Navigating academic medicine and building a sustainable career can be daunting for physician leaders. They may need to manage the competing demands of clinical care, research, and teaching without adequate institutional support or mentorship. Financial pressures, evolving recruitment landscapes, and limited exposure to academic medicine pathways early in training may present further barriers for physician leaders to achieve career development and retention. These challenges are amplified by systemic issues in academic medicine, such as funding cuts and inequities in advancement, highlighting the need for physician leaders’ strategic career planning.(1) These systemic barriers may accumulate, leading physician leaders to experience burnout and/or consider leaving their roles.(2,3)
In response to these concerns, this discussion article presents conceptual frameworks and strategies for physician leaders in academic medicine to craft a sustainable, professionally fulfilling, and impactful career. While the literature we draw upon is primarily U.S.-based, many of the concepts may resonate with, or be adapted by, physician leaders internationally.
Concerns Among Physician Leaders in Academic Medicine
Physician leaders’ intentions to leave their roles, in line with a 2023 study’s reported 11% national attrition rate, are concerning.(4) This study found that high-level leadership at academic medical centers was frequently cited as a reason for physician leaders’ intentions to leave their institutions.(4) These findings highlight concerns for potential incongruencies and tension between high-level leadership and physician leaders in academic medical centers, although the exact reasons remain a gap in the research.(4)
Given how critical leadership positions are within organizations, the consistency of medical education training, clinical care, and efficiency, it is particularly concerning that we do not have a national grasp on the attrition rate of leadership positions within academic medical centers. A thorough understanding of physician leaders’ decision-making processes is missing, including how they weigh values and context to finalize a series of decisions and interpretations before taking action.
As physician leaders may leave their positions in academic medical centers, their overall careers as healers or academics may take a new shape. They may step down and adjust their full-time equivalent (FTE) to return to more clinical service, teaching, or research.(5) However, it is unknown how these data could inform us about how some physician leaders may pivot and choose not to leave a position entirely, recalibrating themselves into a new variation of their professional identity. Clarity on such shifts could clue those overseeing professional development programming, mentors, and coaches about the maturation of physician leaders’ careers and how to frame sustainable career plans for long-term retention within academic medicine.
While the reasons contributing to physician leaders’ intentions of leaving their roles, institutions, or academic medicine entirely may be multifactorial, studies have suggested that burnout may be a strong contributing factor.(1–3) The factors contributing to physician leaders’ burnout may stem from a combination of personal, professional, and systemic challenges.(6) The cumulation of these challenges may cultivate uncontrollable stress that affects physician leaders inside and outside of work.(6)
High rates of physician burnout(2,3,6) amplify the need for closer investigation into effective leadership structures in academic medicine, along with strategies for physician leaders to maintain their sense of well-being, belonging, and motivation in their roles.
Leadership’s Role in Facilitating Sustainability in Academic Medicine
A strong sense of leadership and structure is essential to the stability of the workforce at a given academic medical center.(4-6) One case report analyzing Mayo Clinic’s leadership structure highlights how collaborative, team-based, and patient-centered leadership serves as a foundation to create a mission- and culture-aligned team, and ultimately, the institution as a whole.(7)
The findings in this study highlight how a top-down commitment to creating a sustainable workforce within an institution may foster trust, collaboration, and community-centered engagement — all of which may serve as protective factors against physician burnout, and ultimately, attrition. It is important for physician leaders to feel valued and empowered within the leadership structure at their academic medical center.
PURPOSE-DRIVEN FRAMEWORK FOR CAREER SUSTAINABILITY AMONG PHYSICIAN LEADERS
A “career” is generally defined as the continued employment of an individual in a professional role that typically aligns with one’s values, strengths, and passions, while facilitating both personal and professional development over time.(8) Sustainable careers allow one to advance and develop while making meaningful contributions to the field and broader community.(9) The sustainability of such a pathway is characterized by mutually beneficial consequences for the physician leader and for those within their professional and personal life (i.e., work organization, family).(4,10–12)
Ultimately, career sustainability is a complex phenomenon that requires us to take a dynamic and systemic perspective that simultaneously considers the person, their context, and developments over time.(9,13)
What makes a career sustainable and successful?
