The New Mandate for Physician Leadership
For as long as medicine has existed, physicians have been more than caretakers. From ancient healers to modern-day specialists, society has looked to doctors to be the steady hands in moments of crisis, the trusted voices in times of uncertainty, and the pillars our communities lean on.
Most recently, Covid-19 made that very clear. In those early months, the nation faced what was essentially a prolonged Mass Casualty Incident. Doctors were leading war rooms, negotiating supply chains, standing in front of cameras to explain the unexplainable, and holding the line for communities that were scared and grieving.
Now, we face a different kind of crisis. The confluence of a deepening workforce shortage and an aging patient population has created an unprecedented infrastructure and access challenge for the American healthcare system.
In response to this crisis, non-physicians like nurse practitioners (NPs) and physician associates (PAs) are now central to how America receives care, and the future of care delivery is decidedly team-based in nature.
It’s time for physicians to use our credibility to power better multidisciplinary teams. Doctors must become the captains the system needs. And captains do not climb alone, they lift others as they rise.
The Workforce Has Changed. Leadership Must Too.
In a recent article, The Silent Restructuring, I argued that the healthcare workforce is undergoing a quiet but profound shift. Advanced practice providers (APPs) are no longer auxiliary support; they are central to care delivery in every setting from critical care to primary care to telehealth. In some communities, they are the only accessible providers.
Advanced practice providers are the majority of new clinical entrants. In 2020, APPs accounted for more than sixty percent of the pipeline while physicians made up just thirty seven percent. National projections point to a significant physician shortfall across the next decade at the same time the population grows older and sicker. In addition, a large share of practicing physicians is nearing retirement.
That is not up for debate. That is the operating reality to design around.
The future of care will be built by teams—physicians, NPs, PAs, nurses, pharmacists, social workers, techs—used as a force multiplier for access and aligned around a single goal: better patient outcomes. The choice in front of us is simple, either we shape our new workforce into high-performing teams that protect quality and safety, or we allow fragmentation to widen further.
It’s time for us to step up, use our training and credibility, and power the multidisciplinary teams that patients now depend on. If physicians do not lead this evolution, the system will evolve without their guidance, and patients will pay the price.
A Legacy Worth Reclaiming
Some of our finest medical institutions were built on the principle of physician-led, team based care.
My alma mater, The Cleveland Clinic Foundation, founded in 1921, has sustained a physician-led group practice that integrates care, research, and education, with 29 consecutive years at number one in cardiology and vascular surgery. Cleveland Clinic was organized around one idea: “To Act as a Unit.” This was a mantra instilled in every single new hire on day one.
The Mayo Clinic’s leadership is also entirely physician-driven, and its governance model intentionally rotates roles to foster a deep bench of future leaders. The results: perennial #1 rankings in U.S. News & World Report’s “Best Hospitals,” CMS 5-star ratings, Leapfrog “A” grades for safety, and Vizient recognition for quality.
The broader pattern also matches these exemplars. Data shows hospitals led by physicians deliver higher quality care, generate stronger patient satisfaction, and control costs more effectively than non-physician-led institutions. In 2022, physician-led hospitals accounted for nearly 14 percent of all top “patient experience” awards, despite being fewer than 5 percent of hospitals assessed.
True physician leaders have the capacity to bridge the frontline and the C suite, align roles and protocols with how care is actually delivered, and make accountability real.
The lesson here is that a physician’s approach to multi-disciplinary collaboration matters. These successful models don’t elevate physicians at the expense of others, but empower every member of the care team to deliver their best work, under leaders who understand the stakes from the inside.
What Kind of Physician Leader Does Healthcare Need?
So what does this new kind of physician leader look like?
The physician leader of the future fights for the patient above all else, and works tirelessly to ensure the care received, regardless of who delivers it, is of high caliber.
They champion their teams and their patients, elevating performance across the unit and upholding uncompromising standards for competence, safety, and compassion.
In fact, the AMA’s position on team-based care is clear: leading means engaging every member of the healthcare workforce in the pursuit of shared patient outcomes.
Physicians must also be clear-eyed about the new workforce that we are leading. There are concerns about training variability, uneven preceptorship, and a lack of infrastructure for high-quality continuing education amongst advanced practice clinicians. But uncovered care gaps can’t be closed by physicians alone. There simply aren’t enough doctors to backfill them visit by visit.
The answer is to engineer the system we need by embracing our reality and acting with intention. This requires three things, unequivocally:
Set the Standard. Establish team-wide clinical norms and quality standards, and hold yourself to them first.
Lift the Team. Build shared training, supervision, and real-time feedback so everyone practices safely and grows.
Act as a Unit. Shared accountability, no silos, no turf.
Leadership is not about reaching the summit first, it’s about ensuring others can ascend with you: setting standards, creating pathways, and building the shared infrastructure teams need to practice safely.
Leadership Is a Muscle
Some people are born with leadership traits, but talent is not a strategy. Real leadership is built the same way we build clinical mastery — deliberate training, honest feedback, and repetition until it becomes muscle memory.
Formal leadership programs now exist that teach conflict navigation, negotiation, financial literacy, and project execution through cases, simulations, and peer learning. For example, the Pediatric Leadership Alliance (PLA) uses Kouzes and Posner’s Leadership Challenge framework to train early career physicians in five core practices, blending short teaching with small group drills, simulation, and a personal learning contract that drives follow through.
In a PLA evaluation, 87% of participants met their leadership goals with measurable gains in feedback, conflict navigation, and team engagement.
If we want physician leaders who can bridge the gap between clinical excellence and system transformation, leadership training should be woven into the fabric of medical education and reinforced across an entire career.
The Call to Physicians
Healthcare will no longer be physician-exclusive, but it can be physician-led. NPs and PAs sit at the center of American care. I’ve heard some physicians claim that this is a threat to medicine’s legacy. But I think it’s an invitation to strengthen it.
A doctor’s training equips them with a panoramic view of the patient journey, their credibility carries weight in policy and institutional governance, and their oath binds them to place patients above all else. Physicians need to wield these assets in service of multidisciplinary teams and make them stronger because of our leadership.
The future of care will belong to organizations that master collaboration, where physicians elevate APPs through shared standards, ongoing mentorship, and uncompromising accountability. If physicians fail to lead, we put the entire system at risk. If we lead boldly, we can create something better: a workforce aligned in purpose, well-equipped, and built to expand access for every patient who needs care.
We need to step forward to build a future where the patient always benefits from the best of the entire care team. That is the mandate of this moment, and the type of leadership worth reclaiming.
Rafid Fadul, MD, Co-Founder & CEO, Zivian Health
