Large health systems are increasingly filling their top job from within, and the person moving into the CEO’s office is often someone who already holds the president title.
Of 22 permanent CEO appointments at large health systems between mid-March and late September 2026, 16 went to executives already working at the organization, or 73%, according to an analysis of Becker’s executive moves coverage. In the same period of 2025, insiders landed eight of 14 appointments, or 57%.
The number of outside hires held steady at six in each period, while internal appointments doubled.
The shift comes as CEO turnover broadly is running hotter than last year. Hospital and health system CEO appointments in 2026 reached 91% of 2025’s full-year total in about seven months, according to Becker’s tracking. More vacancies at the top have come with more boards betting on someone they already know.
President as the top choice
The most common route to the top in 2026 ran through the president’s office. Five of the 2026 internal picks either held the president title or received it as part of their succession plan, compared with two in the 2025 window.
Tacoma, Wash.-based MultiCare Health System named President Florence Chang its next CEO in June. She joined the system as CIO in 2006. Fountain Valley, Calif.-based MemorialCare elevated President David Kim, MD, as part of a succession plan that outgoing CEO Barry Arbuckle, PhD, started with the board several years earlier. Children’s Hospital of Philadelphia promoted President Joseph Mitchell, MD, following a planning process that began in 2024.
Other systems created the role specifically to signal the next leader. Arlington-based Texas Health Resources named COO Winjie Tang Miao president, effective April 5, a position the system said was created “to identify the executive who will assume the CEO position at a future date.” Scottsdale, Ariz.-based HonorHealth made John Neil, MD, president immediately when it announced he would become CEO in March 2027.
Operations and finance leaders also moved up. Four COOs became CEO at large systems in the 2026 window, compared with one in the same period of 2025, including Ben Spence at Fort Myers, Fla.-based Lee Health and Mimi Coomler at Tucson, Ariz.-based TMC Health. Two CFOs made the jump: Doug Shirley at Louisville, Ky.-based ScionHealth and Alec King at Houston-based Memorial Hermann Health System. Memorial Hermann said Mr. King’s appointment followed “a multiyear succession planning process focused on developing internal leadership.”
Hire now, promote later
“Internal” does not always mean a long-tenured leader. Four of 2026’s internal picks had joined their systems about 14 to 15 months before being named CEO. Dr. Mitchell came to CHOP from Boston Children’s Hospital in April 2025. Dave Caspers joined Brentwood, Tenn.-based Ardent Health as COO in March 2025 and was named CEO in June. Mr. Shirley joined ScionHealth as CFO in April 2025.
The pattern suggests some boards could be recruiting outside talent into the No. 2 seat and testing them there before handing over the top job.
Other picks had decades of tenure. Mr. Spence joined Lee Health in 1995. Matthew Edwards, MD, spent more than 30 years at Winston-Salem, N.C.-based Atrium Health Wake Forest Baptist before he was appointed CEO in September.
Where outside hires came from
Systems that went outside mostly recruited leaders one level below CEO, such as hospital presidents, market presidents and system vice presidents. Portland-based Oregon Health & Science University tapped Amy Shlossman, a senior vice president at Baltimore-based LifeBridge Health, in June.
Only two sitting system CEOs moved to lead another large system in the 2026 window, and one was a homecoming. David Zaas, MD, returned to Durham, N.C.-based Duke University Health System, where he spent nearly two decades, after only a few months as CEO of Atrium Health Wake Forest Baptist. Ann Arbor-based Michigan Medicine CEO David Miller, MD, was named CEO of Nashville, Tenn.-based Vanderbilt Health.
The move toward insiders reflects how the CEO role has changed. Systems are managing Medicaid cuts under HR 1, margin pressure and consolidation, including the shift away from individual hospital CEOs toward market and regional leaders. In that environment, boards appear to value continuity and leaders who already know the system’s operations, finances and culture.
Editor’s note: This analysis includes permanent CEO appointments at large health systems, including academic and children’s health systems, reported by Becker’s between March 11 and Sept. 28, 2026, and the same period in 2025. Interim appointments were excluded; interim leaders named permanent CEO were counted as internal. The figures are not a comprehensive census of all CEO changes.
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