Sustainable careers involve the proactive and reactive actions of employees and their employers.(13) Sustainable careers thus require more than individual agency, such as integrating work-life needs and harmony within an academic medical center.(9) Sustainable careers also include physician leaders’ responses to difficult circumstances or decisions, such as when an individual decides whether or not to leave a job because of burnout.(2,4)
For their part, organizations, including academic medical centers, may differ in the degree of proactivity when dealing with the sustainability of their workers’ careers.(14) The use of mass career customization is an example of proactively addressing dynamic individual career needs in academic medicine.(11)
Within academic medical centers, some leaders may be more proactively concerned with career sustainability, while others may be more reactive in accommodating their employees’ needs.(10,15) As such, the idea of being “in a lifelong learning mode” is important for a physician leader to facilitate a sustainable career in academic medicine. This openness to learning and a growth mindset can be complemented by the culture, institutional policies, career resources, and leadership structure of an academic medical center.
Key Takeaways
Sustainable career practices not only enhance engagement, well-being, and productivity, but also play a critical role in mitigating leadership attrition.
By aligning personal strengths and values with organizational roles, physician leaders can maintain professional satisfaction and reduce the likelihood of leaving their positions or the academic setting altogether.
Applying the Sustainable Career Paradigm
The Sustainable Career Paradigm is a dynamic process model in which health (defined as physical, emotional, and social well-being), happiness (engagement), and productivity (performance) are the three core indicators of a sustainable career.(13) The dimensions of person, context, and time are three key dimensions to examine sustainable careers (see Figure 1).(9)
The Sustainable Career Paradigm encompasses a framework that physician leaders may use to envision the dynamic interplay between who they are as people, the individual context they are in, and changes they may experience over time as a foundation for planning sustainable careers.(9,13)
Explaining the Sustainable Career Paradigm
First, the person is the central actor. It is hence important to understand how individuals, through their values, strengths, actions, and the interpretations they have of experiences, affect the sustainability of their careers.
Second, careers are affected by the multiple contexts in which they evolve: the work context, in addition to other layers of context, such as the context of one’s private life, the organization they belong to, the context of the broader labor market, and one’s society and culture.(14) In academic medicine, it refers to the institutional, cultural, and structural environment in which activities occur and includes factors such as departmental priorities, funding models, faculty roles, and promotion criteria, all of which influence individual behavior and career trajectories.(16)
Third, careers evolve over time, and thus, it is important to consider what makes a career sustainable across the lifespan. One must consider both intra-individual changes as well as changes occurring within the different layers of context.(9,12)
THREE PILLARS TO CREATING A SUSTAINABLE CAREER IN ACADEMIC MEDICINE
We frame success as a dynamic journey encompassing advancement, meaningful contributions, and fulfillment, which can be gauged through objective measures (e.g., academic promotion, productivity metrics, retention rates) and subjective indicators (e.g., engagement, satisfaction).
Happiness: The First Pillar
Professional fulfillment (PF), or engagement in meaningful work, is the intrinsic positive reward we derive from our work. It is the elusive sweet spot where our work aligns with our values, leverages our strengths, and contributes to something meaningful.
The core elements of PF include purpose, autonomy, mastery, connection, recognition, and impact. PF has been positively linked to wellness, optimal functioning, productivity, and behavior change/maintenance.(10,15) This connection highlights the notion that when we experience inherent satisfaction and enjoyment from doing something, we feel contented and are motivated to continue doing it.
Physician leaders may use the Stanford Professional Fulfillment scale to assess the degree of intrinsic positive reward derived from their work, including happiness, meaningfulness, contribution, self-worth, satisfaction, and feeling in control when dealing with difficult problems at work.(17)
Well-Being: The Second Pillar
Well-being is not just the absence of disease; it is a multidimensional state encompassing physical, mental, emotional, social, spiritual, and financial health, in which individuals feel satisfied, resilient, and connected.(2,9) Cultivating well-being involves more than just feeling good. For physician leaders, it involves functioning effectively and contributing meaningfully in the service of something greater than oneself. Physician leaders and their institutions may measure well-being through the Mayo Well-Being Index or similar scales.(1)
Productivity: The Third Pillar
Productivity among physician leaders in academic medicine is a multidimensional concept that reflects their clinical, teaching, scholarly, community service, and administrative contributions. Productivity plays a critical role in shaping physician leaders’ career advancement, institutional reputation, and healthcare innovation. When thoughtfully measured and aligned, productivity becomes a strategic tool to optimize the three Ps:
Profit, by enhancing operational efficiency and securing research funding.
People, by fostering professional fulfillment, mentorship, and equitable advancement.
Planet, by advancing public health, sustainability, and socially responsible innovation.
Objective measures of “academic” success include research and scholarly productivity, professorial promotion, teaching performance, and salary. Subjective measures include professional life satisfaction, contribution to society, academic freedom, and mentoring trainees and colleagues.(11,12,18)
Key Takeaways
Happiness: Achieved through purposeful work, autonomy, mastery, social connection, recognition, and meaningful impact.
