Everyone wants to make a good impression. But in the process, it’s easy to be perceived as presumptuous, circumventing hierarchy, and ambitious (not the good kind). Hence the hazards of “managing up” when you see the opportunity. Ideally, no young doctor should fear approaching a supervisor with ideas and observations.
“Oftentimes, people sit back and expect those with a leadership title, ie the boss, to solve the problems,” said Valerie Weber, MD, an Ohio-based International Coaching Federation-credentialed executive coach who has served as division chief of General Internal Medicine. “When someone comes forward with ideas and solutions, it is outstanding.”
Indeed, in the following four scenarios young physicians found that stepping in, speaking up, and offering solutions can transform patient care and even fast-track one’s career. Here’s how they did it…
1. A Set of Notes Lead to a Treatment Breakthrough
Infectious disease physician Michael Scoma, MD, spends his days managing complex multisystem patients, “the kind who rarely fall into textbook definitions, and never follow specific boundaries,” he said. But recently he had a resident step up to change the trajectory of a complex patient’s care — just weeks into her infectious disease rotation.
An ICU patient was an immunocompromised transplant recipient having daily fevers of unclear origin and declining multisystem function. “Multiple teams were involved, the clinical picture had become muddled, and the plan of care was growing inert,” Scoma said. His intern approached him with what he refers to as a “pristinely typed one-page outline of the patient’s cultures, antibiotics, inflammatory markers, and imaging, each section color-coded, and cross referenced.”
“It didn’t just help — it shifted the momentum,” said Scoma. “This intern’s analysis gave us the clarity that had been missing, allowing us to step back and delineate a pattern that had been overlooked which led to adjusting the treatment plan.”
By aligning fevers, cultures, and antibiotic timing side by side, she exposed a subtle pattern the team had missed. That helped the doctors adjust their antibiotic plan, remove redundancies, and focus on the true source of infection. Within days, the patient’s fever broke and organ function began to recover. The breakthrough, said Scoma, didn’t come from new data, but from seeing familiar data with fresh eyes.
“What struck me was this intern’s intuition whereby she recognized the clinical chaos and, instead of waiting for direction, brought order and clarity,” said Scoma. And that moment reminded Scoma that managing-up medicine isn’t about navigating personalities — it’s about elevating patient care. “Sometimes the most junior voice in the room is exactly what the case — and the team — needs to hear.”
2. Doctors Aren’t the Only Ones to Impress
When Caitlin Hauser, MD, first started as an OB hospitalist with OB Hospitalist Group (HG) in Richmond, Virginia, she quickly realized that gaining trust on the unit would be just as important as clinical skill. “I wouldn’t say it was one specific thing that I did that made people trust me, but I do think that it was a culmination of events that allowed me to gain the trust of the nurses and of the private practice providers,” she said.
She recalls one early example in which she took the initiative to step up in a critical moment. One day, she was the only OBHG clinician at the hospital and there was a call overhead for help. A private practice clinician was having problems with a shoulder dystocia case and had been trying for some time to get the baby out. “We have overhead pages for emergencies, and we have one doctor — me — that was on the floor that day,” she said. “Me and my midwife came to the room, immediately assessed the situation and were able to get the baby out.”
“I do think being in training recently, we have exposure to a lot of these emergencies that the private practice docs just don’t have the volume to handle,” said Hauser. In residency, she saw scenarios like this every day. She assessed the situation and was able to reassure the doctor and get the baby out.
Beyond stepping up when needed, Hauser focused on building strong relationships with both nurses and the 80 private practice physicians who deliver at the hospital. She took time to include nurses in discussions before entering patient rooms, ensuring they were prepared and engaged. “The nurses want to feel involved,” she said, thus she has made a point to always include them in conversations before they go into the room. “When I went into the room, they were already on my side, already knowing what the plan was going to be,” said Hauser.
She also found that being transparent about her status as a newer graduate was seen as an asset, not a shortcoming. Soon she found herself invited to a weekly conference to talk about the policies on the unit and even a part of helping to create a new postpartum hemorrhage algorithm at her hospital.
Hauser’s efforts paid off and by January of her first year, she was promoted to site director for the hospital, overseeing OB hospitalists and midwives, coordinating schedules, liaising with hospital leadership, and participating in quality improvement initiatives.
3. A Vision to Revitalize an Exhausted Department
When Valerie Weber, MD, first started as a division chief of Internal Medicine, she inherited a relatively small group of general internists who all did roughly the same thing — outpatient practice, hospital medicine, and inpatient consults.
“Most of the docs were dissatisfied with the status quo but hadn’t done anything about it — beyond a lot of grumbling,” said Weber. Then, a junior faculty member approached her with an idea for how to shake things up. “It was a very detailed and data driven plan showing that if we got the hospital to invest in a hospitalist program, we could really grow our group, provide needed services to the hospital, and grow our outpatient practice as well — solving multiple problems at once.”
“The old, traditional model of physicians in internal medicine seeing hospitalized patients in the morning, then seeing office patients all day, and maybe heading back to the hospital — essentially being a ‘jack of all trades’ — was becoming less workable as patients in the hospital were becoming sicker/having higher acuity, and changes in insurance reimbursement drove hospitals to want to reduce length of stay,” said Weber. These newer realities required physicians to be available in the hospital all the time. Getting a hospitalist group started was a new trend that was emerging around the country that Weber said her team hadn’t implemented yet. “I encouraged him to develop a business plan, and we then presented it to hospital leadership to get the required support.”
The way this staff member approached her as his chief, with data and a well-thought-out plan for growth, improving patient care, and increasing satisfaction of our docs, was the best example of successfully managing up that Weber has witnessed in her career.
“He came to me with solutions to problems that existed within our practice and the hospital,” she said. “The hospitalist program was wildly successful — I ended up appointing him the lead of it — and it now extends over multiple hospitals.”
4. Building a Wellness Program That Transforms Surgical Outcomes
“At our integrated plastic surgery and wellness practice, we were initially offering a narrow set of wellness services — IVs [ intravenous], a few peptides, and basic weight optimization — primarily operating in parallel with our surgical care,” said Diane Alexander, MD, FACS, plastic surgeon and co-founder of Artisan Beaute in Atlanta.
Cristina Del Toro Badessa, MD
That changed when she met Cristina Del Toro Badessa, MD, whose background in emergency medicine and integrative health expanded the practice. Del Toro Badessa came in with a goal to support surgical patients by looking at their cellular health — hormones, gut function, nutrition, and inflammation — so they could go into surgery in the best state possible and heal more effectively afterward.
That included hormone balancing, gut health protocols, brain health, regenerative therapies like exosomes, and longevity support. “More importantly, she began integrating these services directly into our pre- and post-operative patient care pathways,” said Alexander.
This completely reimagined the role of wellness in their patients’ surgical outcomes. “We saw reduced bruising, faster wound healing, better energy and resilience during recovery, and higher patient satisfaction,” Alexander said. In fact, the clinic has now formalized a “Surgical Optimization” program recommended for all surgical patients.
Diane Alexander, MD, FACS
Alexander said the partnership reshaped her own perspective after 25 years in practice. “I’ve always been curious why some patients heal so well and others don’t,” she said. “I do the same thing in every surgery — the same sutures, the same technique.” She believed internal health played a role but didn’t have the capacity as an in-demand surgeon to address it alone.
Working with Del Toro Badessa has far exceeded any visions she had for expanding her business. And it’s not just the science behind what she’s doing. “Yes, she’s expanded the offerings, but more it’s about establishing relationships, the trust of the patient,” said Alexander. “The way that patients and the staff love her is fundamental to the success of what she’s doing.”