New Book Offers Chief Medical Officers Battle-Tested Solutions to Healthcare's Toughest Leadership Challenges

WASHINGTON, DC – March 27, 2026 – The American Association for Physician Leadership (AAPL) announces the publication of Difficult Dilemmas for Chief Medical Officers: 30 Case Studies , a groundbreaking resource that provides physician leaders with proven approaches to the most daunting challenges they face in healthcare leadership roles.

Edited by Rex Hoffman, MD, MBA, chief medical officer at Providence Holy Cross Medical Center, and Doug Koekkoek, MD, a veteran healthcare leader with more than two decades of experience mentoring CMOs across major health systems, the book assembles insights from seasoned physician executives with more than 150 years of combined leadership experience.

"As a chief medical officer, I know I will keep this book close, since I am likely to be confronted with some of the scenarios contained herein," Hoffman writes in the book's introduction. "It has been said that being a chief medical officer is the best job in medicine because it offers a unique opportunity to engage with all hospital operations and personnel. As with most jobs, it, too, has its challenges."

Real Dilemmas. Real Solutions. Real Impact.

Difficult Dilemmas for Chief Medical Officers: 30 Case Studies draws on more than 150 years of collective CMO experience to guide physician leaders through complex real-world scenarios.

The book presents 30 authentic case studies organized into four essential domains:

• Physician Management:

  Navigating crises from HIPAA violations to impaired physicians

• Physician Acceptance of Workflow and Best Practices:

  Overcoming resistance to evidence-based protocols

• Hospital and Medical Group Administrative and Operational Challenges:

  Solving complex system-level problems

• Leadership Competencies:

  Building the skills to handle situations that test judgment and courage

Each case study follows a consistent format: presentation of the scenario, in-depth analysis of the decision-making process, and detailed explanation of how an experienced CMO successfully addressed the challenge.

"Think of it as playing Jeopardy with a lifeline — except your 'phone a friend' is an experienced Chief Medical Officer who has already solved the problem you are facing," Hoffman explains.

Addressing Critical Challenges in Physician Leadership

The book tackles scenarios that keep CMOs awake at night: How do you manage an intoxicated physician? What is your approach when a high-performing surgeon refuses to send patients to a skilled nursing facility? How do you address quality and safety gaps while maintaining physician engagement? When do circumstances warrant terminating a physician, and how do you execute that decision?

Doug Koekkoek, MD, who has been instrumental in building strong physician cultures centered on quality, safety, and patient experience at Providence St. Joseph Health and PeaceHealth, brings decades of expertise in developing robust peer review and utilization management structures. His respected leadership has helped develop and mentor a generation of chief medical officers across the West Coast.

"This book provides physician leaders with something invaluable — the collective wisdom of CMOs who have successfully navigated these treacherous waters," said Koekkoek. "It is the affordable alternative to hiring consultants and the practical complement to formal education programs."

Meeting the Needs of Today's Physician Leaders

Difficult Dilemmas for Chief Medical Officers is designed for current CMOs seeking peer-tested solutions, aspiring physician leaders preparing for executive roles, and healthcare administrators responsible for physician performance and operations across hospitals, medical groups, health systems, and health plans.

The book offers significant advantages over other leadership development alternatives. Unlike expensive consultants or lengthy executive programs, readers can access expert guidance immediately, learn at their own pace, and reference specific scenarios as challenges arise in their own organizations.

"The reader can read at their own pace, and it is far less expensive than a consultant, mentor, or formal educational curriculum," says Hoffman.

About the Editors

Rex Hoffman, MD, MBA, is chief medical officer at Providence Holy Cross Medical Center in Mission Hills, California, where he has served since 2019. After a 19-year career as a practicing radiation oncologist, Hoffman earned an MBA in the Business of Medicine from the Kelley School of Business at Indiana University before transitioning to healthcare leadership. He has also served stints as interim CMO at two sister hospitals within Providence. Hoffman is dedicated to helping current and aspiring CMOs succeed through practical, experience-based guidance.

Doug Koekkoek, MD, has been an influential leader in healthcare for more than two decades, leading primary care and specialty physician practices across major health systems. His respected leadership at Providence St. Joseph Health and PeaceHealth was instrumental in building strong physician cultures centered on quality, safety, and patient experience. Koekkoek is a fellow in the American College of Physicians and a senior fellow in Hospital Medicine at the Society for Hospital Medicine. He received his medical degree from Oregon Health Sciences University and completed his internship, residency, and chief residency at Providence Portland Medical Center.