Meh. I think everyone has different styles of leadership and management; and as the others have said above it's very much dependent on the context of where you're working, with whom you're working with, and what speciality you're practicing in. I would imagine (and wouldn't be surprised) that there is stark contrast between those of us who are in family practice vs. in the surgical specialities.
I work as a family physician in my clinic in rural Australia and I (along with one other family physician) cover the base hospital just down the road. We have a handful of junior doctors (from interns to residents to registrars) and medical students rotating out to our country town throughout the year, and personally, I've found that I achieve much more been a paternalistic educator and mentor rather than distancing myself as some big boss on a high horse. We've used a system where one of us per group is a 'mentor' (to provide counselling or advice to the junior medico if they want or need it) and the other one of us is the 'supervisor' (who does the term performance reports, formative feedback, and wot not), so there is no conflict of interest; and rostering is done between the two of us senior attending doctors and with the help of our impartial admin secretary. We have a open-door policy and we are all on a first-name basis, be that between junior and senior medical staff, as well as between the nursing and allied health. I don't care much for pretentious titles and kowtowing to the boss attitude. If you practice long enough, you start to realise how petty and trivial these things are.
Don't get me wrong, I still have standards. I do expect people to work hard, show-up to work on-time, be professional and respectful, et cetera. I think you can still instil good work ethic and professional standards without the need to employ punitive demoralising and shaming tactics; like, I personally cannot see the benefit in telling my Intern that because I was not satisfied with his discharge summary, I am now docking 'x' demerit points and he's got to work weekends and do night shifts for the next fortnight; similarly, I cannot see the benefit of those senior registrars/residents who insist on belittling and humiliating a junior resident/intern on ward rounds, nor at those who like to talk down to nursing or allied health staff -- this is simply bullying and I cringe when I see colleagues I admire descend to this level of behaviour; I'd personally rather hire a polite half-competent resident than a rude arrogant genius registrar. Just because I was hazed as a junior doesn't mean I have to be a dick to those now under my command now that I'm a senior. Just because something has been done for a long time doesn't make it the right thing to do now. An important thing to realise that senior clinicians have a big influence on the attitudes and experiences junior clinicians take away with them, which in turn influences how they will themselves practice as senior clinicians; I'm probably over-generalising but I would dare to say a lot of people are steered away from surgery based on some select bad experiences during their clinical rotations in that specialty service, which is a pity because it is an excellent specialty at its core but riddled with this toxic hazing culture by a few bad apples who crush the ambitions of junior doctors because of difficult personalities and instances of bullying and lack of trainee support.
With regards to sacking people, of course there are the small percentage of *****s in any line of work who are complete slackers or criminally negligent and have to be dismissed after multiple chances have been made available to them to try and redeem themselves, but to be honest I have found a vast majority of people who do medicine are the 'Type A Personality' and respond to a slap on the wrist verbal sit-down-and-talk warnings and mentoring sessions, or to prepare a presentation. I've only ever dismissed one person in 8 years and he was a complete idiot that clearly didn't want to do medicine, was actually dangerous and blatantly negligent in his practice in medicine; he Ieft me no choice. Otherwise what I've typically done for a small handful of registrars/residents each year is simply fail them for this clinical training term and give them the option of repeating the with me (or my colleague) so that I address the problems instead of shafting them to another health district to be someone else's problem. (Perhaps this is a luxury of the Australian public health system, since a vast majority of the salaries paid to doctors-in-training is subsidised by the state government.)
In my opinion, I don't think medicine is like any other industry in terms of its job and training requirements. I don't think you can compare going to Maccas and been a fry cook (which so happened to be my first job) to medicine; funnily enough, even at Maccas, I had a senior crew member in the kitchen stand by me and patiently teach or "mentor" me on how to best cook the meat paddies and prepare the buns for the first few days I was there, and believe me, I was incompetent as they come and made a waste-bin of mistakes without getting penalised. The thing about medicine is that it is as much about service delivery (i.e. the "job" part; rostering, workforce-workload management, etc.) as much as it is about the ongoing traineeship of junior doctors to become senior ones (i.e. the "school" part still very much continues in the hospitals and clinics) -- of course there is a higher standard now that you're in a professional workplace of a hospital/clinic, but how many other professions have senior doctors blatantly acting as teachers right at the bedside of their patients with sometimes 10 or more junior doctors / medical students huddled around like as if they were still a tutorial room back at uni. I don't know about America, but in Australia, we have recognised this, and written into a majority of junior doctor contracts and specialty college training programs that there is protected teaching time away from clinical duties during the work week, that there allocation of senior doctor mentors (on a voluntary basis on the part of the junior doctor), and that junior doctors shouldn't be penalised in such a fashion of having to pull extra shifts because they sucked at doing something they're still actually learning to do. Speciality board and colleges are also enforcing their members (as a mandatory component of their CPD) to partake in education and training workshops so as to improve our approaches with managing the difficult trainee and addressing the issue of increasing mental health awareness and physician burn-out amongst our ranks -- largely because Australia has had several junior (and senior) doctors commit suicide in the last couple of years. Medicine is premised on progressive evidence-based practice, we should apply the same attitude with how we manage our junior staff; simply encouraging a hazing culture which has been done for the last century is not conducive by any modern standard.
