SUPPLEMENT
Think and Talk Like You Went to Business School
Stephen R. Stephan, MD and David L. Skaggs, MD, MMM
Abstract: Most orthopaedic surgeons do not have formal training
in business education. We have learned that success comes to
those who study hard, choose the correct answer on multiple-
choice tests, and focus on patient care and operating. In contrast,
business school graduates learned that success comes to those
who apply interpersonal skills to build relationships and trust, in
addition to taking risks. Medical school and business school
teach one to confront the “real world” with quite a different
perspective. In this manuscript, we will touch on a few things that
we can learn from business school graduates.
Key Words: orthopaedic surgery, medical school, business
school, relationships
(J Pediatr Orthop 2022;42:S53–S55)
A s orthopaedic surgeons, we have traditionally been the
top of our class throughout our education and training.
Many of us were in the top 5% of our high school class,
went to prestigious universities where we excelled in difficult
premed courses, then went on to medical school. To match
successfully into orthopaedic surgery, we had to have ri-
diculously high United States Medical Licensing Examina-
tion Step 1 and 2 scores, obtain honor grades in almost
every preclinical and clinical course, and then shine on
subinternship away rotations. In 2020, there were 1177 ap-
plicants for 849 orthopaedic surgery positions in the United
States.1 Everything involved in becoming an orthopaedic
surgeon is focused on individual accomplishment.
In contrast, people who went to business school were
taught early on that collaboration, collegiality, and most
importantly, relationships, were the keys to success. They
view the real world as a golden opportunity to network
and forge connections with others to grow and get ahead.
What follows are some lessons we can learn from them.
For ease of reading, the personal experience of the senior
author (D.L.S.) will be in first person. He received his
Masters of Medical Management, essentially an MBA for
physicians, from the University of Southern California
in 2006.
From the Department of Orthopaedic Surgery, Cedars-Sinai Medical
Center, Los Angeles, CA.
No financial support for this publication.
The authors declare no conflicts of interest.
Reprints: David L. Skaggs, MD, MMM, Department of Pediatrics and
Neurosurgery, 444 South San Vicente Boulevard, Los Angeles, CA
90048. E-mail: david.skaggs@cshs.org.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/BPO.0000000000002122
J Pediatr Orthop  Volume 42, Number 5 Supplement 1, May/June 2022
Copyright r 2022 Wolters Kluwer Health, Inc. All rights reserved.
DISCUSSION
In general, business school teaches its students to
build trust, take risks, learn from failure, and understand
how to “talk the talk.” By working on these skills, business
people can venture out into any field and apply their
learned knowledge to any subject.
Building Relationships and Earning Trust
Building a relationship is the first step in establishing
trust. Historically, physicians have been skeptical about
establishing trust, especially with administrations. It
would not be rare to hear a physician say, “you must get
everything from the administration in writing.” This atti-
tude is not always correct and can be harmful. If one does
not have some level of trust with those they work with,
they should probably consider leaving the job. This has
been especially evident in signing contracts with future
employers.
There are pros and cons when using an attorney to
help with contract reviews, and you, as the focus of the
contract, need to make sure you know what you want and
how badly you want it. Many times, when attorneys re-
view a contract and insist on changes, it appears to breed
distrust. This may not be the best advice for everyone, but
I have never had an attorney help with my contracts, and I
have been on both sides of the table in this situation. Some
people even believe that surgeons, just like athletes, should
have agents to guide negotiations. This may be true for
some physicians, but the bottom line is that the bigger the
institution, the less likely any change will be permitted to
the contract, particularly for a first job. Many issues, such
as call, triage, and operating room time can be docu-
mented in an e-mail. If you feel a contract is “against”
certain aspects, discuss this with your potential boss, and if
you are not satisfied, look elsewhere. Essentially, by
knowing what you want and how badly you want it, you
can negotiate effectively with your future employer. There
is often some give and take, and only you can fully es-
tablish how much in each direction. This is where lawyers
can sometimes interfere and cause distrust between the 2
parties. You essentially want to have a compromise be-
tween the 2 sides that both are happy with, and knowledge
of both positions typically results in a positive outcome for
each side. In business, one learns that having trust in your
team and those you work with is a sign of strength and
dedication to the team and the mission. If your employers
believe you trust them, they are more likely to trust you.
In the book The Best Medicine A Physician’s Guide to
Effective Leadership by Dr Bruce Gewertz, Surgeon-in-Chief
of Cedars-Sinai Medical Center, and Dave Logan, Senior
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Stephan and Skaggs J Pediatr Orthop
Lecturer at University of Southern California Marshall
School of Business, they tell us, “you don’t have to win every
argument.”2 In fact, one should approach others with the
idea that “my relationship with you is more important than
the issue.” Although easier said than done, this mentality has
personally resolved numerous differences in my career.
