The Other Side of the Gap: What No One Tells Physicians About Making the Executive Leap

By Mike Cantor, MD, JD, CEO and Founder of The Cantor Group & Parallax Collaborative,

and Maura McGinn, Founder and CEO of Impetus Talent

We recently published a piece on what companies get wrong when hiring physician executives.

The response told us something important: the gap runs in both directions.

Companies don't know how to hire for these roles. And most physicians stepping into them

haven't been prepared for what the job actually requires. This piece is for the physicians.

It's Not a Promotion. It's a Career Change.

You survived years of training designed to filter out everyone who couldn't cut it. You managed

life-and-death decisions under pressure, led interdisciplinary teams, and earned the trust of

patients and colleagues alike. So when the opportunity to step into an executive role arrives, the

assumption is that the skills that made you a great clinician will translate.

They don't. At least not automatically.

As a clinician, you're a player on the team, focused on one patient, one encounter, one outcome

at a time. As a physician executive, you become the coach. You're responsible for outcomes you

didn't personally produce and a team whose work you can't always see. You have to lead through

influence rather than authority.

No one teaches you how to do that in medical school. And most companies don't have the

bandwidth to develop you once you're in the seat. That's the gap. And it's yours to close.

You Probably Don't Know Your Phenotype Yet. Here's How

to Figure It Out.

In our experience there are three distinct types of physician executives: the External Evangelist,

the Internal Operator, and the Clinical Strategist. If you haven't read our earlier piece on the

phenotypes, you may want to start there.

Most physicians think they know which one they are. Many haven't had enough business reps to

actually know. The self-knowledge has to be built. Three questions worth sitting with honestly:

What draws you when you have unstructured time at work? Are you gravitating toward

external relationships, conferences, and the pitch? Or toward operational problems, workflow

gaps, and process improvement? That instinct is a key data point.

What do your non-clinical colleagues come to you for, and what do they quietly route

around you on? Not patients, not clinical peers. The CFO, the product manager, the commercial

lead. Their behavior tells you as much or more than your self-assessment.

What did you hate in your last role? Knowing what you don't want to do is just as important as

knowing what you like doing. If utilization management reviews made you miserable, that's

information. If you dreaded external meetings and came alive when you were in the operational

weeds, that's information too.

The honest caveat: you may not fully know until you're in it. But the self-awareness you build through these questions, what draws you, how others leverage you, what drains you, is exactly the kind of clarity that makes you a stronger candidate and a more effective leader. The

physicians who thrive in executive roles aren't the ones who claim to do everything. They're the ones who know where they do their best work and focus on it.

The Impact Narrative: How to Tell Your Story

Another important issue is that a large percentage of qualified physicians struggle to clearly

articulate their accomplishments. They can describe what they worked on. They can explain the

clinical rationale. But when asked "what was the measurable outcome, and what did it cost to get there?" many go quiet.

The business rationale matters enormously in interviews, in board presentations, in client pitches,

and in internal advocacy for resources.

The physicians who make this transition well develop the “impact narrative,” a concise account

of the problem you identified, the solution you designed, why you made that choice, what it cost,

and what it measurably produced. Not just "we improved quality metrics" but “we had a patient

in the hospital for over 250 days with no one managing him. I built a team, implemented a daily

census review, and pulled the average length of stay from 15+ days down to 5, which delivered a

return on investment (RoI) of 2.5.” This flips a vague quality story to a concise description of

impact on cost and quality.

If you can't tell that story yet, start building it now. Look back at the last two or three initiatives

you led. What was the problem and what was it costing the organization? What did you do and

why? What did it actually produce and how do you know?

The deeper shift that happens as you move into leadership is this: you stop working in the

business and start working on it. The more senior you become, the more that distinction defines

your value. You're no longer accountable for executing a list of tasks. You're accountable for the strategic, financial, and operational impact of decisions that involve people, process, and

technology, each with real costs and real opportunity costs elsewhere. The impact narrative is

how you demonstrate that shift has happened. It's the difference between a physician who is

doing their job and one who understands the business they're helping to run.

