Healthcare is a complex industry that presents numerous challenges to those who seek and provide care. Physician leaders have a unique opportunity to question, influence, and shape healthcare’s future. By leveraging their clinical expertise and decision-making abilities, physician leaders can advocate for systemic improvements, including access to care, reduced costs, and improvements in quality and equity, ultimately leading to better health outcomes.(1,2)
Effective leadership involves guiding and inspiring individuals or groups toward a shared vision while making difficult decisions that balance immediate needs with long-term objectives.(3) Successful leaders maintain focus by ensuring their teams remain aligned and motivated while offering necessary support during challenging times to foster resilience and trust.
The leadership journey for physicians is rarely a linear path. A structured framework, however, can help early-career physicians develop foundational leadership skills while allowing those in later stages of their careers to influence institutional culture. This article explores the core competencies and attributes at each phase of a physician leader’s career, contributing to the development of effective physician leadership in healthcare.
Physician leaders are unique because they must develop competencies for both their clinical and leadership careers. This dual developmental path becomes increasingly important when evaluating the competitiveness of physician leaders with non-physician leaders as candidates for senior leadership roles within a healthcare organization.
Early-career physician leaders must focus on building the knowledge, skills, and abilities outlined by the American Association of Medical Colleges (AAMC) and American Board of Medical Specialties (ABMS) to succeed as clinicians (Table 1). Non-physician healthcare leaders may enter the workforce immediately or take a more complex trajectory, acquiring essential leadership experience and developing the necessary attributes through early career exposure. In contrast, physicians enter multi-year training programs after medical school to continue their clinical preparation. This distinction is depicted in Table 1, where physician and non-physician leadership competencies are displayed based on the leader’s career phase.(4)
Before describing a physician leader’s journey from early to late career, it is essential to consider the core attributes that define their ability to excel in professional leadership roles, which have been derived from the American Board of Medical Specialties (ABMS) standards for initial certification and the Human Resource Competency Models.(5,20) Table 2 provides an overview of these core attributes, which form the foundation of a physician leader’s professional capabilities and guide their development throughout their career. Here, we have used these attributes to discuss the physician leadership journey and analyze competencies learned and utilized throughout.
To meet the needs of emerging physician leaders better, academic institutions could explore avenues for cultivating these professional attributes and leadership skills earlier in the physician’s career, in parallel rather than in sequence to developing their clinical expertise. This approach will not only save valuable time, but also will allow for a shift toward more experiential learning earlier in the physician leader’s career journey.
EARLY CAREER: BUILDING THE FOUNDATION
Case Example: A chief resident observes that several patients on the teaching service have been readmitted to the hospital over the past three months. In response, she undertakes a quality improvement initiative aimed at reducing the readmission rate.
She encounters resistance, however, from some attending physicians who think the proposed changes add to their documentation burden and question whether the readmissions reflect systemic issues beyond their control. This early-career physician leader is leveraging her clinical expertise to identify a quality issue and applying essential skills in project management and team coordination to address it.
By leading this initiative, she gains valuable experience in data analysis, interdisciplinary collaboration, and process improvement, which are core competencies that are essential for emerging physician leaders. Through this process, she not only contributes to enhancing patient care and hospital performance, but also develops leadership capabilities that will serve her in future roles, allowing her to meaningfully influence clinical practice and healthcare delivery.
The early phase for an emerging physician leader extends from medical school until approximately five years after the completion of formal training. Traditionally, this period has been focused on learning and refining clinical expertise to become independent in clinical practice. For those aspiring to leadership roles, however, it is critical to explore areas beyond clinical medicine, such as quality improvement, education, informatics, operations, and finance. Physician leaders should use this phase to learn how to balance their clinical responsibilities with emerging leadership interests, gaining foundational skills and insights that will help them in their future leadership trajectory.(4)
Core Competencies
Table 1 provides a summary of competency domains and specific competencies for physician and non-physician leaders developed by nationally representative healthcare leadership organizations. The major competency domains for the early-career phase are clinical skills and patient care. One can also see in Table 1, however, that other domains and specific competencies are relevant.
For example, the domains of professionalism, ethical practice, and interpersonal and communication skills are relevant to both clinical care and leadership. Competency development can be initiated in this early-career phase through quality improvement projects, patient safety committees, service as a chief resident, or membership in hospital leadership groups.