Well-being: Encompasses physical, mental, emotional, social, and financial health dimensions.
Productivity: Reflects balanced contributions across clinical care, teaching, research, and service aligned with institutional priorities.
GUIDELINES AND PURPOSE-DRIVEN DECISION MAKING
The National Health Care Leadership Competency Model 3.0TM organizes 28 leadership competencies into seven domains depicted in Figure 2, grouped under two categories: action domains and enabling domains.(14,19)
Action domains (execution, transformation, boundary spanning, and relations) focus on the direct work of leaders, what they do to drive performance and change within healthcare organizations. These domains reflect the visible, outcome-oriented behaviors of physician leaders.
The enabling domains (values, self-awareness and self-management, and health system awareness and business literacy) support and enhance the effectiveness of the action domains by focusing on physician leaders’ internal development and contextual awareness. These represent the foundations of leadership readiness, the mindset, knowledge, and personal growth that may enable physician leaders to act effectively.
These concepts and their significance, along with ideas for physician leaders to achieve them in academic medicine, are outlined in Table 1.
Key Takeaways:
Leadership competencies encompass both action and enabling domains.
Emotional intelligence and business literacy are critical for success.
Practical exercises facilitate competency development.
CAREER SATISFACTION MATRIX FOR DECISION-MAKING
The Career Satisfaction Matrix illustrated in Figure 3, anchored in the dimensions of skill level and enjoyment, offers a practical framework for physician leaders to navigate career advancement in academic medicine.(20)
By categorizing professional activities into four quadrants (high skill/high enjoyment, high skill/low enjoyment, low skill/high enjoyment, and low skill/low enjoyment), physician leaders can make informed decisions about where to invest their time and energy.
Tasks that fall into the high skill/high enjoyment quadrant, such as mentoring, leading research initiatives, or developing educational programs, are ideal for showcasing excellence and building a reputation. These activities may often translate directly into promotion and leadership opportunities. Meanwhile, activities in the low skill/high enjoyment quadrant signal areas that are ripe for professional development, allowing physician leaders to grow in ways that are both personally fulfilling and strategically aligned with institutional priorities.
This matrix may help physician leaders prevent burnout by identifying tasks to delegate or redesign. It also serves as a dynamic tool for physician leaders to align their daily work with their long-term career goals in a complex and evolving academic medical environment.
Key Takeaways:
Prioritize high skill/high enjoyment activities for career growth.
Leverage low skill/high enjoyment tasks for skill development.
Delegate or redesign low-skill/low-enjoyment tasks to maintain motivation.
CONCLUSION
Together, these frameworks create an integrated roadmap for physician leaders to cultivate sustainable careers in academic medicine. The Sustainable Career Paradigm establishes the overarching lens by emphasizing health, happiness, and productivity across person, context, and time.
The National Health Care Leadership Competency Model specifies the skills, behaviors, and enabling capacities, such as emotional intelligence, strategic decision-making, and business literacy, that may enable leaders to navigate complex organizational contexts and maintain well-being.
The Career Satisfaction Matrix provides a practical decision-making tool for aligning daily tasks with both skill and enjoyment, operationalizing the happiness and productivity dimensions of sustainable careers while reinforcing engagement and professional fulfillment.
Physician leaders may use this framework to reflect on their values, priorities, and mission, aiding their consideration and planning for sustainable careers in academic medicine.
Implications for Practice
Physician leaders who do not cultivate core competencies, such as emotional intelligence, strategic decision-making, boundary spanning, and values alignment, risk contributing to increased burnout, disengagement, and leadership attrition within academic medicine. Without these skills, physician leaders may struggle to navigate complex institutional dynamics, foster collaboration, or adapt to evolving professional demands. This may result in misaligned roles, stalled career progression, and diminished organizational impact.
The absence of reflective practice and goal-setting undermines resilience and fulfillment, while poor interpersonal and business literacy erodes trust, team cohesion, and system-level innovation. By fostering professional fulfillment, well-being, and effective leadership competencies, physician leaders may help reduce attrition in academic medicine. Engaging in meaningful work, developing core leadership skills, and aligning daily tasks with values, passions, and strengths has the potential to enhance individual satisfaction and productivity, while supporting long-term retention and stability within academic medicine.
To build on the literature regarding career sustainability among physician leaders, further studies are needed to understand how organizational and systemic factors may influence career sustainability across subgroups of physician leaders.
Acknowledgment: Mohan V. Belthur, MD, FAAOS, and Jasmine K.M. Lopez, BS, BA, contributed equally to this article and share primary authorship.
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