The first article in the series focused on organizational-level solutions to reduce task overload. These strategies have a disproportionately large impact on physicians’ overall work experience and their risk for burnout.(1) A second critical lever for change, however, is improving the managerial effectiveness of physician leaders.
Data and the lived experience of most physicians consistently indicate physician leaders have the biggest impact on frontline physicians’ job satisfaction, well-being, and retention/turnover.(2,3) To achieve this, organizations must help physician leaders toggle more seamlessly from reactive managing to proactive coaching and developing their teams.
Optimizing the Physician Leader Role
Physician leadership development has come a long way over the last half-century. Previously, leadership skills were often presumed to be automatically conferred by the title “doctor” or naturally acquired after years of practice.
The rapidly changing landscape in healthcare necessitated more formalized leadership training to improve their managerial effectiveness. Healthcare organizations, as a result, have invested heavily in developing physician leaders so they can drive ongoing organizational improvement — particularly during the past 20 to 30 years.(4)
Leadership programs and models have evolved to better equip physician leaders to handle current challenges within healthcare (e.g., occupational burnout, psychological safety, new care models).(5,6) Despite this progress, two persistent challenges, highly unique to the physician leader, have not been adequately addressed. Without solving those two problems, even the best-designed leader development programs will fall short of their potential impact.
Problem 1: Role Overload
Physician leaders often accumulate multiple responsibilities over time — clinical care, management tasks, research, and teaching — yet time is rarely allocated for these roles. Why?
Physicians typically advance to leadership positions by demonstrating the capacity to take on more responsibilities rather than acknowledging limitations. Meanwhile, few healthcare organizations employ a systematic approach to determine the actual time required to fulfill leadership expectations. Instead, clinical workload is commonly reduced by an arbitrary percentage, without determining the true time demands of various leadership-related tasks. This practice frequently underestimates the time needed, resulting in persistent compression of time for leadership work.
When time allocation accurately aligns with role requirements, physician leaders and their direct reports usually experience greater effectiveness in managing their responsibilities.(7)
Problem 2: Reactive versus Proactive Leadership
Because physician leaders rarely have enough time because of overloaded schedules, they often spend most of their time addressing urgent and reactive-oriented issues. This reactive posture directs their attention toward urgent but less important activities that feel like constantly playing “whack a mole” or “firefighting.”
As a result, less urgent but higher value leadership activities get sidelined: relationship-building and strategic planning. Leader effectiveness — the goal of any development program — is hampered because physician leaders don’t have enough time to fully engage in the higher value leader activities most critical for organizational success.
Unlocking Physician Leaders’ Potential
The following three strategies provide a roadmap for organizations to unlock the full potential of physician leadership.
1. Ensure sufficient role clarity and role capacity.
Organizations must start by reassessing the true time required to effectively execute all the responsibilities. Doing this starts with getting granular with the job scope and task responsibilities for each physician leader’s role (e.g., department chair, medical director, vice chair).
This level of clarity allows organizations to calculate how much capacity or time should be allocated for different role types. In most instances, this should help improve a leader’s bandwidth to execute on highly important but less urgent relational tasks that most drive their ability to influence and engage their teams.
Suggested health system tactics:
Audit: Review and refine job descriptions for each physician leader role (e.g., department chair, vice chair, site lead, medical director) with sufficient clarity around the scope of the role. Have certain roles grown or shrunk in scope? How itemized or specific are the task expectations? Are some tasks no longer relevant to the role? Are additional tasks missing from the job description?
Align: Ensure appropriate organizational partners have buy-in on the more refined job and task descriptions.
Assess: Determine how much non-clinical time is truly required to meet the various leader roles and task expectations. For example, if certain leader types have up to 10 direct reports and the organization expects monthly 30-minute one-on-one meetings, then that can be calculated like a clinic schedule.
2. Require one-on-ones to nurture the relationship.
Nearly 70% of employees’ experience and engagement is influenced by their primary leader or manager.(8) This is why strong leader–team relationships are essential for supporting, coaching, and influencing their team members.
