The Question I Ask Every Physician the Day They Get the Title

A surgeon I worked with last year had been named Chief Medical Officer of a regional health system. He had a corner office, a deputy, and a seat at the executive table he'd been angling toward for three years. Two months in, he told me he felt like a fraud.

"I don't do anything anymore," he said. He meant he wasn't operating. He meant the thing that had defined him — the thing that told him who he was — was no longer what he did every day.

That's not an unusual story. In fact, it's almost the rule.

When physicians step into executive roles, the assumption is that the hard part is learning the business side — strategy, finance, board dynamics. Those things matter. But the piece that actually trips people up is quieter and less discussed: identity.

For most physicians, clinical competence has been the bedrock of professional self-worth for 15 to 25 years. You were the expert in the room. When things went wrong, you made the call. Your authority was earned, visible, and validated daily.

Then you become a CMO, VP of Medical Affairs or a Department Chair, and almost none of that applies.

You're now leading through influence, not authority. Your value is abstract — shaping strategy, building culture, managing up and sideways and down. The feedback loops are longer. The wins are harder to name. And no one tells you that on day one.

I ask every physician executive I start working with a version of the same question: "What parts of your old identity are you bringing with you, and what's getting in the way?"

Usually, it's not a blank stare. Usually, it's a very specific answer they haven't said out loud yet.

The hardest thing to let go of is often the need to be the expert in the room. Physicians are trained to have answers. Executive leadership, at the highest levels, is often about holding uncertainty — running a process, asking better questions, letting others lead the implementation. That's not weakness. But it can feel like it, particularly when the people around you are also very accomplished.

The physicians who transition well don't pretend the shift isn't happening. They name it. They find a peer or a coach or a mentor who actually gets it — not someone who will tell them to "trust the process," but someone who can say, "yes, this specific part is genuinely hard, and here's how I've seen others navigate it."

The ones who struggle tend to hold on. They keep one foot in clinical work long past the point where it serves the organization. Or they over-correct and pretend the clinical piece didn't matter, cutting off the most important thing they bring to the executive table — which is actually knowing what the work feels like from the inside.

There's no clean answer here. The identity shift is real, it takes time, and it's not linear.

But here's the question worth sitting with: if you stripped away the clinical title and the executive title, what would you say your leadership is actually for?

"The physicians who transition well don't pretend the shift isn't happening. They name it."

★ TRY THIS WEEK

Use The Executive Identity Audit below to surface what's actually driving your decisions right now. Seven questions. Thirty minutes. No performance required.