The Leadership Learning Curve: Dr. Vidhya Prakash on Imposter Phenomenon and Adaptive Leadership

Vidhya Prakash, MD, FACP, FIDSA, FAMWA, Chief Medical Officer and Associate Dean of Clinical Affairs and Population Health at Southern Illinois University (SIU) School of Medicine, joins host Mike Sacopulos for a candid conversation about her AAPL-published book, The Leadership Learning Curve: A Woman Physician's Journey as Chief Medical Officer .

Dr. Prakash traces her path from an immigrant childhood in Cincinnati through infectious diseases, Air Force service, and hospital executive leadership. She speaks candidly about imposter phenomenon, adaptive versus technical problem-solving, and leadership lessons from military service, while also describing her role in founding the Alliance for Women in Medicine and Science (AWIMS) at SIU, a grassroots initiative that has measurably improved faculty promotion and tenure equity.

She offers practical guidance on balancing clinical practice with executive responsibility; distinguishing adaptive from technical leadership; treating leadership as both an art and a practice; reframing failure; applying Air Force leadership principles of integrity, service before self, and excellence in all we do; and helping more physicians, especially “accidental leaders,” step into leadership roles.

This transcript of the discussion has been edited for clarity and length.

Mike Sacopulos: Could you describe your path to becoming a physician leader?

Vidhya Prakash, MD, FACP, FIDSA, FAMWA: I was raised in Cincinnati, Ohio, though my immigration journey actually starts in France. My family is Indian; my parents married in India, and my father was working in France, which is where my brother and I were born. We immigrated to the United States when I was a toddler and became naturalized citizens — this country is all I've known. I didn't always want to be a physician; I planned to become a lawyer until ninth grade, when an anatomy and physiology class with a teacher named Jim Allison made me realize I had a real passion for understanding the human body and fixing what's broken in it. I went to Ohio State for college and the University of Cincinnati College of Medicine for medical school. From there, I did my internal medicine residency and infectious diseases fellowship in San Antonio while serving in the military, then transitioned to SIU School of Medicine in 2014. Military service ran in my family — two uncles served in the Indian Army — and giving back to a country that had given me so much meant a great deal to me. I've now been at SIU for over a decade, the last four and a half years as Chief Medical Officer and Associate Dean of Clinical Affairs and Population Health.

Sacopulos: Your book is described as both a leadership toolkit and a candid personal account. What made you decide to write it, and who did you have in mind as your reader?

Prakash: The book didn't start as a book — it started as a journal kept by a young CMO who felt like a novice, like a fish out of water. As I researched topics I didn't yet understand — conflict mediation, Medicare and Medicaid, managed care, emotional intelligence, leading through a crisis — I wrote down what I learned so I could eventually hand it off to the next chief medical officer. What began as a few journal pages evolved, over four years, into something much bigger than I anticipated.

Sacopulos: You write about the imposter phenomenon. How prevalent do you think this is among physician leaders, and what are the first steps to moving past it?

Prakash: The term was coined by researchers Clance and Imes and describes the overwhelming sense that one's accomplishments stem from luck or hard work rather than innate talent. Research shows it's widely prevalent across careers and is especially common in medicine, without any clear association with one gender over another. I score very high on it myself. I think the best way to mitigate it is to talk about it — to recognize you're not alone. We've held circles at SIU Medicine around imposterism, and it's comforting to build a community where people understand and can dig into why they feel that way.

Sacopulos: Your title mentions a learning curve. Where was the steepest part of that curve for you?

Prakash: There were steep stretches in every area — managing a crisis, learning to read a budget while balancing the big picture with specific line items, conflict mediation. But stepping back, I think the biggest misconception about leadership is that the leader is supposed to know everything. What I learned was that my job is to frame the problem, understand the stakeholders, know my team's strengths, and bring the right people to the table to solve problems collaboratively. There are moments when, as the leader, you simply have to make the call. But the more challenging, complex problems require listening and stakeholder input rather than a snap decision — that's the common thread across every leadership role I've held.

Sacopulos: How has your clinical background in infectious diseases and internal medicine shaped your approach to executive decision-making?

Prakash: During my interviews for this position, people kept asking whether I'd stay in clinical practice, since I could have chosen not to. I always said the same thing: I will not not be a doctor. That goes back to Jim Allison's class — my passion for fixing what's broken in people, and now, in systems and teams. Both roles require listening; 90 percent of the time, if you let a patient talk, they'll tell you the problem. Healthcare's time pressures have eroded that art of listening, but I've carried it into leadership — listening for understanding, because often the people with the problem are also the people with the solution, especially with the right data and the right people in the room. I stay in clinical practice because I love it, and because I'd lose credibility with the people I lead if I stepped away. I see firsthand the issues in the clinic and the burnout our clinicians face. My why is a mix of passion and a sense of responsibility to be credible and accountable to the people I lead.

