After four months as associate dean of the School of Medicine of Addis Ababa University, cardiothoracic surgeon Abebe Bekele, MD, PhD, approached the university president to offer his resignation. “I told him, ‘I don’t know what I’m doing — my administrative assistant knows better than I do,’” he says.
Rather than accept his resignation, the president advised him to seek out leadership development education, mentorship, and coaching. Bekele took the advice and eventually served as dean of the Addis Ababa Medical School before moving to Kigali, Rwanda, in 2018 to become founding dean of the School of Medicine at the University of Global Health Equity (UGHE).
Now he is working to make sure Africa’s medical school deans — and, indeed, physicians in general — have opportunities to develop leadership skills through formal instruction.
“The future of institutions on the continent is leadership,” Bekele says. “It’s not about resources. It’s not about funding. It’s about preparing the leaders, especially the young leaders, for tomorrow. Leaders don’t just emerge. They are developed.”
The recognition of the importance of physician leadership is burgeoning throughout the world.
In the United States, health system administrators are motivated by research that has demonstrated that when physicians fill leadership roles, the performance of healthcare systems improves, says Peter Angood, MD, former AAPL chief executive officer. He cites survey results showing that at least 75% of U.S. physicians are interested in leadership development.
“For the first time ever in healthcare’s evolution, first time in the evolution of the AAPL, there’s this peak of interest in the need for the physician workforce to have leadership development,” he says.
Outside the United States, physician leadership is likewise valued in countries with highly developed healthcare systems, says Graham Dickson, CEO of LEADS Global, a not-for-profit enterprise that works to enhance health leadership capacity worldwide. But he believes that physician leadership is even more valued in other parts of the world.
“In countries like Canada and the U.S., the United Kingdom, and to a great extent in Australia and New Zealand, there is less emphasis on the importance of physician leadership than in some of the Middle East countries and in continents like Africa and South America,” he says. “In those other cultures, there is a greater reliance on physicians for leadership simply because physicians are the primary deliverers of care and they may also serve as the primary voice of leadership within the health system. However, there is a growing global awareness of the value of physician leadership development because of the growing complexity of all health systems.”
That said, valuing physician leaders does not necessarily equate with valuing leadership education. Throughout the world, nonclinical administrators inaccurately assume that an excellent physician will automatically make an excellent leader.
Angood says, “In many countries, if you think about who’s going to be an administrator in a hospital or a health system, it is assumed to be a physician because they’re the smartest people and they have the most training in clinical decision-making. So it makes sense for them to be a leader, but they show up totally unprepared.”
Physicians themselves may not be able to evaluate whether they have the skills to be effective leaders, Dickson says. Because of their extensive education and lifesaving clinical skills, physicians are often viewed as unique and special, an assessment that may cloud the reality that leadership is a discipline of study. It requires specific capabilities or competencies that they may not have developed.
He remembers interviewing a physician who was struggling in his new leadership role. “He told me, ‘Six months ago, I was a world-class neurosurgeon, and today I’m a bumbling idiot in a boardroom,’” Dickson says. “The more physicians actually get into leadership roles, the more they understand what they don’t know, and they begin to feel insufficient and vulnerable.”
Dickson explains that “… they may get out (of leadership roles) because they don’t like that feeling of inadequacy — they didn’t go into medicine to feel vulnerable; they went into medicine to help vulnerable people. Or they embrace the challenge, and they say, ‘Well, I’m going to get the skills that I need.’”
The Quest for Leadership Training
Getting the skills they need is not always easy. Indeed, the infrastructure needed to support physicians as they develop leadership skills is lacking in most countries, Angood says. That includes the United States, where nonclinical administrators often expect physicians seeking leadership positions to have a master’s degree in business administration, public health, health administration, or a related field.
“Yet they don’t appreciate that an added credential doesn’t necessarily give the improved leadership or management skills that are needed in order to help change that healthcare system or change the industry overall,” Angood says.
