THE LEADERSHIP ROLE NOBODY TRAINED YOU FOR
Wired For More | STRATEGIC LEADERSHIP SERIES | OCTOBER 2026
Your clinical judgement took years to build. Colleagues trust it. When things are difficult, people turn to you.
Then you become a medical director.
Everything you learned about practicing medicine still applies. Nothing you learned prepared you for what happens next.
WORK FOLLOWED YOU HOME AGAIN
The conversation ended at five o'clock. On the drive home, you replayed it. The words you chose. The response you got. What you should have said. What comes next if the behaviour continues.
You arrived home at five forty-five.
Your family was there. The day happened without you in it. Someone made dinner. Someone asked how your day was. You said fine. You were thinking about the conversation.
At eight o'clock, you realized you had not actually heard what your partner just said to you.
This is not an occasional experience. This is most Tuesdays and Thursdays now. And last week, it was Monday through Friday.
The issue at work followed you home again.
CLINICAL EXPERTISE DOESN'T PREPARE YOU FOR LEADING FORMER PEERS
You know the clinical environment. You understand the pressures your colleagues face. You have credibility with people who might otherwise be skeptical of decisions made far from clinical work.
That foundation got you into the role. What you encounter when you get there is different.
A colleague's behaviour has become increasingly difficult. You need to address it. You also need to work alongside them clinically. In the hallway. In the operating room. In the morning huddle. The relationship has history. The stakes feel higher than they would if this person worked somewhere else.
You understand clinical consequences with precision. Leadership consequences with former peers are harder to predict.
Two physicians have an interpersonal issue beginning to affect the department. You need to move it forward. The facts are incomplete. The accounts differ significantly. And after the resolution, everyone still works together.
A decision needs to be communicated to colleagues who strongly disagree with it. You have the authority to make it. They have to implement it. They have the consequences of living with it.
ONE DIFFICULT COLLEAGUE CONSUMES EVERYTHING
You prepared for the conversation on the drive to work. You thought about it between patients.
You considered how this person might respond. You weighed what needed to be said. You thought about the relationship, what it has been, what it could become.
The meeting lasted thirty minutes. By the time you left the room, the thinking had not stopped. It had shifted.
Did I handle that properly? What should I have said differently? What happens if the behaviour continues? Who needs to know? What's my next step? What's the process? Am I following the right process?
You went to the next meeting still carrying it. You went home still carrying it. A week later, you're still carrying it.
The visible workload was thirty minutes. The invisible workload is consuming your leadership capacity in ways the schedule never reflects.
One unresolved interpersonal situation can occupy more mental and emotional bandwidth than every other leadership responsibility combined.
You don't have a workload problem. You have an unsolved-problem problem. And the problem is still unsolved.
ACCOUNTABILITY EXCEEDS THE AUTHORITY YOU ACTUALLY HAVE
You're responsible for the outcome. Several of the decisions required to achieve it sit elsewhere.
With Medical Affairs or HR. With another department. With someone more senior. With a process you need to work through. With a budget decision made last year. With a policy written for situations that do not quite match this one.
You carry the accountability. You're borrowing the authority. This is the part of the role nobody tells you about until you are standing in it wondering why the responsibility landed with you and the authority landed somewhere else.
You can influence. You can persuade. You can make a case. You cannot decide unilaterally on the thing you're accountable for. The frustration is real. What's more real is the ongoing responsibility you carry for an outcome you do not have sufficient authority to control.
YOUR FAMILY ABSORBS WHAT WORK DOESN'T CONSUME
You're physically present. Your attention is elsewhere.
A conversation with your partner gets shorter than it should because you are thinking about the department. A question from someone you care about doesn't fully land because part of your thinking is still at work. You're present for dinner but not actually present for dinner.
You know this is happening. You also know that the work is legitimate and the responsibility is real. So you carry both.
Your family absorbs what work doesn't consume. They become the space where your diminished margin shows up. Not through unkindness or absence. Through a presence that is not fully there.
They notice. You notice them noticing. Neither of you says it directly.
THE QUESTION ARRIVES QUIETLY
Do I want another term?
Not as a crisis. As a question you begin asking yourself somewhere around month nine of a two-year role.
Would I do this again?
It's a legitimate question. The role is real. The work is consequential. It is also consuming parts of your life in ways you did not fully anticipate.
Would I encourage another physician to take this on?
That question matters because it shapes what you say when someone asks you about the role. Your answer, given quietly in a hallway conversation, carries weight.
POTENTIAL SUCCESSORS ARE WATCHING
They see what happens to a physician who steps forward.
They see the time the role requires beyond the scheduled leadership hours.
They see one difficult situation consume weeks of thinking.
They see you carry accountability for an outcome you don't fully control.
They see your family absorb the spillover.
They hear you answer their question about whether you'd do it again with a pause that is longer than it should be.
That observation becomes part of their own decision about leadership.
The physicians watching your medical directors today are not just observing the role. They are deciding whether they want it. What they see determines who steps forward next.
THE ORGANIZATIONAL DISCOVERY
Two years from now, a vacancy will open. The organization will reach out to physicians they were counting on to lead next. Several will decline.
The organization will be surprised. These are high-performing physicians. Committed. Capable.
The leadership pipeline will suddenly look different than it did.
What the organization will discover, if it looks closely, is that the succession problem has been forming right now. The physicians they were counting on watched their predecessors and updated their own answer about leadership.
The cost was not a single decision or a single year. The cost accumulated through every week a difficult situation consumed more capacity than the leadership structure acknowledged.
THIS IS A CHOICE ABOUT INFRASTRUCTURE
For the physician already in the role, the question is individual: Is another term worth the cost?
For the organization, the question is structural: What conditions are shaping that answer?
Meriot Leadership Institute works with both.
For physicians navigating the leadership role after the title arrives, individual coaching addresses the specific situations consuming your capacity and the invisible workload the role demands. The work restores access to your own regulation, authority, and judgment under the sustained pressure of leading former peers.
For healthcare organizations concerned about physician leadership sustainability and succession, the work addresses the structural conditions determining whether physicians choose to lead and whether capable successors step forward. The cost of getting this wrong extends far beyond a single vacancy.
The succession problem you will face in two years is shaped by the conditions you build right now.
Next in the series:
Part 2 | Before the Vacancy: what your strongest potential physician leaders are learning by watching the people currently doing the job.
Wired for More | Meriot Leadership Institute | meriotleadership.com
The Strategic Leadership Series | Part 1 of 2 | October 2026
