Charting the course: Dr. Abdurrahman's prescription for medical leadership

“People think leadership has to be a loud person standing in front of everybody, declaring themselves the leader. Leadership isn't a dictatorship. Leadership is not always that loud person.”  -- Dr. Zainab Abdurrahman

On this episode of "The Allergist," we explore what leadership in medicine actually means with Dr. Zainab Abdurrahman, an accomplished allergist and clinical immunologist. Dr. Abdurrahman, who wears many hats including that of an assistant clinical professor of pediatrics at McMaster University and the incoming president-elect of the Ontario Medical Association, shares her insights on what it means to be a leader in the medical field.

Leadership, as Dr. Abdurrahman explains, is not just about being at the forefront; it's about inspiring and motivating others, guiding teams towards a common goal, and sometimes, leading from behind to allow others to shine. This episode is not just about the theoretical aspects of leadership but also about its practical applications in the challenging landscape of healthcare.

Dr. Abdurrahman's journey is a testament to the diverse forms leadership can take, from being the team lead in mock codes to shaping the future direction of healthcare in Ontario. She discusses the challenges and opportunities that come with being a female leader in medicine, breaking stereotypes, and paving the way for future generations.

So, whether you're an aspiring leader, a medical professional, or someone curious about the intersection of leadership and medicine, this episode offers valuable insights and inspiration. Join Dr. Mariam Hanna and Dr. Zainab Abdurrahman on "The Allergist" as they explore the essence of leadership in medicine and how it shapes the healthcare landscape.

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Transcript

Dr. Mariam Hanna: Hello, I'm Dr. Mariam Hanna, and this is The Allergist, a show that separates myth from medicine, deciphering allergies and understanding the immune system.

Do you remember mock codes during training? A call to action, followed by a set of coordinates, and then a quick dash to the right location. We file into our roles, and there was always the essential one: the team lead. Our success or frustration through the rest of the code would ride upon not only our abilities but those of our team leader. The next ten minutes would test their leadership knowledge base, ability to remain calm under mounting pressure, and communicate effectively to the rest of the team. That's not too much to ask, is it? Our success or frustration depended on them. Our cohesion, our chaos was a result of their direction. Leadership in medicine is a big topic. It's not just a chapter in a textbook. It's a calling. Being a leader is a fundamental role of being a physician. We're looking for leaders in medicine as our healthcare system gets challenged and calls for change, improvement, and new direction mount. When the topic of leadership in medicine came up, I was actually surprised at how many extraordinary candidates I could approach across Canada; we've been making waves over the past decade. Today's guest, however, really stood out, and you'll soon see why. It's my pleasure today to welcome Dr. Zainab Abdurrahman. Dr. Zainab Abdurrahman is an allergist and clinical immunologist. Dr. Abdurrahman is a woman who wears many hats. She's an assistant clinical professor of pediatrics at McMaster University and runs a busy community practice in Mississauga, Ontario. She is currently a board director at the Ontario Medical Association. Drumroll, please. She is the incoming president-elect of the Ontario Medical Association. That's right. In 2025, the president of the largest provincial medical association in Canada will be this incredible allergist, Dr. Abdurrahman. Thank you so much for taking time out of your busy schedule to join us, and welcome to the podcast.

Dr. Zainab Abdurrahman: Thank you. Thank you so much for inviting me to talk about this great topic.

Dr. Mariam Hanna: Dr. A, we're going to have a lot to talk about on this big topic. So let's start with the hardest question, just to get you warmed up. What is leadership?

Dr. Zainab Abdurrahman: This is a great question because leadership is so many things. Leadership is the ability to inspire, motivate others to achieve potential. It's also mapping out where we need to go as a team or as an organization, and helping guide a ship to get to the location. It's also a different type of role in each different situation. So, like you talked about with mock codes, you could think of someone standing at the head of the bed directing a team, but it could also be someone working quietly in the background who is seamlessly coordinating and allowing others to shine. So leadership is a lot of different things and may not be what you think of as classically leadership standing at the foot of the bed, but also could be the quiet movements that start a whole tsunami.

