Let me begin by stating the obvious: it is becoming almost impossible to thrive as an academic generalist. It doesn’t matter if you practice in the hospital or in the clinic, in an academic medical center or in the community, in group practice or solo—the pressure and demands of day-to-day work have gone from challenging to soul crushing. Our patients and health systems expect us to be constantly connected. Boundaries between work and home have faded. Salaries and workload are orthogonal. Our pipeline is drying up. There may not be enough of us to meet the demands of the population today. If the trend continues, there won’t be enough of us to care for you and me tomorrow.

Is it a crisis? Yes. But behind this crisis is an opportunity. Your opportunity.

No one understands medicine like we generalists do. We are not restricted to the myopia of one organ system or disease condition. We think about the whole patient, their family, their socioeconomic situation, their physical and biopsychosocial environment, and all the complex interactions between these domains. We devise new ways to solve old problems, using values and principles that are not only true to us but also anchored within the patient and their loved ones when making clinical decisions. As described by Graves and Conigliaro, we are foxes rapidly evolving to the situation, not hedgehogs paralyzed by fear.1

This whole person, whole system approach isn’t an isolated event. We do the same for our colleagues all the time. Getting crushed by the ER on a busy night shift? Hey, let me answer that next page. Running late in clinic and patients waiting? Hey, let me grab that next patient for you. Need to head out early for a family engagement? No problem, I will cover. We also do the same for our operational challenges. Templates out of whack? Let’s optimize. Inpatient volumes spiking? Let’s think about a swing shift or additional team. The examples of caring and problem solving are endless.

What I describe is an antidote to what ails general medicine—what business guru Bob Quinn calls a fundamental state of leadership.2 When entering this state, we draw on our own fundamental values and capabilities to manage a crisis. We instinctively choose what is right instead of what is best for us. Core values emerge and our focus shifts from within (ourselves) to others. The result is generative: people move from compliance to committed. That extra mile no longer feels “extra.” Solutions flow and creativity abounds, so problems are not only tackled but also brought along people with it.

I chose leadership as a path because it became clear to me that this fundamental state needed to touch more than just my clinic, my hospital team, or my immediate peers. My views as a generalist have uniquely shaped how I think about and react to daily conundrums. For example, when I meet with faculty who are underperforming, my generalist instincts wonder, “what else could be going on?” When I look at financial statements or negotiate with clinical partners, I remind the administrators of what the work looks like in graphic detail: pajama time, personal sacrifices, and academic misadventures combined.

Even though generalists outnumber every other medicine subspecialty, few have answered this call to leadership. And few have found that fundamental state of leadership. That is why I write to you: we cannot be architects of the change we want to see unless we rise to positions where we can make this happen and embrace leadership as a career path. Only then can we move beyond cogs in the system—to becoming the system.

To fix the system, you must lead the system. We need more generalist Department Chairs. It is your turn to accept the challenge.


  1. Graves K, Conigliaro J. A fox among hedgehogs: The value of generalism in leadership. Leadership Forum. https://www.sgim.org/article/a-fox-among-hedgehogs-the-value-of-generalism-in-leadership/. Published March 2024.
  2. Quinn RE. Moments of greatness: Entering the fundamental state of leadership. Harv Bus Rev. 2005 Jul-Aug;83(7):74-83,191.




Author Descriptions

Dr. Chopra (VINEET.CHOPRA@CUANSCHUTZ.EDU) is Chair of the Department of Medicine at the University of Colorado. A career hospitalist, his research and academic efforts are devoted to improving the safety of hospitalized patients.