Many countries are trying to address this leadership gap, according to Dickson. He and colleagues developed the LEADS in a Caring Environment Capabilities Framework in the late 2000s. It consists of 20 capabilities under five domains that leaders need to effectively lead healthcare organizations through change: Lead self, Engage others, Achieve results, Develop coalitions, and System transformation.
The framework has been widely adopted across Canada, where Dickson is based. More recently, the LEADS framework has been embraced by major organizations in India and Chile, and within the past year, by the Victorian Healthcare Association in Australia.
The AAPL is unique in the world for its spectrum of courses, created specifically for physicians and other clinicians, on healthcare management and leadership topics. The organization has continually evolved over its 50 years to keep pushing the leading edge of physician leadership development globally.
At this point in its evolution, AAPL also recognizes the need to focus additionally on the development of interprofessional clinician leadership skill sets that are essential for optimal performance. Its array of offerings allows individuals to dip in for a specific topic — say, Building and Leading Effective Teams or Interdisciplinary Relationship Management — or make the deeper commitment to pursue the Certified Physician Executive (CPE) credential. The CPE recognizes completion of extensive coursework to build knowledge, skills, and competencies, and a collaborative Capstone experience.
“If a physician knows they want a high-end administrative career path, then they should know they should have a CPE credential behind their name,” Angood says. “It’s hands-on, it’s practical, and it’s real, which is different than master’s degrees or other generic leadership training.”
One International Leadership Journey
Patricia A. Abboud, MD, MBA, CPE, executive director of medical services at Sidra Medicine in Qatar, earned the CPE credential and a master’s degree from the University of Massachusetts Amherst after transplanting her career to the Middle East in 2017. A critical-care nurse-turned-pediatric intensivist, Abboud took on many leadership responsibilities during a 12-year stint at Dayton Children’s Hospital, with only on-the-job learning to guide her.
She joined Sidra Medicine when the 400-bed state-of-the-art women’s and children’s hospital first opened, positioned herself as a leader from the outset, and committed to a multiyear leadership-development journey. Abboud held several leadership roles at Sidra before being appointed to her current position — equivalent to associate CMO — in 2025.
Within Qatar’s population — roughly 3 million — only about 10% of residents are Qatari nationals. Thus, many physicians and physician leaders are recruited to Sidra Medical from other countries. Physician leadership is a very high priority for the organization, with limited leadership-development training for physicians in Qatar.
“Many of my colleagues are pursuing master’s degrees from wherever they consider home — a lot from the UK, some from Australia, some from Ireland and other places,” she says.
Most expatriate physicians working at Sidra Medical stay for a few to several years, so the health system especially seeks to promote Qatari national physicians into leadership positions as a way to ensure stability. The government provides financial support for Qatari nationals to pursue medical specialty fellowships abroad, with the expectation that they return to practice in the country. It also sponsors national physicians to undertake leadership training overseas.
Building a Stronger Infrastructure
In Canada, several initiatives seek to equip physicians with leadership skills. All medical schools are required to teach leadership as a requirement for accreditation. The Canadian Medical Association offers programs through its Physician Leadership Institute (PLI). The Canadian Society of Physician Leaders offers a comparable certification, based on the LEADS framework.
Despite that, Dickson does not consider the leadership development infrastructure in his country to be fully realized in terms of fragmentation, scope and breadth of substance.
For example, the leadership-education requirement for medical schools does not ensure that all medical students graduate with leadership competencies. “It varies dramatically from medical school to medical school because how leadership is taught is left up to each medical school to determine,” he says. “Leadership is rarely taught as a discrete unit, but rather, its competencies are integrated and assessed within a broader educational framework known as CanMEDS. Certification ultimately requires acquiring explicitly stated competencies that can vary from program to program.”
