Physician leaders should begin planning their exit from their first day on the administrative role, much like how clinicians plan patient discharge at admission, Jim Keller, MD, former chief medical officer of Park Ridge, Ill.-based Advocate Lutheran General Hospital and a practicing maternal-fetal medicine physician, said in an upcoming episode of “Becker’s Healthcare Podcast.”
Dr. Keller stepped down as a CMO in early 2025 and has continued practicing. But he said a smooth return to clinical work isn’t a given for physician leaders who don’t plan for it.
The risks of ignoring transition plans
Dr. Keller said he doesn’t think many people are putting a lot of energy into exit plans, especially at the system level.
“I don’t think the individual leader right now can count on the system to put together a path,” he said.
Physicians in particular rarely expect to lose a leadership position, which can make for a harder landing, Dr. Keller said. “There’s also the risk of not knowing what to do with yourself, and the risk of not being able to contribute any longer,” he said.
Staying in a role too long carries risks for both the organization and the leader. For organizations, it can lead to stagnation. For leaders, it can lead to burnout.
“If an individual stays on past the point where they feel they can contribute adequately, or they perceive that their contributions aren’t valued, they can become burned out,” Dr. Keller said. “They can start developing compassion fatigue. All the things we talk about for physicians toward the end of their career can happen to physician leaders as well.”
This is happening to younger leaders too, he added.
“I think the biggest cost of not having an exit plan, or an appropriate exit plan, is that at the end of your career, you’re like the physician who harms a patient without ever meaning to,” he said. “You’re harming the healthcare system by staying on too long. And it goes back to making sure you have a plan from the minute you start these administrative roles.”
What leaders and systems can start changing
For individual leaders, the most important thing they can do to prepare is establish their clinical competency and a reputation as a strong physician before moving into leadership, Dr. Keller said.
“As you’re in a leadership role, no matter how hard you try, your clinical skills and clinical acumen are going to be more and more difficult to maintain, if they’re not deteriorating,” he said. “So you have to have that very strong foundation before you start spending time away from that space, so that you can move back into a clinical role.”
Having a strong succession plan is also important for leaders and the system.
“Having a succession plan and transitioning out of your role deliberately does two things,” he said. “First, it probably keeps you from being transitioned out of your role against your will, which I think we all have to admit happens more commonly. Second, people knowing that you have a transition plan and a succession plan allows the institution to retain and recruit talent. If there’s a young, emerging leader who’s really bright with great ideas, but they look around and see there’s no path for them within the organization, they may go elsewhere.”
At the system level, losing talent and experience is one of the greatest risks of poor transition planning. Systems can lose younger talent who don’t see a path into clinical leadership, as well as the institutional knowledge of experienced leaders once they exit.
“We need to find a better way to utilize retired leaders and give them softer landings,” Dr. Keller said. “Just having somebody stop on a certain day and then not using their talent and institutional knowledge is a big risk and a big waste. It’s slightly offset by bringing in new talent, but there’s no reason you can’t take advantage of both.”
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