My path to leadership arose from something very simple—there were things I wanted to see happen that I couldn’t do alone.

In middle and high school, most of those things were primarily for fun: Boy Scout contests, an overnight basketball marathon to raise money for charity, changing an annual formal dance into a beach party (“The Beach Ball”). I don’t remember embarking on any of those projects with much forethought. An idea would take hold of me and, as I persisted in sharing my excitement, a path forward would start to reveal itself as people joined me, adding their ideas and enthusiasm. As obstacles appeared, so would a set of solutions pointing to the permissions and resources that we needed to move forward. It was fun to do something that had never been done and even more fun to do it with a group of people who were as energized as I was. For me, it felt more like a pick-up game of sandlot football than anything I would have called leadership. People wanted to play, they just needed a nudge, and I was glad to provide it.

Medicine was not great for my confidence. Everyone around me had some talent or level of expertise that seemed well out of my reach. On a good day, I felt average. What kept me floating above the anxieties was the sense of purpose I felt in patient care. I was good at caring for people and my desire to do so helped me master what I needed to master to do it well. I always seemed to be able to get over the next hurdle and that was enough to keep me moving through medical school and training. I never imagined myself having the confidence or stature to hold a titled position of leadership, and frankly, never aspired to it.

I entered practice during a time of turmoil. The Clinton health plan had collapsed; subsequently, corporations and “managed care” were rapidly taking over health care across the country. Many of my patients lost access to care as hospitals and health systems cut back access to save money. In addition to my practice, I was working to develop myself as a teacher and had started a PhD to become a researcher. Suddenly, there were a lot of things I wanted to see happen. Looking at all the dysfunction and inequity in the health system, I wasn’t sure what I could do. I was certain I needed to do something. I could not do any of it alone.

Moral distress slowly distilled into something more like purpose. I threw myself into the mix of advocates and policy-makers in the community and on campus and the dynamics I discovered in high school re-emerged. As I persisted in pursuit of a purpose, allies appeared, paths revealed themselves, and obstacles gave way to solutions. I found myself in a wonderful new place of possibility, bridging the resources of our campus with the rich, and diverse set of possibilities and people in the community. I gained sponsors on both sides and opportunities emerged to write grants, start initiatives and build programs. From an academic perspective, I was following completely non-traditional path, but it was working and felt incredibly rewarding.

Through years of iterations, of false starts and failures, as well as successful projects and programs, something happened. I began to feel confident. It was not an “I’ve got the answer” sort of confidence, but more of a “We got this” feeling when faced with a new opportunity or challenge. After 20 years of knocking on doors, probing the cracks, and, when necessary, picking a few locks (metaphorically, of course), I had a sense there was always a way to move a good idea forward and the confidence that I could work successfully with others to make that happen. I had started and led a few programs on and off campus and, through that, had learned my way around as well as the ins and outs of budgets, human resources, and the arcana of university administrative processes.

Eight years ago, I felt confident enough to say “yes” when my new chair asked if I would consider taking the newly vacated division head position as an interim. In the wake of that decision, a few things shifted—my purpose now is mostly helping other people actualize their own purpose. One thing hasn’t changed; many days, it still feels like a good pick-up game. It’s still fun to do something that’s never been done, and even more fun to do it with people who are passionate and energized.



ACLGIM, Advocacy, Clinical Practice, Leadership, Administration, & Career Planning, Medical Education, Wellness

Author Descriptions

Dr. Earnest ( is division head, General Internal Medicine, University of Colorado School of Medicine, and ACLGIM President.