Healthcare organizations are asking more of their physician leaders than ever before. This is especially true for physician executives. The role, once focused on quality oversight and medical staff governance, now spans strategy, operations, financial performance, and enterprise-wide care delivery. And of course, boards expect measurable results in every area. Despite the increased responsibilities and expectations, many organizations have not redesigned the roles, authority structures, compensation models, or development pathways to align with this evolution. The result is a widening gap between what we ask physician executives to do and what we have actually built to support them.
That gap was the focus of a recent MGMA webinar, “Rethinking the Physician Executive: How Role Design, Compensation, and Development Drive Recruitment and Retention,” which I had the privilege of presenting alongside my Jackson Physician Search colleague Andrew Walker and Dr. Kristin Mascotti, Chief Medical Officer for CommonSpirit Health Mountain Region. Drawing on national data and real-world experience, we discussed where organizations often fall short and what leading groups do differently. If you missed the live session, here are the highlights of the discussion with some actionable takeaways.
The Shifting Demands on Physician Leaders
As organizations face increased demand for care and shifting regulatory environments, operational and financial pressures continue to intensify. Impactful leaders are needed now more than ever, so of course, the competition for capable physician executives is at an all-time high. The expectations for the role are clearly expanding, but most organizations still promote for clinical excellence rather than leadership readiness. Strong clinicians are often “voluntold” to pursue physician leadership without formal management training, then asked to navigate P&L accountability, staffing, and budget oversight with little preparation.
In our experience, quality and patient care initiatives tend to come most naturally to physicians stepping into leadership. Strategic and financial competencies are often where the biggest gaps appear. The clinician-to-executive identity shift can also pose problems, along with the challenge of managing former peers and competing stakeholder demands. If this complex transition goes unsupported, the physician leader is bound to struggle.
Role Design: Clarity of Authority
One theme resurfaced repeatedly: most organizations define physician executive roles by title rather than by responsibilities or decision rights. A lack of clarity around expectations and authority is a leading driver of frustration and early departure. Clarity about what a physician leader can actually decide, strategically, operationally, financially, and around quality, is one of the strongest retention levers available.
During the webinar, we talked a lot about dyad and triad leadership models and what makes them successful. Whether it’s a physician leader paired with an administrator or a trio of a physician leader, an administrator, and a nurse leader, these partnerships require a clear understanding of each leader’s responsibilities and authority. Dr. Mascotti described her own triad (CEO, CMO, and CNO) and highlighted the factors she believes contribute to the group’s success, namely psychological safety and trust. Put simply, her triad partners are the people she can close the door and talk candidly with when things get hard.
The best organizations recruit shared leadership roles with the other leaders’ strengths (and weaknesses) explicitly in mind. They also head off common pitfalls, such as role ambiguity, authority conflicts, and unclear escalation paths, by carefully defining roles and responsibilities before hiring. They avoid ambiguity by assigning primary and secondary ownership across strategic priorities, so each leader knows what they lead and where they back up their partner.
Compensation Must Keep Pace with Scope
Compensation is the most commonly neglected area we see. Too often, pay stays flat as a high performer’s responsibilities expand (a phenomenon known as scope creep) with no at-risk component tied to organizational outcomes and peer comparisons limited to the local market.
MGMA DataDive is the primary benchmarking tool for getting this right, but most organizations use only a fraction of its capability. Its Medical Director Compensation dataset covers operational physician executives from CMO through medical director, and an academic dataset captures compensation by faculty rank and tenure. MGMA members can also work directly with the data strategist team.
Just as important as the hard number is compensation structure. Present the package in terms of total rewards: base plus incentive plus benefits. Leadership development is also a benefit, so include offerings such as executive coaching, mentoring, tuition benefits, and mission trips. Both parties may benefit from tying compensation to documented ROI: revenue cycle improvements, reduced length of stay, lower readmissions, and strategic growth. Reevaluate compensation as responsibilities evolve.
Recruiting for Physician Executive Competencies
When recruiting physician executives, recognize that finding candidates who tick every competency box is unlikely and often unnecessary. Prioritize based on where the organization needs to go. The competencies we see mattering most are strategic thinking, change leadership, data literacy, and dyad or triad effectiveness. Data literacy, in particular, grows more critical as organizations fight for every dollar.
Physician leaders should also be involved in recruitment early and often. A physician-to-physician conversation is the single most compelling selling point for a candidate. It helps them understand the dyad/triad structure, the culture, and their path for advancement, and it signals that their voice will be heard.
Retention Starts with Onboarding and Development
The top drivers of physician executive turnover are consistent: role misalignment, lack of decision rights, cultural misfit, isolation and burnout, and compensation that lags the market. Structured onboarding is essential, but ongoing development matters just as much as initial preparation. Executive coaching that builds emotional intelligence, self-awareness, and relationship skills pays dividends over time.
Smaller medical groups with limited resources are not without options. Identify a local physician leader as an informal mentor — many are willing without compensation. Redirect a portion of the CME budget toward leadership skills like finance, strategic thinking, and crucial conversations. And take advantage of beginner-level leadership courses offered by MGMA and other organizations.
Building Leadership Infrastructure That Lasts
The through-line of our discussion was simple: role design, compensation, and development are not separate initiatives but a single, integrated framework. The organizations that retain their physician leaders build the role deliberately, align compensation to actual scope, audit that scope at least annually, align board and CEO expectations with the reality of the dyad, normalize feedback and coaching, and celebrate physician leadership publicly and often.
If you are building or evaluating your own leadership infrastructure, a strong first step is to audit your existing physician executive roles against those six areas — and to explore what the MGMA benchmarks reveal about your current compensation approach. With a clear picture of the role you are hiring for, it becomes much easier to find the right person for the role.
Whether you are redesigning an existing physician executive role or planning for a new one, the right recruitment partner brings both strategic and tactical support. Jackson Physician Search specializes in physician executive recruitment and would welcome the opportunity to build a partnership around your organization’s specific needs. Reach out today to learn more.
About Tom Rossi
Tom Rossi has over three decades of dedicated experience in recruitment and leadership within the healthcare sector. Before 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.
