On the afternoon Hao-Hua Wu, MD, a spine surgeon at the University of California, Irvine, spoke with Becker’s, an urgent case was already testing one of his central beliefs about medicine: The operation is only part of the job.
Before he could get to the technical work, Dr. Wu had to secure operating room time, align anesthesia and neuromonitoring, make sure the right trainees and equipment were in place, and speak with the patient and family.
The surgery itself still mattered most. But Dr. Wu’s point is that even a technically perfect operation can be undermined if everything around it is poorly led.
That realization has shaped how he thinks about one of medicine’s quieter training gaps: Physicians spend years learning how to diagnose disease and perform complex procedures, but receive far less formal preparation for leading the people and systems required to deliver that care.
“I’m often in situations where I am not the person that’s totally in charge of everything,” Dr. Wu told Becker’s. “But at the same time, there are a lot of people around me that still look up to me for guidance.”
For spine surgeons, leadership rarely begins with a title. It shows up when an OR schedule falls apart, a resident needs feedback, a patient leaves a negative review or several specialists must align around one difficult case.
Dr. Wu believes those skills can be taught, and should be taught before physicians are forced to learn them by trial and error.
The leadership gap opens early
Dr. Wu first became interested in leadership during orthopedic residency at University of California San Francisco after reading about the idea that influence does not depend on formal authority.
The concept fit residency particularly well. Residents answer to attending physicians while simultaneously guiding medical students, nurses and other team members. They are still learning, yet others already depend on them.
The tension becomes even sharper after fellowship. Dr. Wu believes the leadership gap may be most visible in the first years of practice, when a new attending is expected to project confidence to patients, teach trainees, build a reputation and make independent decisions while still developing.
“You can feel things like imposter syndrome,” he said. “You start out and you’re like, ‘Man, I haven’t done a case yet, but somehow I have to market myself as someone who’s great at surgery.’”
Patients can review that experience publicly. Trainees expect good teaching. Administrators expect productivity. The young surgeon has to meet those demands while preserving room to learn.
“How do you give yourself space to learn, deliver excellent care, but also to teach?” Dr. Wu said. His answer has been to treat leadership less as a personality trait and more as a set of skills that can be practiced.
A bad moment does not require a bad reaction
One of those skills is learning not to confuse emotion with reality. Dr. Wu experienced that the morning of the interview. An urgent spine case scheduled for 9 a.m. was delayed until noon because another patient needed an emergency brain operation.
His initial reaction was frustration. Then he reconsidered. The OR staff had not disregarded him or his patient. They were responding to a more immediate emergency.
“The biggest thing that’s misunderstood is that what you feel as an emotion is not necessarily truth,” Dr. Wu said. He identified what he was feeling, considered what remained within his control and secured the next available operating room time.
That pause matters in a high-pressure environment. A surgeon who reacts by yelling at staff may satisfy the emotion of the moment while damaging the relationships needed to solve the problem.
“If I didn’t try to do that, it would be very easy to let the emotion force me to be reactive rather than proactive,” he said. Technical authority does not automatically make a team work. Leadership often begins with how the surgeon responds when things do not.
The patient experience is part of leadership
Dr. Wu applies the same thinking to patient care. He uses a framework he calls LEAD: listen, empathize, advocate and deliver.
“I want there to be emotional connection,” he said. “I want them to feel like they’re heard.”
That shapes how he interprets feedback. One patient complained about waiting. Dr. Wu thought the criticism was fair, but he also knew why appointments sometimes ran long: He was spending more time with patients.
Instead of shortening the visits, his team began setting expectations differently. Patients were told they might wait longer because he spends additional time in the room, and that they would receive the same attention when their turn came.
The adjustment preserved something he valued while responding to something the patient valued. That same tension appears at a larger level. Health systems can easily measure RVUs, surgical volume and complications.
Some of the work Dr. Wu values most is harder to quantify. Calling a patient after surgery does not necessarily produce additional reimbursement. Spending longer listening can reduce clinic throughput. Mentoring a resident may never appear on a productivity dashboard. He does those things anyway.
“The hospital values the fact that I bring a lot of RVUs from the surgeries I do,” he said. “They don’t give me more money when I call my patient after surgery to check in on them, but I do that for me because I know that’s what I value.”
For Dr. Wu, that is one of leadership’s most important disciplines: knowing what you are optimizing for. Without that clarity, external incentives can quietly decide how physicians spend their time.
Work-life balance may be the wrong goal
The same principle shapes how Dr. Wu thinks about burnout. He does not believe a demanding surgical career can always be divided neatly into equal portions of work and personal life.
A complication does not wait until business hours. A patient may call at 11 p.m. A surgeon may technically be off and still be the person best equipped to solve the problem.
Dr. Wu prefers “work-life integration.” The goal is not to match every hour of work with an hour away from medicine. It is to build enough restorative experiences into life that the work remains sustainable. For him, that includes basketball, family and reconnecting with mentors and colleagues.
The people he sees thriving over long careers, he said, tend to integrate the two rather than constantly trying to keep them separate.
Leadership before the title
Spine surgery continues to become more technical. Robotics, navigation, minimally invasive techniques and motion-preserving procedures are expanding what surgeons can do.
Dr. Wu believes some of the skills that determine whether those capabilities translate into good care are far less technological. Manage emotion before it manages you. Resolve conflict without damaging the team. Listen closely enough to know when criticism is useful. Teach while continuing to learn. Know which values to protect when institutional incentives point somewhere else.
None requires becoming a department chair. That is the point.
Dr. Wu became interested in leadership because he realized early in training that waiting for authority was impractical. Patients and colleagues already needed him to influence outcomes from wherever he stood.
Medicine will always need spine surgeons who can perform technically excellent operations. His argument is that the best ones also learn how to lead everything around them.
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.
