BEFORE THE VACANCY

STRATEGIC LEADERSHIP SERIES | OCTOBER 2026

What future physician leaders learn by watching the people already doing the job.

A physician doesn't need to be offered a medical director role to start deciding whether they would ever want one. They are already watching.

They see the colleague who finishes clinic and moves straight into a difficult department meeting. They see who gets called when an interpersonal issue escalates. They notice how much time leadership takes, how difficult decisions are handled, and how much authority the medical director actually has when something needs to change.

They notice the evening emails. They notice when a colleague who once seemed energized by leadership starts talking about stepping back.

And somewhere in those observations, a future decision is taking shape.

SUCCESSION BEGINS WHILE FUTURE LEADERS ARE STILL WATCHING

Succession planning often becomes visible when a term is ending, a leader announces their departure, or an organization begins looking for the next medical director, division head, or physician executive.

The future candidate has been gathering information for much longer.

Physicians work close enough to their leaders to see parts of the role that rarely appear in a position description. They see the clinical work that still needs to be done. They see the interpersonal issues that repeatedly return to the medical director. They see the difficult conversations, competing expectations, and decisions that have consequences for colleagues they know well.

They see whether the leader appears to have credible support when a situation becomes complicated. They also see what happens to the leader's time.

A physician considering leadership may be evaluating much more than the title, stipend, protected time, or formal responsibilities. They are evaluating the lived experience of the role.

THE CURRENT MEDICAL DIRECTOR IS PART OF THE SUCCESSION ENVIRONMENT

Consider the physician who has been identified informally as someone with leadership potential. Clinically respected. Thoughtful. Good judgement. Trusted by colleagues. The kind of person people already approach when something difficult happens.

From an organizational perspective, they may look like an obvious future medical director. Their perspective may be quite different. They have watched the current leader spend months dealing with one unresolved interpersonal issue. They have seen colleagues become frustrated with decisions the medical director had limited ability to influence. They know leadership responsibilities regularly spill beyond the hours formally allocated to the position.

Perhaps they have heard the current leader say, "I don't know if I want another term."

That sentence carries information. It says something about the accumulated experience of the role.

SUPPORTING CURRENT LEADERS IS PART OF DEVELOPING FUTURE ONES

A healthy physician leadership pipeline develops through experience. Current leaders need preparation for the situations they are being asked to handle. Emerging leaders need opportunities to develop judgement before carrying full responsibility.

Organizations need visibility into the leadership experience to understand what encourages strong physicians to step forward and what makes them hesitate. That can include clearer authority, meaningful protected time, access to experienced support, preparation for difficult interpersonal situations, and development that reflects the realities of leading physicians and clinical teams.

It also requires attention to the transition from colleague to leader. A physician may become accountable for the work of people who were peers yesterday and will continue to be professional colleagues tomorrow. That relational reality shapes how authority is exercised.

When current leaders can exercise judgement effectively, address difficult situations with appropriate support, and maintain a workable relationship between their leadership responsibilities and the rest of their professional life, future candidates see that too. Their observations create a different picture of what physician leadership can look like.

Every current physician leader is showing someone else what the role costs and what it makes possible.

THE VACANCY THAT APPEARS LATER WAS BEING DECIDED RIGHT NOW

A vacant physician leadership position is a visible succession event. The conditions leading to it have been developing for years.

Future medical directors are already in departments, divisions, clinics, and hospitals watching how leadership works. They are noticing what happens when conflict emerges. They are seeing where accountability sits. They are learning how much of the role follows a leader home. They are watching whether experienced physician leaders remain willing to continue.

And they are quietly deciding whether leadership is something they can see themselves doing.

For CMOs, Chiefs of Staff, VPs Medical Affairs, and others responsible for physician leadership development, that creates an opportunity to look at succession earlier. Look at the experience of the physicians leading today. Look at the people others already turn to. Look at the physicians showing sound judgement before they have a formal title. Look at what those potential leaders are learning from the environment around them.

The leadership pipeline is already forming. What are your strongest potential physician leaders learning from the people currently doing the job?

THIS IS A QUESTION ABOUT YOUR SUCCESSION ENVIRONMENT

What are the conditions shaping whether capable physicians step forward into leadership? The answer determines your succession stability two years from now.

Meriot Leadership Institute works with healthcare organizations to examine the leadership environment and the conditions shaping physician engagement in formal leadership roles.

That work includes strengthening current medical directors through executive coaching and leadership development, building team capacity through strategic facilitation and group coaching, and developing leadership infrastructure that makes the role sustainable and attracts strong physician leaders.

The succession problem you will face in two years is being decided by what you build into the leadership environment right now.

Wired for More | Meriot Leadership Institute | meriotleadership.com

The Strategic Leadership Series | Part 2 of 2 | October 2026