In 1953, philosopher Isaiah Berlin published “The Hedgehog and the Fox,” an essay in which he applied an ancient Greek poem to modern leaders. The fable of the fox and the hedgehog is attributed to poet Archilochus, who wrote, “the fox knows many things, but the hedgehog knows one big thing.” Berlin’s piece enjoyed popularity in discussions of leadership, as he described popular historical figures such as Plato and Nietzsche as “hedgehogs” while Shakespeare and Aristotle were determined to be “foxes.”

There are many famous “hedgehogs” who are known for being exceptionally successful at one thing. Their stories demonstrate the power of early specialization leading to peak performance. A common narrative involves golfer Tiger Woods, who was carrying his first club at the age of 2 years and played competitively as a teen. Venus and Serena Williams are two other hedgehog examples, as they specialized in tennis early and became two of the greatest players in the sport. Malcolm Gladwell’s book, Outliers, gives other examples of giants in their field and opines that this success is likely the result of prolonged and focused practice.

Although “foxes” are equally famous and successful, their stories are less well known. In his book, Range, David Epstein describes the story of LeBron James, who was a top football prospect as a high school senior in Ohio, despite his fame as a basketball star. Tennis legend Roger Federer played nearly every sport as a child and chose tennis later in his life. Despite this, Federer earned more than 1,250 wins and 20 Grand Slam championships.1 In Range, Federer’s story is compared with Woods’ to illustrate there are multiple paths to excellence.

Despite these examples that broad experience can lead to excellence, little is known as to how these patterns of skill and knowledge acquisition translate to leadership. As we explore paths of leadership preparation, establishing a framework for leadership is important. Joanne Ciulla, an American philosopher in leadership ethics, wrote a definition that is relevant here, “Leadership is not a person or a position. It is a complex moral relationship between people, based on trust, obligation, commitment, emotion, and a shared vision of the good.”2

Using this definition, we consider how experience as a generalist might translate to leadership ability. Practicing general medicine requires the development of relationships based on trust. Working to relate to others can advance one’s self-understanding and self-management, which are crucial skills in effective leadership. Also, those who have a variety of experiences are usually more curious, and curiosity can lead to comprehensive assessments of problems. Lastly, experience in different arenas often leads to humility, which, in leadership, helps with stakeholder engagement and empathy.

There are studies that examine what healthcare teams find to be effective leadership skills. In one, researchers conducted focus groups and structured interviews to understand what makes a great leader. Their results showed that a great leader acts with personal integrity, communicates effectively, pursues excellence, builds and maintains relationships, and thinks critically.3 A good general internist will recognize these as essential functions for high quality patient care in either an inpatient or ambulatory setting.

Delivering high-quality patient care can feel challenging in a world full of complexity. Much of what we have thought of as stable now feels unpredictable, such as our workforce and the cost of supplies. In moving forward, General Stanley McChrystal’s words come to mind. As he describes in the book Team of Teams, when faced with complexity and uncertainty, the best response is not one that is predictable and rigid. Rather, it is one where many people, with a variety of knowledge and experiences, rapidly form teams to address new problems.4

Returning to the fox and the hedgehog, it is important to observe how these two animals behave when threatened. The fox finds many clever ways to avoid predators whereas the hedgehog curls up into a spiky ball and lies still every time. In our evolving world, moving forward takes leaders who have a variety of experiences to pull from. It takes leaders who are familiar with rapidly forming teams, communicating clearly, and who possess self-knowledge and self-regulation. Leadership in an evolving world is a role for which general internists are well suited.


  1. Association of Tennis Professionals. Player profile. Roger Federer. ATP. Accessed February 15, 2024.
  2. Rutgers Business School. Joanne B. Ciulla. RBS. Accessed February 15, 2024.
  3. Hargett CW, Doty JP, Hauck JN, et al. Developing a model for effective leadership in healthcare: A concept mapping approach. J Healthc Leadersh. 2017 Aug 28:9:69-78. doi:10.2147/JHL.S141664. eCollection 2017.
  4. McChrystal Gen SA, Collins T, Silverman D. Team of Teams: New Rules of Engagement for a Complex World. Portfolio Penguin, 2015.



ACLGIM, Leadership, Administration, & Career Planning

Author Descriptions

Dr. Graves ( is an associate professor and currently serves as Chief Medical Officer for Inpatient Health and works clinically as a hospital medicine and palliative medicine physician. Dr. Conigliaro ( is the Barron Professor of Medicine and was recently appointed Interim Chair of the Department of Medicine at LIJ Medical Center, North Shore University Hospital, and the Zucker School of Medicine and an Editor in Chief of the Journal of General Internal Medicine.