From Clinician To C-Suite: When Expertise Isn’t Enough — Addressing Systemic Barriers to Physician Leader Success

The objective of this study was to identify system-level contributors to physician leadership fatigue and propose organizational strategies to improve physician executive retention and well-being. A qualitative, multi-institutional study was conducted using in-depth interviews and group sessions with 17 U.S. physician executives. Themes were analyzed regarding role expectations, onboarding, organizational support, and perceived causes of leadership fatigue. Leadership fatigue was found to arise primarily from systemic issues rather than individual shortcomings. Participants described ambiguous expectations, minimal structured onboarding, inadequate leadership development, and weak integration into executive teams, leading to isolation, distress behaviors, and burnout. Disruptive behaviors commonly reflected distress instead of willful noncompliance. We concluded that physician leader turnover and lost organizational value are largely preventable through systemwide reforms. Health systems should clearly define physician executive roles, invest in longitudinal leadership development, implement purposeful onboarding, align values, and treat distress as a trigger for support. Addressing institutional drivers, rather than individualizing burnout, is essential to sustaining effective physician leadership and improving care outcomes.