Physician leaders are essential to bridging clinical care and the business of medicine, yet new research shows that leadership fatigue, driven by systemic factors, is prompting burnout, disillusionment, and turnover. Our study of 17 U.S. physician executives amplifies their voices and points to real solutions for healthcare organizations.
Background and Operational Significance
Unclear expectations and lack of institutional support undermine physician leaders, resulting in high turnover and lost value. Healthcare organizations risk increased costs and diminished care quality unless systemic contributors are addressed.
Leadership fatigue among physicians is not an individual failing, but a collective outcome of unclear roles, inadequate support, and loss of professional identity. The assumption that clinical excellence naturally translates to leadership success leaves new executives unprepared for the ambiguity, political pressures, and isolation of the C-suite.
In the absence of clear expectations and shared understanding of physician executive accountabilities, physician leaders often are set up to fail.(1) Their executive colleagues possess varying perspectives on what they should or should not be doing. Furthermore, navigating potential pitfalls and landmines to contribute maximal value to the organization can be complex, confusing, and demoralizing. The results are often a less than compelling realization of benefits of investing in the physician leader role and physician leader turnover. This is an expensive proposition that could be avoided with a proper understanding of the critical success factors needed to hire right-fit physician leaders, who then are positioned to become valued contributors to the success of the organization.
With rising healthcare costs and increasing fiscal demands on health systems, the cost of hiring a physician leader without adequate development, in addition to the confusion among the executive team, highlights the need for improving how health systems develop, socialize, and utilize physician leaders.
Conceptual Framework
The role of a physician is demanding. Many work long days, well into the evening or after their scheduled shift, completing seemingly endless documentation and conducting patient follow-up. Physicians often feel that they are viewed by the organization as a unit of production, rather than a valued team member. Boundary spanning, for example, is just one way in which physicians have inadvertently played an active role in easing the financial burden in an ever-changing environment.(2) This most commonly is due to an expectation that physicians: 1) take on an ever-increasing patient load; 2) maintain careful and constant oversight of documentation and coding; and 3) will drum up additional business through advertising or other means.(3)
As the business of healthcare compresses independent clinics into systems, the demands on physicians are increasing yet again. With the expansion of physicians into key leadership roles, we see another set of challenges: transitioning the clinician to leader — a shift that is capitalizing on a pool of physicians that already is diminishing in many specialties.
The researchers examined the nexus of these critical concerns (Figure 1) among physician leaders, leading to the question: In the absence of effective development, how quickly will physician leaders experience leadership fatigue after promotion into a formal leadership role?
Figure 1. Conceptual framework.
Definitions: Intentional Leadership Development: the constellation (or lack thereof) of didactic, mentoring, coaching, and reflection that contributes to the accretive effectiveness of a leader. Cumulative Workplace Distress: the collection of workplace occurrences of burnout, moral injury, and/or PTSD that have an adverse impact on the psychological, emotional, and/or physical state of an individual. Inadequate Role Clarity: the lack of alignment across stakeholders as to the scope of responsibilities, accountabilities, and performance expectations of a physician leadership role. Lack of Support: the absence of clear expectation-setting, direction, feedback, validation, and appropriate consequences; this may contribute to a feeling of abandonment or being cast adrift, rudderless. Role Stress: feelings of psychological, emotional, and/or physical stress that may be triggered by cumulative workplace distress. Content Knowledge: the information, skills, and experiences that empower leaders to effectively perform their duties. Leadership Fatigue: the experience of physicians who have transitioned or are in a state of transition from exclusively clinical practice to incorporating some degree of formal leadership role and responsibility that manifests as struggling to stay motivated, passionate, engaged, and/or energetic about their physician leadership role and/or finding it difficult to motivate, guide, engage, and/or encourage team members; this may be a reflection of the combination of cumulative workplace distress, absence of intentional leadership development, and inadequate role clarity. Abbreviations: CWD, cumulative workplace distress; LD, absence of intentional leadership development; RC, inadequate role clarity.
Research Methods
We conducted a multi-institution qualitative study with 17 physician executives (Table 1). Focused interviews and group sessions revealed real-time pain points and organizational gaps. Research questions included ways in which physician leaders experienced cumulative workplace distress, unresolved conflict, shifts in expectations related to professional identity, and ways that physician leaders felt unsupported with difficult decisions.
Key findings of the study included the following:
Physician leaders without clarity and support experienced rapid disillusionment when promoted with minimal leadership development and little clarity on their roles or authority.
Most participants cited feeling unsupported by executive colleagues and isolated from former clinical peers.
Lack of clear roles and executive team integration left many physicians feeling overwhelmed and struggling to meet the multitude of complex challenges from billing, quality, and becoming physician disciplinarians.
Persistent “role ambiguity” and a lack of structured mentorship resulted in stress behaviors ranging from withdrawal to unhealthy coping.
Systemic “cumulative workplace distress” — including burnout, moral distress, and conflicting values — was present in almost every case.
The hidden curriculum of medical school of “just figure it out” was damaging. In addition, leadership development was rare, ad hoc, or nonexistent, and a significant contributor to individual attribution or sense of failure, which added to cumulative workplace distress.
