Your First Leadership Role in Medicine
Nobody Taught You This in Fellowship
You got the title. Maybe it's medical director. Maybe it's division chief or vice chair of something. Congratulations. Now what?
Here's the truth nobody tells you: the skills that made you an excellent clinician or researcher are not the same skills that will make you an effective leader. Not even close. And yet, academic medicine hands out leadership roles as if the transition is obvious.
It isn't.
The First 90 Days Matter More Than You Think
Michael Watkins wrote an entire book about this—The First 90 Days—and it remains one of the best resources for anyone stepping into a new leadership position. His core argument is simple: what you do early on determines whether you succeed or fail in the role long-term.
For physicians, I'd add a layer. Your first 90 days set the tone for how your colleagues see you. Not as a clinician anymore. As a leader. That shift in perception is fragile, and it happens fast.
Here's what I tell every client walking into their first leadership role: listen before you fix. You're a physician. You're trained to diagnose and treat. But leadership isn't a patient encounter. The people you're now leading have been doing their jobs without you in charge. Respect that.
Three Mistakes I See Over and Over
1. Trying to prove you deserve it. You already got the role. You don't need to justify it by overhauling everything in your first month. The urge to make an immediate mark is strong. Resist it. Observe first. Build relationships. Understand the landscape.
2. Saying yes to everything. New leaders want to be seen as collaborative and available. That's admirable. It's also a fast track to burnout. Your clinical load probably didn't shrink much when you took this on. You need to protect your time from day one, or the role will consume you.
3. Leading the way you were led. Most physicians have never had a great leader in academic medicine. So they default to whatever they experienced—which was often command-and-control, or worse, absent leadership. Be intentional about the kind of leader you want to be. Don't just replicate what you've seen.
What Actually Works
Start with one-on-one conversations. Meet with every person who reports to you or works closely with you. Ask them two questions: What's working? What's not? Then actually listen.
Get clear on your authority. What decisions are yours to make? What requires approval? Where does your budget come from? These questions feel mundane, but ambiguity here will undermine you. I've watched talented physicians struggle for months because they assumed they had authority they didn't—or failed to use authority they did.
Find a peer outside your department. Leadership can be isolating, especially when you're new. Having someone you trust—who isn't in your reporting line—makes a real difference. This is one of the reasons coaching works so well in these transitions. You need a space to think out loud without political consequences.
You Don't Have to Figure This Out Alone
The best leaders I've worked with aren't the ones who had it all figured out from the start. They're the ones who were honest about what they didn't know and got support early.
If you're stepping into your first leadership role—or you've been in one for a while and it still feels like you're guessing—I'd love to talk. Reach out for a conversation about what coaching could look like for you. No pressure, no pitch. Just a real conversation about where you are and where you want to go.