Dr. Mariam Hanna: I like that you said that because I was classically the one that would look down or avoid eye contact when they were looking for the team lead. So tell me, why are you actually so passionate about this topic? Where did this fire start?

Dr. Zainab Abdurrahman: I think the fire started because oftentimes people think of it as just a classic type of leadership. It has to be a loud person standing in front of everybody, declaring themselves the leader. Leadership isn't a dictatorship. Leadership is not always that loud person. I think I'm passionate about it because there are so many different aspects of leadership, and there are a lot of different ways that you can lead. You can lead in something as small as just going to vote in an election that affects you and your peers in your community. It can be as big as taking on a role, such as being a board director of the Canadian Society as yourself. It could be so many different ways. And so I'm passionate about it because I see the opportunities for us to essentially shape our communities, our organizations that we're part of, and to have an impact. And I'm passionate about sharing with others the different ways they can do it and letting them know it doesn't have to be in a classic way. It can be in your own way. You can be a leader in the way you choose to be. And it's not only for a select few; it's actually for everyone.

Dr. Mariam Hanna: What a beautiful answer. Okay, I'm going to put you on the spot, and only if you're comfortable. Is there a key moment that you remember for you personally that set you on this path? Was there like an "Aha. This is what I'm meant to do"?

Dr. Zainab Abdurrahman: I think about a lot of different times that this has come up, but one of the things that I always think back to is when I was actually really little, and I remember having a report card and showing it to my mom and being a bit worried because although the grades were fine, you know, it's those comment boxes that get you. And I remember reading the comments, and there were two comments I was particularly worried about. One said, "Zainab is bossy," and the second one said, "Zainab talks too much in class." And I remember thinking, oh, boy, this is it. We're getting in trouble for this. And my mom said, "You know what? Authoritative females are often seen as bossy until you become the boss. But it's very disrespectful for you to talk in class, which takes away from your own learning as well as your peers' learning, and that is unacceptable." And so in that moment, I got in trouble for talking a lot in class and talking out of turn, but I did not get in trouble with being bossy. And I realized, you know what? Being authoritative and being outspoken is not the thing that's bad, but obviously, speaking out in class and being disruptive in class is. And so in that moment, I realized, you know what? Being called bossy or being authoritative and that talks a little bit about how we say it to, perhaps young girls and females in general, it's the term bossy versus perhaps if I was a male, I probably would have been said at, ah, leadership qualities. And my mom just said, being bossy is fine. It means you're going to be a boss, but don't talk out of turn in class. And so in that moment, I realized that talking out of turn in class is bad, but being authoritative and wanting to lead is not. So that's one of the first moments I would say I can think back.

Dr. Mariam Hanna: Your mom sounds like a boss, and you, Dr. Abdur Rahman, are definitely a boss. I'm going to call out a topic that you mentioned very nicely. What challenges do you face specifically as a female in these types of positions?

Dr. Zainab Abdurrahman: Yes, there are a lot of preconceived notions about certain characteristics. In some genders, being perhaps very straightforward and very straight to the point is actually often commended, and people often will look up to that kind of behavior. But when it's done, perhaps by a female, people can be a little bit more defensive and may call it out in a negative way more so. And this has been, I think, a struggle with it. I think of even my pediatrics residency, and in the first year, everyone gets different nicknames, and mine was "the surgeon," and that was because I'm not one to, although I'm a bit of a talker, as you may know, in one sense. But when I'm doing rounds, when I'm running a team, I don't enjoy external extra talk that we don't need. I want us to be focused on the patients, what we're doing, what our plan is for the day. I want it to be clear. And I was very focused on clear, direct communication and everyone having their assigned roles for the day. And I ran my team similar to a surgical floor. And so I got the nickname of the surgeon just based on that style. And a lot of people sometimes viewed that style as perhaps being more. I'd be told I was more aggressive or I ran a tight ship and I should be careful because some people may not like it. And I thought if I was a different gender, would the responses be the same? And so sometimes it's that we have to break those kinds of molds, that being perhaps very straightforward and not covering everything in flowery language is not appropriate for a female. I very much pride myself on being very straightforward. And so when people come to me for advice, they know that I'm going to be very honest, I'm going to be straightforward, and I'm not going to lead you astray where you're not sure what I'm saying. So, in a sense, I'm great in a political role. In a sense, perhaps I'm not the best in a political role, but I am very straightforward, and people know that they'll get an honest answer.

