, but after fourteen weeks, he said they had disappeared.
I read it all with a particular kind of interest. I’m a physician. I also have an MBA. And everyone in that debate was asking the same question: Where do leaders get their sense of purpose?
Physicians already know the answer. We just don’t say it loud enough or often enough.
You Walked In With a Why
Medicine gives you your Why early on.
You feel it the first time a patient trusts you with something they haven’t told anyone else. You feel it at 2 a.m., on call and tired, when you go back to the bedside anyway. No one needs to send you to business school to find purpose. You came into leadership carrying one.
I earned my MBA through an online executive program. It gave me practical tools. Now I understand strategy and marketing in ways I didn’t before, and I’m glad I took the program.
But purpose was never at the center of that education.
To be fair, some business schools do teach it. But generally, it’s a side dish. Strategy, finance, and marketing are the main course of an MBA.
And that meal is built for what the philosopher James Carse called a finite game. Finite games are played to win. Beat the competitor. Take the market share. Close the quarter.
Carse described another kind, too: the infinite game, played not to win but to keep playing. Simon Sinek later made the idea famous for leaders. Healthcare is an infinite game. There is no final whistle. There’s just the next patient.
Apart from conditions that can be cured with antibiotics, chemo, or the knife, most conditions are chronic. For most patients, most doctors never get to declare victory and go home.
Here’s an interesting twist. Michael Porter is the father of competitive strategy. When he turned his attention to healthcare, he and Elizabeth Teisberg didn’t start with competitors. They started with patient outcomes. That’s the root of value-based care.
When the expert in finite games looked closely at medicine, he had to begin with a Why.
Medicine instills the Why. Business school doesn’t add it. If Marquis is right about those fourteen weeks, it may even wear it down. And nobody — not medicine, not business school — teaches physician leaders to say it.
That’s where things go wrong.
People don’t buy what you do; they buy why you do it.
— Simon Sinek, Start With Why
“That’s Real Life”
During my residency, I worked for a faculty member who wanted us to see patients more quickly.
He said it all the time. In one-on-ones. In the conference rooms. In hallways.
“You’re spending too long in there. You need to move.”
Someone once asked him why.
He shrugged. “That’s the way things are in real life.”
We nodded. We moved faster. And later, in the breakroom, someone muttered what most of us were thinking.
“He only cares about volume.”
I don’t think he cared only about volume. I think he had a good reason. Several, actually.
Faster visits mean more patients are seen in a given time. Patients’ time gets respected. Suffering ends sooner. And doctors’ perfectionism doesn’t get in the way of helping more patients.
Those are moral reasons — a doctor’s reasons.
He probably thought of all those reasons. He just never shared them.
Listen to the difference between the two sentences:
“See patients faster. That’s real life.”
“See patients faster, because the person holding her side in the waiting room is in pain, and you’re the only one who can end it.”
Same instruction. The first one gets compliance and quiet resentment. The second gets commitment.
Don’t Switch Hats
A famous line comes from the night before the 1986 Challenger launch. Engineers at Morton Thiokol, a NASA contractor, argued it was too cold to launch safely. They argued that an O-ring was likely to fail. When NASA pushed back, a senior Thiokol executive told the head of engineering to take off his engineering hat and put on his management hat.
He did. Over the objections of his engineers.
We know how that ended.
Physician leaders hear a similar message: You’re in administration now, so think like a manager. The pressure is real, even if no one says it out loud.
But the answer isn’t to change hats. It’s to refuse to switch at all.
Speak both languages in the same sentence. “Faster” is business-speak. “Because they’re in pain” is a doctor’s language. Your job as a leader is to put them side by side, every time.
How the Why Gets Said
I’ve spent a couple of years in competitive public speaking. Here’s what that taught me about saying a Why so it lands.
Say it all at once. Don’t give the instruction now and save the reason for a memo later. People remember what you say first. If you send out the “what” by itself, the “why” never catches up.
Make it a picture, not a principle. “Improving access” is a principle. Nobody feels it. “The woman who’s been holding on in the waiting room for an hour” is a picture. Everyone feels it.
Repeat it until your team can say it without you. Saying it once isn’t enough. In a speech, you come back to the main message on purpose. Leadership is the same. When your team explains the Why to a new hire before you do, it’s theirs now.
He who has a why to live for can bear with almost any how.
— Viktor Frankl, quoting Nietsche in Man’s Search for Meaning.
The Silence Isn’t Empty
You probably have a Why. Most physician leaders do. That isn’t the question.
The question is whether anyone you lead has ever heard it.
Because when you don’t say your Why, your team doesn’t just hear the absence of a Why. They fill the gap. And they rarely fill it with the most generous version.
“Move faster” becomes “They only care about volume.”
“Document better” becomes “It’s all about billing.”
“We’re changing the schedule” becomes “They don’t care about our opinions.”
That faculty member in my story probably went home most nights believing he was a good doctor leading good doctors. He may have been right.
But some of us left that department thinking he cared only about throughput.
Both stories are about the same man. But only one of them is the one he would have chosen.
Your team is already telling a story about why you ask what you ask. Your only choice is whether to tell it first.
The One Practice: The “Because” Test
Before you give your team an instruction this week, add a “because” sentence that a patient would recognize.
Not a metric. Not a policy. Give a reason that someone in a hospital gown would nod at.
If the only “because” you can find is “that’s how it is” or just a number on a dashboard, pause. You haven’t found your Why yet.
Find your Why. Then say it out loud, right in the same sentence.
