This is a summary about dealing with a difficult boss, based on a talk from the 2018 onthewards conference with Dr. Anthony Llewellyn, an expert in Medical HR. His background is as a Consultant Psychiatrist and Medical Manager with 20 years’ experience as a medical practitioner in public health and leadership roles. Anthony was formerly the Medical Director of the Health Education and Training Institute. He is now a Senior Lecturer at the University of Newcastle and the Co-Founder of Advancemed (www.advancemed.com.au), providing career support to medical trainees.

The difficult boss

Difficult bosses: a topic that is not taught or discussed and really does have a practical effect. Most senior doctors are well-meaning, generally. They care about their patients, trainees, and those they work with. But, as a rule, most senior doctors, “the bosses,” on a good day are probably sub-par managers and on a bad day, far worse than that. The problem with having so many sub-par managers is that the bosses are generally very bad at dealing with those that are the very bottom rung of management.

This leads to problems like this:

“Instead of support, providing understanding or even validation of how I was feeling, the BOSS turned it back onto me and suggested that I am being ‘too sensitive.’”

Junior Medical Officers often experience bullying and harassment

That is just one of the many comments to come out of the NSW JMO census about issues surrounding bullying and harassment. The quantitative data from that census showed that 57.5% of JMO’s were reporting having experienced bullying. Furthermore, 18.6% had experienced sexual harassment in that year. Yet, 40% of all of those that experienced bullying or sexual harassment chose not to do anything about that behaviour in that environment, and for the 60% that did, most of them reported negative outcomes for escalating their concerns. In addition to these statistics, a NSW public sector employees survey found that only 45% had a favorable view of senior management, that is, more than half of the people in health that responded to the survey didn’t think their managers were doing a good job.

Reasons behind poor management

A difficult boss can be challenging, but the question is, why do we have this ‘difficult boss’ problem? There are many reasons and some of those reasons resonate across many fields and professions. Good managers are hard to find. Google, for example, has a team set up to identify good mangers and look after them. More specifically, the health sector is very hard to manage as people tend to be promoted based on their past and current performance. Which is great up until a certain point where that promotion includes a managerial role.

In healthcare, at some stage, an employee will jump from just doing clinical work to also managing and leading a team. If this jump has not been supported by simultaneous managerial development, therein lies a problem. Additionally, good leadership does not necessarily equal good management. There is a skills transfer failure, where doctors are not taught how to put some of their best leadership qualities into the management of people. On top of this, people who are in management need feedback, but often don’t seek it.

It’s all about empathy

A difficult boss can seem unreasonable, fussy or particular. However, sometimes trying to understand where this boss is coming from can benefit you. Yes, it’s all about empathy. You don’t have to agree with what they are doing but you need to think about it from their perspective. As a general tip, remember that your boss has their own boss and that boss is probably driving a lot of your boss’ behaviour. This may explain why some of the things you see (or don’t see, for that matter) your boss doing may be annoying for you. Some studies have shown that up to 75% of the stress of middle managers is derived from their relationship with their superior boss.

The Yes boss

There are a number of stereotypes for difficult bosses, each with their own way of living up to that title. The most common stereotype is, ‘The Yes Boss’. This boss says yes to anything and anyone because they seemingly “don’t want to upset anyone.” They leave you frustrated because a lot of those “yeses” mean you have to do extra things. Thinking empathetically, maybe this boss is very new to the role and unsure of themselves. Or, maybe they worry about establishing credibility with their peers before saying no to things. The positive thing about this type of boss is that they’re generally up for a chat, meaning they may be responsive to a friendly empathic conversation about feeling new and unsure. Or, perhaps you could make it clear that you are happy to support more firm decisions (like saying “no”) when they’re needed.

The Absent boss

The next most common type of difficult boss is, ‘The Absent Boss’. This boss has a well-established reputation for not being there when you need them. They seem to always be off at a conference or at an important meeting. Empathetically, this boss tends to collect a lot of roles, are usually high in demand, struggles to see clinical work as the priority and struggles to manage their time. This type of difficult boss might be a blessing in disguise – could this be your opportunity to lead? This boss is unlikely to be annoyed if you take on more responsibility and even source supervision from elsewhere. This boss may even be more receptive knowing you took the initiative. For example, the absent boss may well be lured back if you can use some of your newly developed management skills to streamline the ward round.

The Bully boss

A difficult boss is one thing but dealing with a bully boss is another matter. In this case, you should tread carefully. There are two main stereotypes of a bully boss that you should be aware of. The first and more common type is ‘The Explosive Bully Boss’. This bully boss is generally driven and committed to their career but has low self-control and emotional intelligence. Annoyingly, they are often well regarded and or tolerated by seniors. But this type of bully usually evolves over time, not overnight. Often, these bosses are usually burnt out and are unaware of the impact of their behaviour. Whilst they have been known to change their behaviour on their own, it is more likely to occur if pointed out by a peer.

The Arsehole boss

The second type of bully boss is, ‘The Arsehole Boss’. This bully boss engages in bullying and belittling of those with less power than themselves. They usually leave people feeling oppressed, humiliated and de-energised. This type of boss may also be referred to as a sociopath or anti-social. There are fewer ways to deal with a boss like this, such as reporting them or avoiding them if you can. Studies have shown that if you move your desk away from the bully then they often re-target.

Hiding in plain sight is another great strategy, especially for trainees. There is often more than one of you that are all being exposed to the same bully. Make a pact with your colleagues that you will never allow each other to be alone with the bully. Always team up and have each others backs. Lastly, don’t be a bystander. If you see this sort of bullying, you should report it. Or, try one of the above strategies to help combat this type of behaviour from occurring again.

How to be a good boss

To cover all bases, sometime in the future some of you will be become THE BOSS. Simple things like feedback can help you avoid becoming that difficult boss in Medicine. The 360-degree evaluation tool (Gregory et al., 2016; Hageman et al., 2014) is one example where a person receives structured feedback from their seniors, peers, and juniors. Consider getting a coach or mentor to harness the skills you already possess.

Lastly, don’t be a bystander, be known as someone who does not shirk responsibility or defer a difficult conversion. Be the boss that is willing to take on some of the more difficult patients or procedures. This may make some of your absences or “yeses” less of an issue for your team.