A new report from executive recruiting firm WittKieffer examines the evolving role of physician leadership within health systems. Michael Anderson, M.D., principal and co-executive director of the Physician Leadership Institute at WittKieffer, responded via e-mail to our questions about the report. 

The report, based on interviews with more than 20 physician executives and WittKieffer’s proprietary research, notes that physician executives have traditionally been responsible for overseeing medical staff affairs, physician group practices, and core quality and safety functions. “While these responsibilities remain foundational, they are no longer the primary source of impact for many organizations,” the report intro states. “Today, these leaders are members of the executive team who help set enterprise strategy, share accountability for financial outcomes, lead technology transformations, and reshape how care is delivered across inpatient, ambulatory, and virtual settings. Clinical credibility carries weight as a source of trust and legitimacy, but its power depends on how it is deployed.”

Healthcare Innovation: What are some reasons strong tech innovations, population health, and value-based care efforts are requiring stronger physician leadership these days?

Anderson: The short answer is that healthcare is much more complex than it’s ever been — not just clinically, but operationally, financially, and technologically at the same time. The reality is that if anyone is going to make sense of that complexity, it will be physicians who understand what’s happening at the bedside and can connect it to decisions at the enterprise level. What’s different now is the expectation: physician leaders are not just interpreting clinical reality; they’re expected to help shape strategy and drive performance across the organization.

HCI: Your report describes a continuum in physician leadership roles from a Stewardship Model to an Operational Excellence Model to an Enterprise Strategy Model. Is there a common way that health systems move through this continuum?

Anderson: Health systems naturally move along this continuum as they grow in scope and scale, organically or through mergers and acquisitions. More importantly, they build “systemness,” or the ability to operate as an integrated enterprise rather than a collection of assets. As that happens, expectations of physician leadership shift as well: from Stewardship to Operational Excellence to Enterprise Strategy. Where things begin to break down is that the leadership model doesn’t keep pace with that evolution. In practice, many organizations are building the plane while flying it. Our point is that this transition is predictable and manageable, and organizations can get ahead of it by developing physician leaders (and the broader executive team) alongside the organization, so the role doesn’t outgrow the leader.

HCI: What factors tend to allow them to move into the Enterprise Strategy Model? Does it depend on the size and complexity of the organization?

Anderson: Size and complexity certainly create the pressure, but they don’t guarantee the move. The real unlock is alignment between mandate, authority, and capability. There is often a chicken-and-egg dynamic: growing complexity demands enterprise leadership, but proactively building that leadership capability can also drive greater scale and performance. Ultimately, the difference-maker is intentionality: whether organizations deliberately design roles, development pathways, and expectations to support enterprise-level leadership. Organizations that treat this capability as something to build (not assume!) move faster and more impactfully.

HCI: Why do organizations tend to underestimate the effort required for physician leaders to expand their scope? What are some common organizational mistakes in structuring their growth?

Anderson: One of the most common assumptions is that clinical excellence and success in smaller leadership roles will naturally translate to enterprise leadership. That’s not how it works. As the role expands, physician leaders are asked to operate in matrixed, influence‑based environments where authority is shared. Many leaders find they’re not fully equipped to navigate that complexity, and as a result, they can hit what my colleague Raj Ramachandran and I have described as a “leadership wall.”

What’s needed is a more deliberate focus on the core competencies highlighted in our research: thinking and acting at the enterprise level, integrating clinical, financial, and operational priorities, leading through influence in complex systems, and managing oneself effectively amid ambiguity and competing demands. Just as important, organizations need to recognize that leadership development is not episodic. It can’t be a one-off seminar or even a degree program; it has to be a sustained, ongoing investment that combines experience, formal and informal learning, mentorship, coaching, stretch assignments, and real exposure to enterprise decision-making.

HCI: The WittKieffer report notes that physician executives are routinely pulled below the level of work their organizations say they need them to perform. Why does this happen and what are some ways to overcome this problem?

