Most physicians don’t set out to become executives. They earn a reputation for clinical excellence, they get asked to chair a committee, and one day someone taps them for a director role or whispers in their ear about the impact they might have as an executive. In other words, many high-performing physicians are “voluntold” for leadership — asked to take on roles they didn’t train for, without clear expectations. As a result, many physician executives are under immense strain, questioning their own effectiveness, and wondering if the grass is greener elsewhere.
The widening gap between what physician leaders are trained to do and what is being asked of them makes it increasingly difficult for organizations to recruit and retain physician executives. This was the topic of discussion in a recent MGMA webinar that I had the privilege of presenting with our Senior Director of Executive Business Development, Andrew Walker, and Dr. Kristin Mascotti, Market Chief Medical Officer for CommonSpirit Health Mountain Region. Much of what we covered was aimed at helping organizations design and support physician executive roles. Upon reflection, I realized the conversation also held useful information for physician executives themselves. Here, I’ll dive into the evolution of the physician executive role, why it may feel harder than it should, and what to ask when evaluating a physician executive job.
The Evolving Responsibilities of Physician Executives
Physician leaders are being asked to take on more responsibility than ever before. The physician executive role once centered on quality oversight and medical staff governance. Today, it includes strategy, operations, financial performance, and enterprise-wide care delivery. And of course, boards expect measurable ROI in every area. As the pressure and expectations heighten, most organizations have not redesigned the roles, authority structures, compensation models, or development pathways to support this evolution.
On top of the increasing demands of the role, new physician leaders often struggle with the identity shift that comes with the transition to physician leadership from clinical practice. You spent years training to be the person in the room with the answer. Leadership asks you to become the person who builds consensus around someone else’s answer, who manages former peers, and who absorbs criticism from colleagues who once shared your call schedule.
That shift is uncomfortable, but it is not a sign that you have chosen the wrong path. In fact, none of the challenges mentioned here are reasons to run away from the job, but they should be acknowledged and addressed before you accept an offer.
Physician Executive Authority
Evolving expectations may result in physician executives taking responsibility for areas over which they have little authority. So, before you accept the role, ask specific questions about your authority in four areas. Strategically, are you at the table for organizational planning and resource allocation, or briefed after decisions are made? Operationally, what direct control do you have over staffing, scheduling, credentialing, and care delivery? Financially, do you own a budget, carry P&L accountability, or influence capital decisions? And on quality, what authority do you hold over standards and peer review?
Ideally, these answers can be documented as a role charter that you help draft. Ask, too, about matrix and dotted-line reporting, which has grown more common as systems consolidate. Knowing who you report to on paper is not the same as knowing who can overrule you.
Then plan to revisit all of it. Scope creep is one of the quiet dangers of doing this job well: high performers accumulate responsibility without any formal revision to the role (or its compensation). Part of your annual review should be a review of your responsibilities, authority, and, of course, compensation.
Evaluate the Dyad or Triad as Carefully as you Evaluate the Physician Executive Job
If you are joining a dyad or triad structure, your administrative partner(s) will shape your experience more than almost any other factor. Our recent joint research with Kirby Bates identifies the most critical components for shared leadership success, starting with shared vision — something to be explored in depth during the interview process.
When you meet your prospective dyad partner, look for the markers of a healthy working relationship: psychological safety, trust, a flattened hierarchy, and a partner without an ego problem. The test I would apply is simple — is this the person you would close the door and talk to honestly when things are genuinely at crisis level?
One practical tool worth raising in that conversation is mapping primary and secondary ownership across your shared strategic priorities, so each of you knows what you lead and where you serve as backup. Role ambiguity and unclear escalation paths undermine these structures more than any skills gap.
Build the Physician Executive Skills Your Clinical Training Didn’t Provide
Our past research found two-thirds of physician leaders had no formal training. The strategic thinking and quality management often come somewhat naturally, but the gap appears in operations and finance — staffing models, scheduling, budget oversight, P&L. None of that is out of reach, but those skills don’t develop without intention. If your organization has a formal development program, use it. If your organization, like many smaller groups, does not have a formal program, you’ll need to build your own. Find a physician leader locally who will mentor you informally. Redirect part of your CME budget toward finance, strategic thinking, and crucial conversations.
Know Your Market Value
Due to the broad scope of responsibilities assigned to physician executives at various organizations, the standard compensation range is also broad. Organizations likely defer to traditional compensation benchmarking resources such as MGMA DataDive, but those numbers may not reflect the scope of responsibility for your specific role.
When negotiating, think in total rewards, not base salary alone. Incentives, benefits, and development — executive coaching, mentoring, tuition support — are all on the table, and development, in particular, is often easier for an organization to approve than salary. Make sure any incentive metrics you accept fall genuinely within your scope of authority. Being measured on outcomes you cannot influence is a setup for a difficult first year.
Additionally, start documenting your impact early: revenue cycle improvements, length of stay, readmissions, growth you helped drive. If you have taken on more responsibility, this too should be a factor in a compensation conversation.
Don’t Lead in Isolation
Isolation and burnout are among the leading drivers of physician executive turnover. You will be dealing with 24/7 expectations, and you may be the only person in your organization holding your particular combination of responsibilities. Build a peer network outside your walls. Seek coaching that addresses self-awareness and relationship dynamics, not just performance review.
What Does Support Look Like to You?
Physician executives leave their jobs for many reasons, but there are common themes: the role was described differently than it turned out to be, the authority didn’t match the accountability, and/or the pay never caught up to the responsibility.
Underneath all of these reasons sits a single question: Will you have the support you need to do the job you are being hired to do? And what does that support look like? Ask these questions before you accept, and revisit them annually. But just as important as how the organization answers is how you answer the question for yourself. So, be clear on what support looks like to you. And when the answer you are given aligns with what you need, you’ll know you’ve found the right fit.
If you are a physician seeking a leadership role or a physician leader looking for a change, the physician executive recruitment team at Jackson Physician Search can help you identify a well-designed role with the support you need. Learn more about the physician executive job search, and reach out to start a conversation today.
About Tom Rossi
Tom Rossi has over three decades of dedicated experience in recruitment and leadership within the healthcare sector. Prior to joining Jackson Physician Search as the Vice President of Executive Business Development in 2023, Rossi served as National Vice President of Physician Recruitment for HCA Healthcare for 20+ years. Before spearheading physician and provider recruitment, Rossi played a pivotal role in HCA’s executive recruitment division and spent six years prior to that leading a team of executive recruiters for a professional services firm.
Outside his professional endeavors, Rossi engages in meaningful volunteer work, contributing to organizations such as Football Parents at Ohio State (FPAOS) and Habitat for Humanity. Rossi cherishes family life and is a proud parent of three adult children.