Many times, in meetings where both sides are dug in on
different sides of an issue, I will state this out loud. It is
amazing to watch how often somebody will immediately say
how he or she sees your side of the issue and tries to reach
common ground. Stating explicitly that your relationship
with someone is more important than the issue is a surefire
way for him or her to feel valued and begin the process
toward a solution. We see this in our day-to-day interactions
with other medical teams in issues of turf or control.
Business school teaches you to never “lose your
cool.” Anytime you are involved in a conflict, it is gen-
erally considered a mark against you—it takes 2 people to
be in a fight. If 1 person is misbehaving, and you do not
interact or lose your cool, others will notice, and respect
you for it. Preventing or de-escalating conflict is highly
valued in quality organizations. For example, in 1 of our
clinics, we had a repeated issue with x-ray technicians
being late. This basically halted the entire clinic, with
multiple physicians, nurses, and patients left waiting. My
initial urge was to send a strongly worded e-mail to the
Chairman of Radiology and the Administrative Director,
with a CC to the C-Suite. After calming down, I instead
sent a bottle of wine to the radiology administrator,
thanking him for doing such a great job with limited re-
sources. Weeks later, I gently mentioned the troubles of
the late technicians, and the administrator responded im-
mediately, wanting to help us and feeling like he was a
respected member of our team. In contrast, the “angry
e-mail” approach would have humiliated him in front of
his superiors and likely created a feeling of wanting to
retaliate, rather than help us. Unfortunately, it takes time
for some problems to be solved, but finding the best way
to get the point across is important.
Your goal should always be to make people feel
better about themselves whenever you have an interaction.
Studies have shown that something as simple as a smile
will make it more likely that people will enjoy their in-
teractions with you, making them feel better about you.
You want people to feel like you have their back, and the
best way to do that is to genuinely have their back. This is
generally earned over many interactions and can quickly
be unearned with 1 bad interaction. This can be done with
everyone you come across in the hospital, regardless of
who it is. If you do not feel you can support someone on
your team, or someone on another team is bad for the
institution, objective documentation of problems leading
to improvement or exit of the employee should be con-
sidered.
Similarly, it is important to make respectful personal
connections with your coworkers and peers in the work-
place. It is unfortunately common to see surgeons forget
the names of scrub techs, nurses, and assistants. It is
customary in my everyday practice to learn everyone’s
S54 | www.pedorthopaedics.com
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 Volume 42, Number 5 Supplement 1, May/June 2022
name in the operating room and associate his or her name
with something that will allow me to remember it. This is a
skill that successful business leaders appear to truly excel
at. Business people tend to change jobs a lot more than
doctors, and they learn to appreciate who has worked with
who, whose kids go to school together, who golfs together,
etc. Remembering people’s names absolutely leads to be a
better workplace environment and builds trust. Dale
Carnegie reminds us, “A person’s name is to that person
the sweetest and most important sound in any language.”
(Personal quote, Dale Carnegie, 2009) People will go out
of their way to help you if you make an effort to know
them and care about them.
In addition to making social connections, it is ad-
vantageous to feel like you are part of the community of
your institution. Feelings of pride and allegiance to your
institution may sound corny, but these are present in the
highest functioning businesses and teams. Getting in-
volved with hospital wide committees helps one to learn
the local culture, jargon, and important issues. There is
only so much time in a day, and hospital committee work
is usually voluntary or underpaid, but if you desire to be
an effective leader in your organization, getting involved
beyond clinical practice is simply a must. Elizabeth War-
ren reminds us, “If you don’t have a seat at the table, then
you’re probably on the menu” (Personal quote, Elizabeth
Warren, 2014). Real joy and meaning can come from
giving back to something larger than yourself.
Taking Risks and Learning From Failures
Medical training has taught us to be risk averse, and
failure is not an option. We were never supposed to come
close to failure in all of our schooling, and the mere
thought of it may make us cringe. The stakes of failure are
much higher for a surgeon than for the typical business
endeavor. In Silicon Valley however, “failure is a badge of
honor,” with second time founders having the most suc-
cess, having likely failed their first time around.3 Taking
risks and learning from failure for an orthopaedic surgeon
9 in the business realm is a great idea, but be sure to
prioritize minimizing risk in the aspects of direct patient
care. Ultimately, it may even be a good idea to work side-
by-side with a business person, learning from them and
seeing them in action first-hand.
As physicians, we fear uncertainty. Yes, we could try
something new, join a different kind of practice, get involved
in a new business or venture, but we fear the possibility of
losing. Most orthopaedic surgeons do not even enjoy
gambling—it is just too risky, regardless of the amount being
wagered. Las Vegas did not want the American Academy of
Orthopaedic Surgeons Annual Meeting in the days of inex-
pensive hotels and meals because we did not gamble enough!