Knowledge
As medical education has evolved, it has become clear that medical practice depends less on the role of an individual physician and increasingly on the performance of clinical operations led by physicians for the benefit of patients. The knowledge encompassed within medical science, while important, is no longer sufficient for dealing with the complexity of these healthcare systems. Hence, the physician and evolving physician leaders must expand their knowledge of health system functions, organizational dynamics, and how planning and financial management translate into healthcare strategies, services for communities, and direct patient care.
While healthcare leaders need to understand the foundation of healthcare laws, regulations, and policies, the essential element for building a robust and well-rounded knowledge foundation in leadership is based on experiences, mentoring, and continuing education opportunities.
Skills
The early-career phase is the time for establishing and refining essential core skills that physician leaders can more fully develop within the everyday work of a busy clinical practice. Among these crucial skills, communication, team management, conflict resolution, and decision making under pressure emerge in clinical medicine with direct relevance to leadership.
Since teams and communication involve people, the early-career phase can be spent learning how to establish common team goals (e.g., a hospital discharge) and to ensure collaboration to achieve that outcome. Understanding how to set priorities and manage time and projects is a skill that can be learned in the clinical environment and has a long-lasting influence in the leadership environment.
Abilities
An early-career physician will develop several technical capabilities during training. The major abilities that require refinement can be categorized broadly as emotional intelligence (EI) or emotional quotient (EQ). Emotional intelligence is the ability to understand the cues for emotional responses in oneself and others. Being aware of the cues that influence these behaviors is essential to ensure that team members are aligned. When they are not aligned, the leader can influence and motivate the team’s behaviors to achieve that alignment. These abilities are derived through building trust, ensuring empathy, and maintaining focus on the needs of the patient and team.(6)
Healthcare is dynamic, and during rapidly changing times, leaders need to be trusted by their teams to ensure they can effectively navigate challenges. The growth that comes from successfully responding to challenges builds flexibility and resilience in the leader and the team.
Behaviors
Physician leaders will develop their own leadership style after years of observing other approaches. Behaviors that transcend clinical and organizational leadership include demonstrating the highest levels of professionalism, ethics, and integrity, personally and professionally. People trust others who are genuine and transparent in their communication. Leaders can establish a culture of continuous improvement and learning if they are willing to reflect on and respond to feedback.
Attitudes
Effective leadership attitudes that can develop in the early career include being positive and proactive. Humility and a willingness to adjust based on successes and failures will enhance progress, while seeking out and listening to others with experience who can provide guidance will develop competency.
Experience
Leadership is built over time. Accepting new experiences in leadership can extend an early-career physician’s skill set. Having hands-on experience with leading teams, managing conflict, and engaging in decision-making is essential. When new opportunities arise, early-career physicians should always put their hands up first, even when the opportunity is a bit out of their comfort zone.
Early-career physicians can seek mentorship from experienced leaders and reflect on the good and the bad of the experiences encountered. Confidence and competence will grow as individuals participate in committees, lead initiatives, and achieve collaborative outcomes.
Challenges and Success Strategies
This phase is important and foundational for the physician’s clinical and leadership career, but it is not without its challenges. Challenges include balancing clinical workload with leadership aspirations through time-blocking strategies like the Eisenhower Matrix, gaining leadership exposure via roles such as chief residency or committee participation, and finding mentorship by identifying role models and engaging in structured mentoring programs (Table 3).
MID-CAREER: ADVANCING LEADERSHIP AND INFLUENCE WITH A TRANSITION TO STRATEGIC LEADERSHIP
Case Example: A physician leader who serves as the medical director for a health plan is responsible for addressing the low compliance rates in annual wellness visits among senior citizens covered by their Medicare Advantage Plan. He drives a comprehensive plan, including implementing software aimed at identifying at-risk individuals, scheduling their visits, ensuring the completion of visits, and maintaining compliance in documentation and billing.
He faces tension, however, between clinical teams who are overextended and administrative staff who are concerned about the financial investment in new technology. He is forced to navigate competing priorities and stakeholder skepticism. He demonstrates mid-career leadership maturity by managing a strategic challenge with multiple constituencies.
By leading this initiative, he engages with change management principles, demonstrates his leadership and influence, and assures the team that this strategic challenge is managed.
The mid-career phase for a physician leader extends from approximately 5 to 20 years after formal training is completed. This period focuses on demonstrated clinical expertise, teaching, mentorship, and, for those interested in leadership, a strong background and familiarity with the qualities and results that exemplify a physician leader. In this phase, progressive leadership roles range from medical director to vice president and, in a more traditional academic organization, section chief through chair.