Anderson: At its core, this is a design issue. Organizations are asking physician leaders to operate at a strategic level while structuring roles that keep them anchored in operational and administrative work. There’s often an urgency bias: immediate demands crowd out time for planning, innovation, and transformation. Many of these leaders are also still practicing clinicians, which adds another layer of pressure. The solution has to come from both sides. Physician leaders need to actively manage their time and prioritize higher-value work, something we focus on in WittKieffer’s Physician Leadership Institute. On the organizational side, the shift has to go beyond “symbolic inclusion” (a seat at the table without real enablement) to removing structural barriers, such as clarifying roles, strengthening support, and enabling delegation, so leaders can operate at the level they’re expected to.

HCI: The paper calls AI and clinical technology integration both a critical mandate and a major source of time tension. Can you explain why the time allocation data suggests that the aspiration to lead innovation outpaces reality in this space? What’s a solution here?

Anderson: Innovation, especially around AI, requires experimentation, iteration, and learning over time. That’s fundamentally at odds with how many physician leader roles are structured today. What we see in our survey data is a clear mismatch between aspiration and reality. Physician leaders are currently spending about 22% of their time on administrative and operational work, compared to 17% on strategy and just 11% on innovation and transformation initiatives. In the aspirational model, that balance essentially flips. The issue is not a lack of vision. It is a lack of protected capacity. Closing that gap means treating innovation as a core leadership mandate and creating the time, support, and infrastructure to sustain it, rather than layering it on top of an already saturated role.

HCI: The paper notes that physician-specific leadership development programs remain underutilized, with only 20% of physician executives reporting participation. Should more health systems look to create these programs and encourage physicians to participate?

Anderson: Yes — but with an important caveat. It’s not just about having programs; it’s about how they are designed and sustained. Effective development needs to be ongoing, integrated into the organization, and tied to real leadership experiences. It should combine content knowledge, experiential learning, and structured reflection. This is consistent with broader industry work, including an AHA working group framework outlined recently in NEJM Catalyst, which highlights the importance of a more intentional approach to developing physician leaders through structured knowledge, exposure, and experience. Importantly, the goal is not academic credentialing; it’s building enterprise leadership capability, the ability to navigate ambiguity, make trade-offs, and lead across boundaries. 

HCI: The WittKieffer report mentions that cross-functional exposure and formal mentorship programs are central to developing an enterprise mindset. How common are these approaches and is it up to the CEO to initiate these structures?

Anderson: We’re seeing more of these approaches, but they’re still far from standard practice. I speak to executives every week who are doing creative things — cross-functional cohorts, mentorship models, rotations across functions — but it’s not yet consistent. Cross-functional exposure is one of the fastest ways to build an enterprise mindset because it shows physician leaders how decisions and trade-offs actually get made across finance, operations, and strategy. Leadership here has to be shared. The CEO plays an important role, but so do the CHRO, chief physician executive, and the broader leadership team.

HCI: The paper notes that over-reliance on the physician voice can, paradoxically, weaken influence. Can you explain why this can happen and how to avoid it?

Anderson: Clinical credibility gets you a seat at the table, but it doesn’t carry the decision on its own. At that level, arguments have to connect to financial, operational, and strategic realities. If you rely too heavily on the “physician voice,” it can come across as advocacy for one perspective rather than leadership for the whole system. The most effective leaders translate clinical insight into enterprise impact. Speaking from my experience as an MD, former CMO, and hospital president, you often want to say, “Here’s what we need to do to keep the patient healthy.” But when the “patient” is a large, complex organization with thousands of employees, no single perspective can dictate any decision.

HCI: Is there anything else about the report you want to stress?

Anderson: If there’s one thing I would emphasize, it’s that this is an industry-wide issue. We tend to treat physician leadership development as something that happens later in a career, within a single organization and for individual leaders. But the demands of the role today require a more deliberate, collective, and long-term approach. That development has to start earlier, beginning in medical school, and continue throughout a physician’s career, supported by health systems, academic institutions, associations, and consulting firms. If we want physician leadership to keep pace with the complexity of modern healthcare, it has to be built consistently and collectively, not left to chance.