The Overconfidence Blind Spot

Medical training builds a specific kind of confidence. You had to believe you could handle

anything to survive. That confidence is an asset in clinical practice. In business it can mask real

gaps in ways that are hard to see from the inside.

The most effective physician executives lead with curiosity instead of confidence. They ask how

the financial model works instead of assuming they'll figure it out. They learn the language of

their non-clinical peers instead of expecting everyone to speak theirs. They invest in understanding unit economics, staffing ratios, and how to build a business case for resources, not

because they're being asked to become CFOs, but because influence requires speaking the

language of business.

This doesn't mean physician executives need MBAs. It means they need to invest in learning the

vocabulary and frameworks of business and apply them consistently. Physicians who end up

leaving business roles are those who couldn't prove their value to the people managing the

budget.

Closing the Gap: Being Intentional About Your Development

The gap between clinical excellence and executive effectiveness is real but it's not fixed. The

physicians who close it fastest are the ones who strategically and actively build business

exposure, not the ones who wait for it to happen organically.

Formal programs exist: use them. The American Association for Physician Leadership offers

courses designed specifically for this transition. They're excellent. Many physicians who end up

in executive roles have never taken them. An MBA or MPH has mixed ROI depending on where

you are in your career. The credential itself matters less than the frameworks and the confidence

it builds. For some physicians it's worth it. For others the same investment of time and money goes further elsewhere. What matters is that you're building the vocabulary and the mental models deliberately, not hoping they emerge on the job.

The apprenticeship model is the most underappreciated path. Find organizations and

individuals who have a clear vision for physician executive leadership and participate in, or even

build, leadership development programs. Many successful health care organizations produce very strong leaders who go on to bigger and better things – look for those organizations and

network with their alumni. Good talent development compounds. Find the organizations known

for it and prioritize them early in your career, even if the role or the pay isn't where you want it to

be yet.

Coaching helps, so use it: it works for pro athletes and for executives. If you’re not in an

organization with career resources, or if you are but want greater confidentiality, get a coach.

Coaching is critical at all stages of your career. Find a physician coach or a coach experienced in

coaching physicians.

Where you start matters more than people think. Growth-stage companies often have fewer

formal development structures for clinical people. Budget constraints are real, career paths are

less defined, and many first-time CMOs at startups are either founders or physicians who already

honed their executive skills somewhere else, often in a health plan or a larger care delivery

organization where physician hierarchies are clearer and the training infrastructure exists.

If you're early in your transition, consider the sequencing carefully. Go somewhere with good

exposure to the type of work you eventually want to do, but with enough infrastructure to

actually develop you. Health plans and larger health systems have established physician

leadership pipelines. Get trained there first. The growth-stage companies will be more attractive

to you, and you to them, once you've built the skills and gotten comfortable in your role.

If you're already inside a business, be deliberate about proximity. Shadow budget meetings.

Ask to sit in on commercial negotiations. Partner intentionally with a product manager or a

finance lead on a project that isn't yours. Find a non-clinical business leader, inside or outside

your organization, who will give you honest feedback on how you're showing up in business

contexts. Most physicians get feedback from clinical peers. The developmental gap closes when

you start getting it from the CFO or the Chief Commercial Officer.

The physicians who don't wait to be developed are the ones who get there fastest.

The Gap Is Closable

The physicians who make this transition well know the skills that made them successful

clinically won't automatically translate into executive roles. And they are the ones who

don't wait for someone else to close that gap.

Mike Cantor, MD, JD is the CEO and Founder of The Cantor Group, a fractional CMO and

healthcare advisory practice focused on PE/VC-backed companies, digital health, and Medicare

Advantage organizations. He is also the co-founder of Parallax Collaborative, a platform

helping physicians navigate what comes next in their professional lives.

Maura McGinn is the Founder and CEO of Impetus Talent, a specialized executive search firm

focused on PE/VC-backed healthcare services, tech-enabled services, and HCIT companies. She

brings 15 years of experience across executive search, HR leadership, and private equity talent.