Aside from executive leadership, mid-career physician leaders may mentor rising leaders or attend leadership workshops to further enhance their leadership skills. Physician leaders may dedicate more time to leadership responsibilities that broaden their influence beyond clinical medicine and seek leadership credentials that legitimize their expertise.(7)
Core Competencies
The mid-career physician is focused on evolving their clinical expertise and honing their leadership competencies. The major competency domains for this mid-career phase are leadership, management, and interpersonal and communication skills. One can also see in Table 1, however, an overlap between early-, mid-, and late-career skills, highlighting that exposure to and development of leadership competencies may present at different times in a physician’s leadership career.
For example, physician leaders may struggle to develop a talent management skillset if they have few direct reports. Similarly, influence and negotiation skills may be limited until the physician leader has attained a role where these skills can be exercised. Growth in the mid-career physician leader is characterized by refining their fundamental leadership competencies and broadening their influence as a leader.
Knowledge
Some mid-career physician leaders may have had little exposure to the fundamental topics in healthcare leadership, while others may have an advanced degree with broad-based leadership knowledge. Regardless of the starting point, a mid-career physician leader should strive to close any knowledge gaps and focus on advanced topics in healthcare like management, policy, and strategy.
The mid-career leader needs an “internal” knowledge lens that encompasses understanding systems thinking, managing people and budgets effectively, and setting a strategy to accomplish goals. In addition, an “external” knowledge lens is needed to understand changes in the law, regulation, policy, and where technology and reimbursement fit in. This learning can occur through formal degree programs, continuing education, conferences, and certification programs through professional societies and those engaged specifically in leadership, such as AAPL.(8)
Skills
The skills a mid-career physician leader needs relate to people management and organization management. Essential skills for effective people management include evolving communication strategies, relationship building, managing and directing teams, mentoring, and learning the art of negotiation.
The mid-career physician leader can be involved in the organization’s activities through management skills that include strategic thinking and execution, resource allocation through the budget process, financial acumen, and understanding of governance. These are all essential skill sets that allow the mid-career leader to work in complex organizations while influencing and executing an agenda.
Abilities
The mid-career physician leader must have the ability to manage and lead at the highest level of an organization. This includes the ability to think and operate at the macro and micro levels of the organization.
At the macro level, these leaders should be poised to lead large institutional or cross-departmental initiatives regardless of the topic. They need to be trusted to solve problems with cross-disciplinary teams that enhance the organization’s efficiency and performance.
At the micro level, these leaders should have a broad-based internal and external network of collaborators from which to draw guidance and advice. In addition, they must have the ability to mentor and develop the next generation of leaders.(9)
Behavior
The behaviors of the mid-career physician leader should reflect the ethics and professionalism of their career choice, modelling their personal values. The leader must be confident enough to manage the politics of a large organization and nimble enough to know when to lead with determination and when to empower others. These behaviors are learned and require that the leader foster input from diverse constituencies as they seek to achieve what is best for patients and the organization.
Attitudes
Mid-career physician leaders should know what they stand for and reflect that in their behaviors as described above. First, a proactive attitude toward the organization, its people, and its focus on caring for patients is fundamental. Second, the leader should be committed to improving the quality of care, integrating innovation, and managing the change process. Third, organizational growth requires dedication to mentorship and leadership development that instills in others the ability to balance competing constituencies and maintain resilience and adaptability as organizations change.
Experience
Mid-career physician leaders may have gained a broad set of leadership experiences managing teams and projects, as well as addressing the consequences of their decision-making. The physician leaders’ mid-career phase is perhaps the most dynamic in terms of growth, with a leader holding two or three progressive roles during this phase. Clinical roles like section chief or department chair, or more administrative roles like medical director, provide opportunities for these leaders to fine-tune their experiences and parlay them into a series of executive leadership roles as they enter the late phase of their careers.(10)
Challenges and Success Strategies
The mid-career phase is often the most dynamic period of growth and influence for physician leaders, but it also presents unique challenges. These include managing increasing responsibilities without burnout through delegation, boundary-setting, and proactive self-care; navigating hospital politics by building institutional awareness and coalitions; and contributing to succession planning by formally mentoring junior colleagues and fostering the next generation of physician leaders (Table 3).