Dr. Mariam Hanna: That's always been how, when I've had a discussion with you or I've had a concern, I could count on you to set me straight. Now, this said from the fact that one of my patients a month ago called me a drill sergeant, and I was like, "Oh, boy, I wonder if we're doing shared decision-making if I'm the drill sergeant." But okay, in what ways do leaders of today look different than what they did a decade or two ago?

Dr. Zainab Abdurrahman: What I would say here is that we've always had different kinds of leaders. The difference now is we're recognizing some of the other types of leaders. Like I talked about, there's that very kind of classical, straightforward, head of the bed calling out where it's a very dramatic presentation. But there have always been leaders. There have always been people who have been running all kinds of teams in the background, and now they're recognized as leaders. Right? So, in the past, you would talk about this great achievement would be assigned to this one person who is the figurehead, but the real leaders are all the people who are also doing the work and leading the teams within. And I think now we recognize that. We recognize there are different kinds of leaders. There are the leaders who lead from behind, and those are the ones who are coordinating and putting different people forward, the ones who are going to find people who have certain skills and they perhaps haven't had the opportunities. They're going to bring people forward, and they'll be in the background, but they will make sure that different team pillars come forward. There will be leaders who are more focused on how to make the entire organization and who can really step away from focusing on themselves as the person or the thing that's moving forward, but the whole group, the whole organization, and there are different ways to do it. And you don't have to be loud and in charge in the front. I think now we recognize leadership can be different types of roles, and it can be as small as you want or as big as you want. We're seeing a lot more from people who are much younger than us. In the past, you pictured leaders as people who are older, seasoned, had been through life, and now think about, Greta. Think about people like that who are very young and are coming out and are making changes, and they're recognizing where we need to go or helping us shift back and look at things in a different way. And so even that is a big change in how you can look at leaders. And leaders may not be in this succession plan. There are leaders at every stage, and I learn from people who are medical students or honestly, like, you talk to high school students now, and you talk about their passions and how they're making change, and it blows my mind. At the same time, I look at people who are much ahead of me who also have great advice for me. So there's a lot of leadership in all the different ways, and I think we are recognizing now that it doesn't have to be one size fits all. Leadership is really all around us, and we're just recognizing those roles that were always there.

Dr. Mariam Hanna: Is there an opportunity for mentorship? Because leaders now come from very many different generations. How does one go about getting the right mentorship in place?

Dr. Zainab Abdurrahman: Oh, absolutely. Mentorship comes at all kinds of different times in your life and from different places. I think you sometimes seek mentorship in certain areas that you want to improve upon. Sometimes mentorship finds you. Someone sees a potential in you that perhaps you didn't even know was there or hadn't thought about really developing. Sometimes it's both ways, so you can be the mentor and the mentee in the same relationship. We talk about this in a lot of different ways. One person may be really great on technology and utilizing a different way of teaching you on certain skills, perhaps that they're really focused on, maybe, you know, other ways to communicate in, perhaps, like, more on nonverbal or perhaps other aspects. So it can be two ways. So mentorship, I think, is not just one direction. And the different kinds of mentorship you need at each time can be different. I think sometimes what you need, too, is just someone to say to you, "This space is available to you," and that's actually not so much mentorship, but that's when you talk about someone opening the door for you. It's not just mentorship. That's sponsorship, and that's something we don't talk enough about. Mentorship, that's an exchange of skills. Me showing you, you showing me; sponsorship is me saying, "Hey, I'm at this table that's up here. Why don't you come up here? I have an event to go to where I'm able to bring a guest. I'm going to bring you so you can meet other people at this level, and you can start building relationships so that you can also come and work at this level." Sometimes it's when you decide to be the section chair of your association for your section, and you say to a friend, "Hey, I know you may not think of yourself as a classic leader, but why don't you be my vice chair?" And now here you are. And that's where you are now.