Sacopulos: It strikes me that listening the way you describe takes enormous patience, when your instinct might be to jump straight into problem-solving. Is that fair?

Prakash: That's exactly right. I write about the adaptive leadership framework in my book, which I learned through a course with Dr. Ronald Heifetz, who coined the term with Marty Linsky. One of the biggest mistakes leaders make is applying technical solutions to adaptive problems. A technical problem has a clear solution, and the person in authority owns it — a broken printer, or filling a call-schedule gap. An adaptive problem is less clearly defined, so the solution requires more learning and listening, and the work shifts from those in authority to the people closest to the problem. That's a real challenge for me as a physician, because in infectious diseases I'm used to seeing patients get better quickly — I'm not naturally patient. But as a leader facing an adaptive problem, I have to relinquish control and become the container for my team's work, raising and lowering the heat as needed. I'm the guardian of the work, not necessarily the one driving it. Leaders who lose sight of that distinction get impatient, reach for a quick fix, and then wonder why it falls apart.

Sacopulos: Medicine is both an art and a science. Would you say the same is true of leadership?

Prakash: Quoting Dr. Heifetz, leadership is an art and a practice. Leaders aren't born; it takes work and learning, and mistakes are an inherent part of it. You can't progress as a leader without stumbling, understanding why, pivoting, and moving forward — which is especially hard for physician leaders, since we're used to there being little room for error.

Sacopulos: Was that a difficult realization to come to?

Prakash: Absolutely, especially as an imposter. We tend to internalize failure as a personal flaw rather than asking what internal and external factors were or weren't in our control, and how to keep it from happening again. That reframe, rather than harsh self-critique, is what allows us to keep moving forward — for ourselves and the people we lead.

Sacopulos: You founded the Alliance for Women in Medicine and Science at SIU. What gaps were you trying to fill, and what accomplishment are you most proud of?

Prakash: AWIMS looks top-down from the outside, but it was actually grassroots. It started with a resident in tears in my office — a geographic single mom with a newborn who was considering dropping out of residency. That conversation led to a support group, which I kicked off the way I know best: with lunch. What began as an informal brunch turned into a raw, cathartic conversation about gender bias and work-life integration among faculty and residents alike. That grew into panel discussions and sessions on negotiation and bias, caught the attention of our Associate Dean of Equity, Diversity, and Inclusion, and was formally established school-wide in 2018. I'm proudest that it remained an organization for the people, and of our promotion and tenure work. We found men and women were roughly even at the assistant professor level, but by full professor, men outnumbered women four to one. Rather than assume why, we brought the data to our clinical chairs, who began discussing promotion and tenure with all faculty more consistently, and we simplified an intimidating hundred-page process. Over the last three years we've broken the record for women promoted to full professor every year — and importantly, the trajectory has risen for men and women alike. That's the best rebuttal to the idea that equity work is zero-sum: fixing a system for a marginalized group benefits everyone.

Sacopulos: What happened to that resident?

Prakash: She graduated. She was at that first brunch, and afterward told me she felt validated — she realized she wasn't alone, and that if others could make it, she could too. That support was all she needed.

Sacopulos: Military leadership culture is quite different from academic medicine. What habits or principles from your Air Force service have stayed with you?

Prakash: I'll never forget crossing the blue line on my first day of commissioned officer training — one of the toughest and most rewarding experiences of my life. The Air Force's core values — integrity first, service before self, and excellence in all we do — always bring you back to the mission. I try to model my institution's mission, vision, and values as clearly as I can and align our people around them — in healthcare, that means never losing sight of our patients.

Sacopulos: Are there other things the military does around leadership development that academic medicine would be well served to adopt?

Prakash: I see more similarities than differences. Keeping the mission at the forefront, the integrity piece, and excellence in all we do — not just meeting the standard but continually exceeding it, because our patients deserve the best — are values I've carried directly from the military into my role as Chief Medical Officer.

Sacopulos: As we wrap up, what do you hope readers take away from The Leadership Learning Curve?

Prakash: I hope prospective physician leaders will say, I can do this — I should take my career to the next level, because my patients and my people need me. We need more physicians in leadership. There's an assumption that healthcare organizations need business-minded leaders, and there's certainly value in that, but combining the best of both worlds — and encouraging physicians into leadership — is the way to go. So many physicians I know, myself included, are accidental leaders — tapped on the shoulder by a mentor or colleague who saw something in us before we saw it in ourselves. That needs to shift. People need to start seeing leadership in themselves, as something tangible, learnable, and lifelong — like medicine itself — and know that they can do it, and that we need them to.

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