One way to build quality manager–employee relationships is by scheduling regular one-on-one meetings. These discussions, by design, must occur regularly to build and maintain a strong manager–employee relationship. In practice, overloaded schedules often push them aside despite their critical role in helping leaders be effective.
Once leaders have better clarity and capacity, three strategies can reinforce this task:
Structure: How should one-on-ones be structured in terms of frequency, duration, and content? This may vary depending on organizational culture, specialty, and/or other factors. Ensure that the right ratio of direct reports does not exceed a leader’s capacity for regular one-on-ones.
Support: What are the barriers to regularly scheduled one-on-ones? Is it logistics (e.g., scheduling, rescheduling), skills (e.g., leader training to do them well), or disinterest (e.g., cultural)?
Monitor: Assess meeting adherence and effectiveness within departments.
3. Utilize self-leadership and 360-degree feedback that sticks.
Many healthcare organizations are emphasizing the importance of soliciting feedback as a part of leadership development. Importantly, the methods used to collect feedback greatly affect their value in helping leaders become more effective in all the roles they play. The most common method is employee surveys completed confidentially.
Leader feedback must extend beyond annual surveys to be effective. One effective method is a 360-degree assessment with particular focus on self-leadership. This type of feedback is a real deep dive for the leader; it helps them get more meaningful feedback around their blind spots for much greater insight and awareness. Blind spots usually create the most problems because the leader isn’t aware of them. It helps leaders move from “I know something’s wrong” to “This is what I need to do about it.”
Ask: Does your organization regularly perform in-depth 360-degree leader or department/team assessments? Or, are these just performed when an acute problem arises?
Review: What type of in-depth self-assessment system is ideal for your organization? What are the common barriers (e.g., time, expense, etc.) that need to be solved to implement better leader assessments?
Do: Implement performance programs that reinforce lifelong and ongoing self-awareness and self-improvement for all leaders — not just leaders with readily identifiable performance problems.
If leaders take the feedback to heart and improve, this type of concrete change will not be lost on their teams. This deepens the team relationship, allowing for greater team performance.
References
Panagioti M, Panagopoulou E, Bower P, et al. Controlled Interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med. 2017;177(2):195–205. https://doi.org/10.1001/jamainternmed.2016.7674 .
Spilg EG, McNeill K, Dodd-Moher M, Dobransky JS, Sabri E, Maniate JM, Gartke KA. Physician leadership and its effect on physician burnout and satisfaction during the COVID-19 pandemic. J Healthc Leadersh. 2025;17:49–61. https://doi.org/10.2147/jhl.s487849 .
Mete M, Goldman C, Shanafelt T, et al. Impact of leadership behaviour on physician well-being, burnout, professional fulfilment and intent to leave: a multicentre cross-sectional survey study. BMJ Open, 2022;12(6):e057554. https://doi.org/10.1136/bmjopen-2021-057554 .
Stoller JK. Developing physician-leaders: a call to action. J Gen Intern Med. 2009;24(7):876–878. https://doi.org/10.1007/s11606-009-1007-8 .
Sonnino RE. Health care leadership development and training: progress and pitfalls. J Healthc Leadersh. 2016;8:19–29. https://doi.org/10.2147/JHL.S68068 .
Shanafelt T, Trockel M, Rodriguez A, Logan D. Wellness-centered leadership: equipping health care leaders to cultivate physician well-being and professional fulfillment. Acad Med. 2021;96(5):641–651. https://doi.org/10.1097/ACM.0000000000003907 .
Morgan JW, Detsky AS, Shea JA, Liao JM. Physician leaders’ perspectives about balancing clinical and leadership responsibilities. Am J Accountable Care. 2020;8(2):26–31.
Harter J. World’s largest ongoing study of the employee experience. Gallup Workplace. September 3, 2024. https://www.gallup.com/workplace/649487/world-largest-ongoing-study-employee-experience.aspx