Lived Experience: What It Feels Like
Physician leaders described their roles as (Table 2):
“Eye candy,” “hood ornaments,” or “token leaders”;
Being “set up to fail” with unclear expectations and little voice in actual decision-making;
Having little, if any, voice in patient and quality issues; and
Experiencing professional damage if they were labeled “disruptive” even as they tried to reinforce their professional expertise.
Why This Matters for Healthcare
High rates of burnout and turnover are prevalent in healthcare across all clinical professions. This not only is a waste of talent, but it also erodes confidence in the physician leadership pipeline and healthcare in general. In addition, rates of addiction, professional exodus, and even suicide(4) are taxing a decreasing pool of physicians.
The study provided compelling evidence that leadership fatigue among physician leaders is chiefly a product of systemic gaps, especially unclear organizational roles, insufficient development support, and persistent identity dissonance. These findings highlight the necessity for healthcare systems to move beyond piecemeal interventions and invest in comprehensive, ongoing leadership development, tailored integration, and cross-disciplinary mentorship opportunities. The results also suggest broader applicability: any high-stakes professional sector where content expertise is presumed to translate into leadership readiness may benefit from a critical reassessment of development and support paradigms. By providing a better understanding of systemic and cultural contributors to leadership fatigue, this work offers actionable pathways for both healthcare and organizational leaders seeking to reduce turnover, increase engagement, and retain top talent.
This research questions the existing story that burnout is a cause rather than a symptom. Burnout simultaneously costs health systems millions of dollars in turnover, absenteeism, and beneficial quality patient outcomes. Failure to address these issues risks further shortages, disengaged teams, and loss of clinical alignment at the leadership table at a high dollar cost for a limited supply of FTE.
Recommendations
Physician leaders are not getting the tools and resources they need to function at the executive level. A degree of managerial hubris exists within the executive level, pointing to the need for physicians to change, but not for administrative leaders to do likewise. Although physicians often are labeled “prima donnas,” it is just as common for administrative teams to demonstrate a lack of awareness or unwillingness to change. This requires an in-depth look at how the executive team is socialized with an intent to assimilate a physician leader. The researchers provide a concise approach to practical recommendations (Table 3), as follows:
Define roles and expectations. Develop clear position descriptions and authority boundaries for physician leaders — don’t leave success to chance.
Invest in leadership development. Move beyond periodic workshops. Offer intentional, longitudinal programs combining mentoring, cohort learning, and real feedback.
Onboard executives like clinicians. Onboarding should be purposeful and peer-supported, not “sink or swim.”
Prioritize emotional support and belonging. Encourage the development of support structures and peer networks, and normalize asking for help.
Integrate culture and value alignment. Ensure organizational goals, values, and incentives are congruent with the professional identity of physician leaders.
Clarify roles and responsibilities for the executive team. Ensure that the executive team understands the specific roles and responsibilities of physician executives.
The New Story: From Disruptive to Distressed
Rather than labeling questioning voices as disruptive, recognize them as distress flags and prompts to strengthen system support, not sideline essential leaders. This research offers a new perspective in how and why physicians respond to burnout and leadership fatigue through a response that considers the fine line that many walk day after day: saving lives while being expected to generate more revenue. The researchers propose a new lens through which to view disruptive physician behavior, shifting the term to distressed physician behavior, which more accurately portrays the challenge of living their values and physician oath.
Conclusion
This work provided compelling evidence that leadership fatigue among physician leaders is chiefly a product of systemic gaps, especially unclear organizational roles, insufficient development support, and persistent identity dissonance. These findings highlight the necessity for healthcare systems to move beyond piecemeal interventions and invest in comprehensive, ongoing leadership development, tailored integration, and cross-disciplinary mentorship opportunities. Importantly, the results also suggest broader applicability: any high-stakes professional sector where content expertise is presumed to translate into leadership readiness may benefit from a critical reassessment of development and support paradigms. By better understanding of systemic and cultural contributors to leadership fatigue, this work offers actionable pathways for both healthcare and organizational leaders seeking to reduce turnover, increase engagement, and retain top talent.
Leadership fatigue is a system problem that only system solutions — grounded in clarity, support, and real leadership development — can truly address. Now is the time for all healthcare organizations to step up.
Acknowledgments: The authors thank the physician leaders who generously shared their time and experiences for this study and the organizational colleagues who supported the development of this work. In addition, a note of appreciation to Dr. Suzanne “Suzi” Waddill-Goad, for your generous contributions to our conceptual framework, and specific insights into burnout in healthcare.
References
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Ramedani S, Miller J, Gonzalo JD. Advancement, barriers, and collaboration: the ABCs of addressing challenges and designing solutions between front-line physicians and business-oriented leaders. BMJ Leader. 2024;8:274-277. https://doi.org/10.1136/leader-2022-000651
Lord D, Kodama C, Granzotti M. Understanding leadership fatigue in emerging physician leaders: a qualitative study of physicians transitioning into executive level roles. 2025.
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