Leadership in plastic surgery today.

This article was developed after the authors heard young plastic surgeons of their unit ask what attribute makes people want to follow a leader. What people most seek to find in a leader has been constant over time and shared in different countries, genders, and age groups. These qualities include honesty, a forward-looking perspective, inspiration, and competence (Kouzes and Posner, Clin Lab Manage Rev 8:340, 1994). However, the residents and fellows thought differently and told the authors how "they" wanted to be seen when they became leaders. They wanted to viewed as shifting engines pulling forward teams of plastic surgery as hard as possible, leaving space for followers to develop and grow. They also wanted to be seen as having impeccable behavior related to the assumption of obligations, and finally as having the "most" informal authority possible, an authority that is not negotiable because it is given by peers to the leader due to personal qualities and actions. Obtaining formal authority at a very young age is fine, but if a surgeon's associates have not given him or her informal authority, the surgeon is only the "boss" and not the leader of the group. Informal authority is constructed over a time line and given by others to the leader because of what he or she has in values and personal attitudes and because of what the leader has done and can go on doing with sustained credibility and competency. Therefore, it is the authors' opinion that the exercise of leadership in plastic surgery is supported by informal authority and that the leader of leaders will be the one who has the most of this attribute that never is given formally.