Dr. Mariam Hanna: What challenges do you face in your role as a leader?

Dr. Zainab Abdurrahman: There are a lot of challenges when you take on a role where you have to represent a large body of people, a large organization. So, the first thing you have to manage is that you cannot make every single person happy. You do have to make decisions that will help support and move forward most of your members, but sometimes, there can be some negative consequences for a small amount. We're always trying to find the best opportunities with the least amount of people having any kind of negative impacts. It's also hard because there's a lot of work that you do that is not perhaps appreciated by others. And so, it's sometimes difficult when you're going through so much work, and perhaps it's not seen or appreciated how much you do have to do. And it is a big time commitment, so that's also something that you really have to learn to balance. And I've done that. One of the things I've also done in my other kind of academic roles has been really focused on wellness and how to balance life. And some of the things I've had to do is really sit down and say to myself, okay, how am I going to do all the things I want to do without burning out or pushing myself too far and realizing that sometimes you have to move around and you have to focus on certain things. When certain portfolios or projects you're involved with get very big, and you have to sometimes say no to certain things or move away from certain things. And that gives you that opportunity. When it comes back to mentorship and sponsorship, when you move out, you can move other people forward and allow them to take on those roles. So, it's a challenge where you have to be real with yourself and be able to give things up, which in medicine is hard for us. We're used to, like, I must do all the things. So, sometimes you have to step back and say, okay, I can do these things really well. Let me make space for other people to move into some of these other roles I was holding. So, I think that is very important, and that's a big challenge. And I think also the other part is you get tapped more. The more you do, the more people come to you and ask you to do. And so, you really have to be honest with them and open and say, hey, what about this other person? They may not have all the exact same skills, but the potential is there. A lot of these roles, there's a big opportunity for education. You don't have to have all the skills to get to be here. There's a lot to kind of buffer you and to teach you and educate you. So, you just need to look for potential more so than people going for realization. What you're looking for, I think, with leadership is potential and then providing the supports and letting those people grow in those opportunities.

Dr. Mariam Hanna: You did actually do exactly what you said when you talk about wellness being so important in leadership and emphasizing wellness. You made me flashback. During the pandemic, we had a virtual journal club where I specifically remember, Dr. Abdurrahman, you guided us through a meditation-type wellness exercise that we did for an entire, like, half an hour of journal club. My child was screaming in the background. I remember this meditation exercise vividly as I was trying to balance and prevent my burnout. Can this work actually prevent burnout?

Dr. Zainab Abdurrahman: You know what? One of the past OMA presidents, Rose Zacharias, she once said, "Leadership is her cure to burnout." And I have to say that I really do agree with her because some parts of burnout have to do with our clinical work and how demanding it can be and how we are just trying to make things work in a very under-resourced healthcare environment, and patients are frustrated. Our healthcare system is crumbling. And so when you're in that situation all the time, it's very taxing on you. So when you take this role on, it allows you to still use a big part of your brain and things that we're accustomed to, but in a different view. And seeing the opportunity of this work making my life in clinic and making my patient lives better is a cure for burnout for me. It allows me to step away from that, so I'm not just constantly drained, but allows me to advocate and work in that. So it really is, you need to balance and use different parts of you that perhaps you don't always get to use day to day, but allow it to still help. And still, it's still medicine. When I'm doing the work at the Ontario Medical Association, it's still medical work, but it's just in a different type of way and allows me to use a different part of my brain, and it rewards me in a different way. So I really do think it's very helpful for me personally for burnout. If this is not your cup of tea, doing, being a board director and reading all the pages and pages of reports and governance, that may not be great for you, but a different form of leadership that you perhaps love, which is going out, talking to perhaps its high school students in that, meeting them, hearing those stories, that could be it for you. So it doesn't have to be this exact same combination, but for me, I find it very rewarding. 

