There is a growing conversation in medicine about leadership. We talk about the need for more physician leaders, more voices at the table, more representation in decision-making spaces. And while these conversations are important, they often overlook a more fundamental issue. The problem is not a lack of physician leadership. It is the model of leadership we continue to promote.
From early training, physicians are conditioned to equate leadership with endurance: the ability to manage increasing responsibility, to operate under pressure, and to maintain performance regardless of circumstance. Leadership becomes synonymous with capacity. The more you can handle, the more you are seen as capable. The more you take on, the more you are seen as a leader.
But this model has limitations. It prioritizes output over awareness, consistency over adaptability, and performance over sustainability. For many physicians, this works until it doesn’t. Until the demands exceed capacity. Until personal circumstances shift. Until the expectation to continue operating at the same level becomes misaligned with reality. At that point, the model begins to break down, not because the individual has failed, but because the framework itself is incomplete.
There is an assumption embedded in traditional physician leadership that stability is the norm, that leadership is something exercised in controlled environments where variables can be managed and outcomes can be predicted. But modern medicine does not operate in that way. Health care systems are increasingly complex. Expectations are constantly evolving. And physicians are navigating not only clinical responsibilities, but administrative demands, systemic pressures, and personal challenges that are often invisible.
In this context, leadership requires more than endurance. It requires adaptability, the ability to reassess, recalibrate, and respond to change, not just externally but internally. It requires self-awareness, an understanding of how decisions are being made, what assumptions are driving them, and whether those assumptions still hold. And it requires boundaries, a recognition that capacity is not limitless and that effective leadership is not defined by how much one can absorb, but by how well one can prioritize.
These are not traditionally emphasized in medical training. Instead, physicians are often encouraged to continue expanding their roles, taking on additional responsibilities, and maintaining high levels of performance without a corresponding shift in how leadership is defined. This creates a disconnect, one where physicians are expected to lead in environments that require adaptability, while being trained in models that emphasize stability.
The result is not a failure of leadership. It is a mismatch between what is needed and what is taught.
If we want to meaningfully improve physician leadership, we have to move beyond simply encouraging more physicians to step into leadership roles. We have to examine the model itself. We have to ask whether the traits we are rewarding (endurance, availability, constant output) are the same traits that will allow leaders to navigate complexity, uncertainty, and change. Because leadership in medicine is no longer just about managing what is known. It is about navigating what is not. And that requires a different approach: not one that replaces competence, but one that expands it; not one that abandons performance, but one that balances it with awareness.
We do not have a shortage of physician leaders. We have a leadership model that has not yet evolved to meet the reality of modern medicine. And until it does, we will continue to see capable physicians struggle, not because they lack leadership ability, but because they have been trained within a framework that no longer fully supports them.
Bertina Marie Hooks is an internal medicine physician.
