American Association for Physician Leadership

Strategy and Innovation

Queen CEO

Grace E. Terrell, MD, MMM, CPE, FACP, FACPE

June 10, 2024


Even after a woman has obtained the CEO role, challenges remain with respect to differences in behaviors they experience.

On January 20, 2000, I became president and chief executive officer of Cornerstone Healthcare and held the title of CEO in that company and eventually three others for 21 years. There was no announcement in the press about my position at Cornerstone, which at the time was a smallish physician-owned multispecialty medical group in High Point, North Carolina. Cornerstone’s first CEO, Dr. Doug Blazek, served in that role from the group’s inception in 1995 until I stepped into the role in 2000. He found that five years of leading the medical group, including addressing behavioral issues with his medical partners, was not conducive to referrals to his surgical practice from his colleagues, nor did the stipend he was paid for the position make up for the income he lost from his surgical practice. In contrast, my internal medicine practice was not dependent on my relationship with my colleagues, and my primary care level compensation accommodated the stipend substitute much more readily.

While I was at Cornerstone, the group grew from an initial $16 million in revenues generated by 42 physicians in 16 medical practices to $300 million in revenues generated by more than 300 providers in 93 practice locations. We were one of the first medical groups to successfully transition to full electronic medical records, one of the first patient-centered medical homes in the country, one of the first medical groups to move to value-based models of care and payment, and a winner of the prestigious AMGA Acclaim award in 2015 for outstanding quality in a medical group.

Like much of the independent medical groups, Cornerstone was eventually incorporated into a larger hospital-owned integrated delivery system in 2016, but not before we had spun off a couple of other companies: CHC Realty LLC, responsible for constructing a couple of 100,000 square foot state-of-the-art medical office buildings, and CHESS (Cornerstone Health Enablement Strategic Solutions), a population health company successfully managing more than 150,000 lives in full-risk value-based contracts.

I initially served as CEO of those two companies, too, and later in my career I served as CEO of Envision Genomics, a biotechnology startup focused on whole genome sequencing with a machine-learning diagnostic technology permitting rapid diagnosis of rare diseases, and Eventus WholeHealth, a medical group that provides integrated primary care and mental health care to medically vulnerable adults who are homebound or residing in long-term care facilities.

I believe one reason I have been able to have a long career as a CEO for multiple companies is that the original role at Cornerstone Healthcare was not seen as particularly prestigious or competitive. The president and CEO of a smallish multispecialty medical group, particularly one that initially was more primary care and medical specialty focused rather than broadly surgical subspecialty focused, was initially a low-status leadership position in the medical community hierarchy when I assumed the role in 2000. Cornerstone was not on anyone’s radar for all the innovations it has subsequently been known for, and the CEO of the medical group answered to a board of 12 physicians with limited authority in our governance structure who in turn answered to all the shareholders for many significant group decisions, such as any capital expenditure over $100,000, addition of new shareholders or member groups, and changes in the income distribution formula.

The initial stipend I received for the position was minimal, meaning I still had to practice medicine full time to maintain my primary care physician income as well as my credibility with my physician colleagues, most of whom dismissed management roles for physicians as a sellout if one did not continue to practice medicine. To get anything accomplished at Cornerstone Healthcare, I had to build consensus with multiple constituents and do so with soft power rather than assumed authority. For a southerner, my speaking style is direct and to the point, but the male-dominated medical group I led with its all-male board of directors meant I had to hone my listening skills, because my natural tendency to speak early in a debate did not always serve me well.

Some research data from Penn State in 2021 found that the more companies praise and tout the past accomplishments of their incoming women CEOs when announcing their hiring, the more likely it is for these women to have shorter tenures in the CEO role. That resonates with me, and the fortuitousness of the low status of my first CEO role allowed me the years of experience I needed to improve my leadership skills without the constant scrutiny that many women experience.

Many women encounter the double-binding effect, or catch-22, in their professional lives, where they are trapped by two interconnecting stereotypes. Women are stereotypically seen as being sensitive and nurturing and thus not fit for leadership roles; when women show that they are competent for leadership roles, they are criticized as not fulfilling the stereotypical expectations for what women should be. The author of the study observed: “When women act confident and leader-like, it can violate these societal expectations of what a women should be, which is highly problematic. Organizations may want to help women by touting their accomplishments, but as soon as they do, it can trigger a backlash.(1)

This research resonates with me, because I have found through the years that touting my own accomplishments can be risky. At graduation every year at my rural North Carolina high school, they gave awards for the top English student, the top math student, the top history student, and the top language student. In 1979, I graduated the top of my class, won all of those awards, as well as a prestigious merit-based Morehead scholarship to the University of North Carolina at Chapel Hill, but the principal chose to give me the awards the next day rather than draw attention on stage to the fact I had won them all. The boy who was class president, rather than the valedictorian, gave the senior speech.

That experience is one of many through the years, where I was encouraged not to draw attention to my accomplishments if they made me stand out too much from those around me. I did not think about it as a gender issue at the time I graduated, that it would be considered “immodest” for me to receive each of the awards on stage; but, in retrospect, I believe it was. Had the roles been reversed, would the principal have held off presenting the boy who was class president with all the academic awards out of a need for “modesty”?

Even after a woman has obtained the CEO role, challenges remain with respect to differences in behaviors they experience. Female CEOs face more aggressive questions on earnings conference calls than male CEOs, according to research from the University of Exeter Business School. Researchers analyzed recordings of earnings calls with U.S. firms over a 13-year period ending in 2018. They defined “verbal aggressiveness” in four measures: the frequency of follow-up questions, the use of preface statements, the number of direct questions, and the questions that begin with assertions like “aren’t you.”

Excerpted from Strategies for Recognizing and Eliminating Gender Bias for Healthcare Leaders by Grace E. Terrell, MD, MMM, CPE, FACP, FACPE.


  1. Bohn K. The Way New Women CEOs Are Announced May Shorten Their Tenure: Penn State Researchers Say The Endorsements May Trigger Stereotyping in Their New Role. Penn State News. June 16, 2021.

Grace E. Terrell, MD, MMM, CPE, FACP, FACPE

Grace E. Terrell, MD, MMM, CPE, FACP, FACPE, is a national thought leader in healthcare innovation and delivery system reform, and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. She is also a practicing general internist.

She currently is executive in residence at Duke University School of Medicine’s Master in Management of Clinical Informatics Program and a senior advisor for Oliver Wyman management consulting firm.

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