When a Strong Physician Struggles as a Leader: How Physician Leadership Development Can Help

What happens when a physician your organization deeply values is struggling as a leader?

This can be one of the more difficult situations for a hospital or health system to address. The physician may be an excellent clinician, highly respected by peers and important to the organization. Yet problems are beginning to surface in their leadership role.

Meetings become tense. People hesitate to speak candidly. Conflict becomes harder to resolve. Colleagues begin working around the physician rather than with them.

In a previous article, “Why Excellent Physicians Need New Skills to Become Effective Leaders,” I discussed why clinical excellence does not automatically translate to leadership readiness and why physician leadership development should begin before a physician receives the title.

But what if the physician is already in the role and struggling? The answer should not begin with waiting for the situation to become a crisis.

Recognize Patterns Before They Become Larger Problems

Leadership problems rarely announce themselves with one dramatic event. More often, a pattern begins to emerge.

People become quieter in meetings. Staff members take concerns around the physician rather than directly to them. The same complaints surface from different people. A physician once regarded as demanding but effective begins to be described as dismissive, defensive or unapproachable.

These patterns deserve attention. Healthcare organizations should also distinguish between an isolated conflict and a broader leadership issue. One difficult relationship may require mediation. Similar experiences reported by several people may indicate that the physician’s behavior is affecting the team.

The earlier an organization recognizes the difference, the more options it has.

Do Not Let Clinical Value Delay the Conversation

Organizations can be reluctant to confront a struggling physician leader because that physician is clinically valuable, highly productive or difficult to replace. The cost of waiting, however, can be significant.

Relationships deteriorate. Strong team members disengage. People stop raising concerns. By the time human resources or senior leadership becomes formally involved, trust may already be damaged.

There is also a risk to the physician. If concerning behavior has been tolerated for months or years, a sudden formal intervention may feel unexpected or punitive. Addressing the issue earlier allows the organization to approach the conversation from a developmental standpoint:

You are important to this organization. We want you to succeed in this role, and there are leadership behaviors we need to address.

That is a very different conversation from one that begins after the situation has reached a breaking point.

Determine What Is Actually Going Wrong

Before prescribing coaching or another intervention, the organization needs to understand the problem.

• Is the physician struggling with communication or conflict?

• Are they having difficulty moving from individual decision-maker to leader of a team?

• Do they become defensive when challenged?

• Are expectations for the role unclear?

• Do they have adequate authority, support and protected time to perform the job?

  
  

This distinction matters. Not every physician leadership problem is solely a physician problem.

An organization can place a physician in a poorly defined role, give them responsibility without sufficient authority and provide little preparation or support. Coaching cannot correct an organizational structure that makes effective leadership unnecessarily difficult.

The organization needs to examine both the leader and the environment in which that person is being asked to lead.

Create a Development Plan With Clear Expectations

Once the problem is understood, the physician needs more than a general instruction to “communicate better” or “be a stronger leader.”

The organization should identify the behaviors that need to change, the impact those behaviors are having and what improvement will look like.

Physician leadership coaching can then focus on real situations the leader is facing: preparing for a difficult conversation, responding differently when challenged, repairing a strained relationship or learning how to invite disagreement without immediately shutting it down.

The physician also has a responsibility in the process. One question I often encourage leaders to consider is:

“What part of this situation belongs to me?”

A willingness to examine that question is an important indicator of whether meaningful development can occur.

Know When the Role May Not Be the Right Fit

Not every outstanding physician needs to hold a formal leadership position.

If a physician continues to struggle despite clear expectations, appropriate support, coaching and genuine effort, the organization may need to consider whether the role is the right fit.

That does not diminish the physician’s clinical contributions or value to the organization. An extraordinary clinician can remain an extraordinary asset without serving as a medical director, department chair or physician executive. In some cases, changing the role may be better for the physician, the team and the organization.

The Opportunity for Growth

A physician who struggles in a leadership role should not automatically be viewed as a failed leader. With the right development and a genuine commitment to change, that physician may have significant capacity to grow.

The value of coaching can be seen in what follows: a leader who handles difficult situations with greater confidence and perspective, earns the trust of colleagues and creates an environment where people can contribute at their best. Those changes can strengthen the physician’s effectiveness and have a lasting impact on the team and organization.

NorthWolf Advisory works with hospitals, health systems and physician leaders through physician leadership development and executive coaching. Drawing on his experience as both a physician and former healthcare executive, Dr. Scott Wolf helps physicians develop into confident, trusted leaders who strengthen the organizations they serve.