To improve patient care or your bottom line, calculated risks
might be necessary. If you think there is a better way to
deliver patient care or customer service, a pilot study with
objective criteria of success is a good way to start. It is hard
for people to object to a pilot study. Start small but look for
big gains down the line.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
J Pediatr Orthop  Volume 42, Number 5 Supplement 1, May/June 2022
“Talking the Talk”
Last, and definitely not least, business people are all
about being able to “talk the talk.” Not only do you have
to know the lingo of your field, you need to be able to
communicate to someone who is outside of your area of
expertise. It has been shown that most of communication
is done with body language, second most with tone of
voice, and third being the actual words that are used.4 For
this reason, in-person communication is more effective
and less likely to be misinterpreted than a phone call or
video, or worse yet, an e-mail or text. If there is an im-
portant issue, you should invest your time and effort in an
in-person meeting if possible.
How you communicate, including the words that
one uses and the emotion behind it, is vitally important to
building relationships and trust, getting your message
heard, and determining your reputation in the enterprise.
For example if you are clearly angry and state, “I am
upset that….” it is taken very differently than calmly
stating in a somewhat detached manner, “my team is
concerned that…” Anger, rarely, if ever, has a place in
business discussions. When someone senses anger in you,
they cannot help but feel defensive.
Here are some other pearls for communication.
When someone says, “let’s be thoughtful,” they are really
telling you, “you were moving way too fast and scaring
me” or “I have not heard any good ideas so far.” Sim-
ilarly, when someone responds to you in a meeting with
“let’s table that,” “let’s circle back on that,” “let’s touch
base on that later,” “let’s take that off-line,” or “let’s set
up a group of stakeholders to look at that,” they are telling
you to drop the subject. One of the most powerful things
you can do is to have a topic discussed or not discussed. If
you feel something is important to be discussed, one
method of assuring that is having many small discussions
in preparation for the meeting, to make sure everybody is
prepared for the discussion. That way, they do not feel
blindsided by it. If you are being shut down during a
meeting and you think the topic is important to discuss,
you may say, “I think people want to feel heard on this
issue,” “let’s show respect for dissenting views,” or “I
don’t want to alienate people with diverse opinions.” This
will help in getting your topic onto the table again.
As in diplomacy, euphemisms are big in business.
Even though we all know the bottom line remains the
bottom line, and “no margin, no mission,” the word
money is almost never used. Instead consider using such
words as “resources,” “support,” or “commitment.”
Avoid saying, “I’m too busy,” as it makes you sound weak
and unorganized. It sounds much more professional to
say, “I don’t have the bandwidth” or “please help me
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Think and Talk Like You Went to Business School
decide how we should prioritize this relative to these other
important issues.”
We have all been in the position where we find it
almost impossible to understand what someone is talking
about when they are using unfamiliar jargon. The best
business leaders, as well as the best communicating sur-
geons, avoid using jargon their audience is unfamiliar with.
Unfortunately, that does not appear to be true of middle
level administrators and managers who are often eager to
show off the new words they learned in business school.
From a positive viewpoint, if we speak the same language of
a group, we are more readily accepted as part of the group.
Trying to get on committees in which finances are discussed
is helpful, or simply reviewing a balance sheet and budget
with the department administrator is an education in busi-
ness vocabulary—but you have to do it on a regular basis to
think in terms of your new vocabulary. “Return On In-
vestment” or “ROI” is one of the most commonly used
terms, and is used to measure the probability of gaining a
return from an investment. It is also a good way of thinking
and communicating with administration. Instead of asking
for clinical space to “help more kids,” demonstrating that
additional clinical space will produce a positive ROI and is
aligned with mission of helping children, is likely to be more
well received. Always look for the “win, win” in which all
parties in an agreement should benefit. 50 Business Terms
All MBA’s Should Know is a useful website to consider
for getting started: https://mbanogmat.com/50-business-
terms-all-mbas-should-know.
CONCLUSION
In conclusion, I would like to leave you with the
quote from Gewertz and Logan, to “view each meeting as
an opportunity to deepen a relationship.”2 The world is
about whom you know and how you treat them. Real
progress is more often made by teams of people, rather
than individuals. The time you put into relationships will
make you far more effective in every aspect of your pro-
fessional life, including patient care.
REFERENCES
1. Prospective Doctor. How competitive is an orthopaedic surgery residency?
2020. Available at: https://www.prospectivedoctor.com/how-competitive-
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2. Gewertz BL, Logan D. The Best Medicine: A Physician’s Guide to
Effective Leadership. New York, NY: Springer; 2015.
3. MacBride E Kathryn Shaw: Entrepreneurship requires practice,
practice, practice [gsb.standford.edu]. 2014. Available at: https://
www.gsb.stanford.edu/insights/kathryn-shaw-entrepreneurship-requires-
practice-practice-practice. Accessed July 7, 2021.
4. Mehrabian A. Silent Messages. Belmont, CA: Wadsworth Publishing
Company; 1971.
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