Program offerings through the Canadian Society of Physician Leaders and the Canadian Medical Association do not have a broad reach. “They have very good programs taught by some of the best people around, but they don’t get a massive amount of traction,” Dickson says. “We have 100,000 physicians practicing across Canada … and you might get a thousand a year taking a PLI program.”
Australia and New Zealand are highly unusual because of the Royal Australasian College of Medical Administrators (RACMA), a specialist medical college that trains and accredits physicians in medical leadership and health-service management. A RACMA credential is not required to serve in a leadership role, but many physicians value it, says RACMA President Erwin Loh, MBBS, MBA, PhD.
“A lot of doctors come to leadership and management roles by default without any prior training and initially think that they can do it because they run a private practice and they think they know how to take that to scale,” says Loh, medical director at Ramsay Health Care’s Peninsula Private Hospital. “But most doctors are smart enough to realize when they are in a role in which they actually lack the required competencies, and then they go on to seek training.”
The RACMA program is extensive. For physicians whose primary focus is healthcare leadership, full fellowship is awarded after at least three years of full-time training covering eight domains of professional practice: collaboration and teamwork; communication; ethics and professionalism; health advocacy and cultural safety; learning, teaching, and informed decision-making; medical and health system expertise; medical leadership; and medical management.
Physicians who are already accredited specialists in a clinical discipline can become RACMA Associate Fellows by completing its Leadership for Clinicians Program. That year-long program includes eight sessions, offered face-to-face or via Zoom, and four assessments.
In any given year, at least 200 physicians are pursuing either full or associate fellow status, Loh says. The college has more than 400 full fellows and about 1,500 associate fellows.
In general, Africa does not have a significant leadership-development infrastructure for physicians, Bekele says. Most medical schools do not offer leadership education in their curricula, and physicians who want formal training typically must seek out international opportunities paid for by outside funding such as scholarships or fellowships — or from their own pockets.
Thus, physicians are often appointed to leadership positions without any formal preparation. In fact, when the Addis Ababa University president notified Bekele of his appointment to serve as associate dean, Bekele had to ask what the job entailed. Then he learned why he was chosen: Medical students had voted him “best teacher” in each of the previous three years.
When he protested that being a good teacher did not prepare him to be a leader, the president told him not to worry. “He says, ‘All of us started like this — just go into the office and deal with it,’” Bekele says. “I learned on the job, unfortunately. I call myself an accidental dean.”
In his current role at UGHE, founded by Boston-based Partners in Health, he is spearheading the Consortium of Medical Schools in Africa (COMS-A) with a mission similar to that of the AAMC. Founded in 2025 with 115 medical schools in 34 countries, COMS-A has already grown to include more than 170 schools whose deans aspire to transform medical education.
Leadership is a COMS-A priority. “The deans of the 466 medical schools across Africa should have at least the basics of leadership,” Bekele says. “The deans grow to become vice presidents, presidents, ministers, ambassadors, so preparing them now is preparing them for the future.”
COMS-A partnered with AAPL to develop a nine-month program to enhance the leadership skills of current and future medical school deans. The program, primarily delivered online, includes a one-week in-person residency, mentorship, and project-based learning. It focuses on governance, financial management, innovation, digital transformation and health equity.
AAPL is providing its resources and personnel pro bono. “It’s a real partnership–co-development of the curriculum, co-delivery and co-evaluation,” Bekele says. “I appreciate AAPL, and especially Dr. Angood, offering this to their African friends for free.”
Because physicians are often tapped for leadership roles early in their careers, Bekele wants medical schools to offer formal education. “That is why in this medical school I’m leading now, leadership is part of the medical school curriculum,” he says.
At the University of Global Health Equity School of Medicine, the dual-degree MBBS/MGHD program is intentionally designed to go beyond clinical training. It equips students with foundational competencies in leadership, health systems management, financing, planning, and project implementation. By the time they graduate, learners are not only clinically competent but also prepared to navigate and lead within complex health systems. “So, by the time they are done, for a young professional at their level, they know the basics,” he says.