Dr. Mariam Hanna: What advice do you give to those that are on this path?

Dr. Zainab Abdurrahman: I'd say the biggest thing I tell people is, listen to yourself. There's a lot of needs in the system. If you're in an academic center, they will say, "We need this kind of person. We need this kind of person." Everyone else has all kinds of needs. You have to figure out with yourself what your interest is and where you want to go. When I first came out and I was finishing practice, I really had actually thought I was going to be a full-time academic. And my institution had said, "We really, actually need a respirologist, more so than an allergist. Do you want to do another fellowship and then come back and we will give you a full-time academic appointment where you can do respirology as well as allergy, and you could do both, but you'd have to go do an extra two years?" And I thought, "No, thank you. That's not what my passion really is. Allergy, immunology, this is where I want to be." And so I said, "You know what? Yes, you may not be able to achieve what you thought in that kind of specific setting, but you're still going to have a partially academic practice and you'll do these other things that you still love and practice your specialty." So I think part of it is being true to yourself. If I'd let myself follow through with that and just be focused on the full-time, I was like, "That wouldn't have made me happy." So I would say the biggest things I would say is listen to yourself. And you know what? If there's things that you want or need further expansion on, go get it. If your issue is you want someone to help you see the potentials around you, consider coaching. There are great physician coaches, and there are coaches who are not physicians, who are great for coaching physicians. So there's opportunities and maybe some of the things that you're working through. You feel you have a lot of impostor syndrome or you have other issues that are holding you back. Go to therapy, talk it out. See what else is holding you back. I think listen to yourself and figure out what you're looking for in that moment and figure you out before you give yourself to everybody else because that's really important. Figure out what your needs are and what you want to do and then go for it. Because there are people who want different things and are happy to move you into certain roles, but you need to figure out what you are going to say yes to and what you will specifically say no to.

Dr. Mariam Hanna: Powerful pieces of advice. All right, time to wrap up and ask today's allergist, Dr. Zainab Abdurrahman, for her top three key messages to impart to physicians on today's topic, leadership in medicine. Dr. Abdurrahman, over to you.

Dr. Zainab Abdurrahman: Thank you. The top three things to keep with you: Every act, no matter how small or how big, can be an act of leadership. Voting and staying involved in your organization is an act of leadership, as is taking on a role that is considered traditional leadership. So, as small or as big as your act, be a leader in whatever way makes sense to you. Second, ask yourself what you want and how you want to make an impact and what you're passionate about, and then pursue that area. Because when you're passionate about it, people can tell, and people naturally move towards you because they hear it in your voice, they see it in your actions. So, figure out what you want and pursue it, and people will come. And the third thing is, figure out what you need. What are the tools you need? Do you need a coach? Do you need a mentor? Or do you just want to have someone to talk to and work through some of the things that are holding you back? Take the time, focus on you. It's not being selfish; it's actually being mindful and preparing yourself for the future.

Dr. Mariam Hanna: Thank you, Dr. Abdurrahman, for joining us on today's episode of The Allergist.

Dr. Zainab Abdurrahman: Thank you so much for having me.

Dr. Mariam Hanna: This podcast is produced by the Canadian Society of Allergy and Clinical Immunology. The Allergist is produced for CSACI by Podcraft Productions. The views expressed by our guests are theirs alone and do not necessarily reflect the views of the Canadian Society. This podcast is not intended to provide any individual medical advice to our listeners. Please visit www.csaci.ca for show notes and any pertinent links from today's conversation. To find an allergist, the app on the website is a useful tool to locate an allergist in your area. If you like the show, please give us a five-star rating and leave a comment wherever you download your podcasts, and share it with your networks because calling all leaders, we're looking for your sponsorship. Thank you for listening. Sincerely, The Allergist.