When William Levine, MD, became chair of orthopedic surgery at New York City-based Columbia University in 2014, he thought he understood leadership.
More than a decade later, he believes one of the biggest mistakes in medicine is assuming yesterday’s approach will work tomorrow.
“If your style is very monotone and you only have one way of doing things or one way of leading, you probably will fail in today’s world,” Dr. Levine said June 11 at Becker’s 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago. “I may actually have to use four or five different leadership styles within the same day.”
For Dr. Levine, who also serves as orthopedic surgeon-in-chief at NewYork-Presbyterian/Columbia University Medical Center in New York City, that lesson has shaped how he thinks about nearly every part of medicine: leadership, surgical decision-making, innovation and training the next generation.
The common thread is adaptability.
The surgery patients may not need
One of the clearest examples comes in the exam room. Dr. Levine said he sees roughly 10 patients each week who arrive after being told elsewhere that they need surgery when, in his view, they may not. The pattern points to one of the most uncomfortable tensions in surgery.
“There is no bigger conflict of interest than a surgeon telling a patient they need surgery if it’s not life- or limb-threatening,” he said. In a fee-for-service system, surgeons are often responsible for recommending a procedure while also benefiting financially if that procedure occurs. Compensation models can deepen that tension.
Dr. Levine said pure work-relative value unit models can change behavior in ways physicians and leaders cannot ignore.
“It’s sad but true,” he said. “You have to fight that fight all the time.”
For him, the healthier model begins with restraint. Patients may arrive convinced they need an operation. His job, he said, is often to slow the conversation down.
“I’m never going to force you to have an operation until you tell me that your symptoms are bad enough,” he said.
Building what did not exist
That same willingness to challenge assumptions shaped one of the most consequential decisions of Dr. Levine’s tenure at Columbia. When he became chair, spine surgery was one of the department’s clearest growth opportunities. Columbia had recruited young spine surgeons before, but the model was not producing the program he believed the institution needed.
“We had done things at Columbia for a million years, and it was the same thing over and over again,” he said. “It was a little like Groundhog Day.”
Rather than hire another individual surgeon, Dr. Levine proposed something more ambitious and unconventional: Recruit three senior spine surgeons at once and build a dedicated spine hospital within a hospital.
Today, Och Spine at NewYork-Presbyterian/Columbia performs some of the world’s most complex spine procedures and has become one of the institution’s signature clinical programs. For Dr. Levine, the lesson is leaders have to recognize when incremental change is no longer enough.
The innovation trap
Dr. Levine has helped develop orthopedic technologies, worked with implant companies and spent decades evaluating new devices and procedures. However, he is skeptical of certainty masquerading as progress.
One piece of advice from mentor John Richmond, MD, has stayed with him throughout his career.
“Don’t be the first and don’t be the last,” Dr. Levine said. Orthopedics is closely tied to industry and device innovation, a relationship he believes has produced enormous advances. But when surgeons adopt new technology before understanding its limitations, risk is created.
His rule is simple: Before a new device or technique reaches a patient, it should be tested carefully in a lab or educational setting.
“When people say learning curve, your mom and dad and brother and sister and loved ones are on the end of that learning curve,” he said.
Dr. Levine pointed to superior capsule reconstruction in shoulder surgery as a cautionary example. The procedure generated enormous enthusiasm and was rapidly adopted across the U.S., but as longer-term outcomes emerged, many surgeons found the results failed to match the early promise.
“Thousands and thousands and thousands of patients had this operation,” he said. “And they failed at about a 90% rate. It was terrible.”
For Dr. Levine, the lesson is that innovation and evidence do not always move at the same pace. “You have to use your judgment and not just be wooed by the latest fancy widget,” he said.
“You have a moral obligation as a surgeon to be a physician first,” Dr. Levine added. “Remember the Hippocratic oath and do no harm.”
The leadership lesson hidden in conflict
Early in his tenure as Columbia’s orthopedic surgery chair, Dr. Levine made a promise to his faculty. He would be transparent. He would be fair. He would explain decisions when he could. But he would not always make decisions everyone liked.
“I would not always make decisions that you’d be happy with today,” he said. “But hopefully you’d respect why the decisions were made.” That approach became especially important during periods of crisis, including COVID-19 and a prolonged nurses strike that tested hospitals across New York City.
Leadership during those moments required a different skill than ordinary management.
“There is a disconnect between the information available to the people you’re leading and you,” he said. “And you can’t always share that information.”
Those moments require trust. They also require leaders to resist the temptation to believe one leadership style will work in every circumstance.
What residents are teaching him
Dr. Levine sees the same principle in medical education. After decades of training orthopedic surgeons, he rejects the familiar complaint that younger generations are less committed or less capable.
He believes they simply are different. And in some ways, better.
“They have a much better and healthier perspective on work-life integration,” he said. The more important lesson, he said, is that senior physicians often mistake unclear communication for poor performance.
Attending surgeons may assume residents know what is expected of them. When expectations are not met, they blame the trainee. Dr. Levine has come to see that differently.
“I was the failure, not you,” he said. “I failed to communicate what those expectations were.” For him, that insight applies to leadership in any setting.
The danger of certainty
Whether discussing surgical indications, new technology, residency training or departmental strategy, Dr. Levine returns to the same warning.
Medicine becomes dangerous when people stop questioning themselves. When leaders believe one style is enough. When surgeons believe every problem needs an operation. When innovators believe new always means better. When teachers believe trainees should learn the same way they did.
The leaders Dr. Levine trusts most are not the ones who always have the answer. They are the ones willing to keep asking better questions.
In modern orthopedics, he believes that may be the difference between adapting and falling behind.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