LATE CAREER: LEGACY AND INSTITUTIONAL LEADERSHIP
Case Example: A chief medical officer is invited to serve on the board of a professional association. He establishes a physician leadership academy to help train future physician leaders in his specialty. He encounters hesitation, however, from some senior executives who question the return on investment and from younger physicians who express skepticism about traditional leadership models, prompting him to bridge generational perspectives while aligning the program with evolving institutional goals.
His expertise and influence help advance the program. By leading this initiative, he demonstrates his leadership ability and influence and exemplifies late-career competencies, including legacy-building and stewardship.
A physician leader’s late-career phase begins approximately 20 to 25 years after formal training is completed. The physician leader has already served various leadership roles with significant achievements in clinical and administrative work. This phase is characterized by sharing leadership knowledge, generational mentoring, and a focus on legacy.
While classic legacy roles include chief executive officer, dean, university president, or provost, the title is less important than the work performed. These physician leaders can perform meaningful work by serving on nonprofit organization boards and guiding their organizations through institutional change and improvements.
Core Competencies
Physician leaders in this career phase are expected to have mastered both clinical and leadership competencies across all competency domains (Table 1). Just as with clinical medicine, experience matters. It is common for physician leaders to be more comfortable with some competencies over others based on their roles, work, and experiences. Nonetheless, a broad understanding of these competencies is a hallmark of this career stage.
Knowledge
Physician leaders who enter the late-career phase should have extensive knowledge of how organizations operate and a deep understanding of the external healthcare environment. These two knowledge sets interact as these physicians are sought for their ability to apply their strategic knowledge to guide long-term planning efforts. Hence, these leaders often engage in board roles, capital ventures, and strategic planning activities. Lifelong learning is essential as the healthcare environment changes along the innovation and policy fronts.
Skills
The late-career phase is focused on transformative activities, including vision and strategy setting, advocacy work, and policy development. With years of experience in negotiation and communication, the late-career physician leader may be seen as a broker who helps find common ground, communicate the vision, motivate, and persuade diverse constituencies to action.
Abilities
Late-career phase physician leaders can balance clinical and business realities while setting strategy. This enables them to advocate for and oversee broad initiatives that help sustain the organization over time. Their expertise in mentoring and developing leaders helps the organization thrive well beyond the leader’s tenure. Their influence and inspiration can help drive the perpetual nature of the organization as well as their own legacy.
Behaviors
Legacy is often discussed at this stage of the physician leader’s career. Legacy does not imply that the physician leader’s career is winding down; rather, with a foundation of significant knowledge and accomplishments, this phase helps the leader decide how to mentor and advise the next generation of physicians and leaders, focus on which programs they enjoy spending their time on, and reflect on the contributions they may have made.
Increasingly, late-career physician leaders are redefining traditional retirement by remaining engaged through consulting, entrepreneurship, and advisory roles in startups or health innovation initiatives. Despite the risk of ageism, their wisdom, maturity, and professionalism, shaped by decades of experience, offer invaluable perspectives that help organizations transform while ensuring continuity and excellence.(11)
Attitudes
Physician leaders in the late phase of their careers must have an attitude of service to others and stewardship of the organization. Their focus should be on the greater good of the organization and the healthcare system as a whole, and their perspective should emphasize sustainability, ensuring the organization remains adaptive and resilient in the face of future challenges.(12)
Experience
Late-career phase physician leaders have a breadth of experience upon which to contemplate and reflect when trying to solve problems in the moment and to address the potential consequences as they shape the organization’s future. This experience also helps them mentor other leaders, which positively impacts the broader health system.(13)
Challenges and Success Strategies
The late-career phase marks a time of reflection, legacy-building, and continued influence, but it also brings its own set of challenges. These include maintaining engagement while transitioning out of active leadership by gradually shifting responsibilities and mentoring successors; defining one’s legacy through initiatives such as scholarships, research programs, or leadership training; and adapting to a rapidly evolving healthcare landscape by staying involved in advisory roles and advocacy efforts (Table 3).
CONCLUSION
The lifecycle of the physician leader is marked by continuous growth, evolving responsibilities, and increasing impact. By understanding the core constructs at each developmental stage and actively engaging in mentorship, skill development, and strategic leadership, physicians can navigate their careers effectively while shaping the future of healthcare leadership.
Investing in structured leadership pathways ensures that physician leaders remain resilient, effective, and capable of driving positive institutional and systemic change.
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