Six months, not six years

Every January I take a week and go back through the roles I filled the year before, and the ones I didn't. I'm looking for patterns, right? And the pattern that keeps showing up is almost boringly consistent. The flexible, progressive roles filled. The traditional ones — the full-time, all-in, give-up-most-of-your-practice leadership seats that looked like something out of the 1990s — sat open.

So it was interesting to read a piece in Becker's this month about Providence creating temporary, topic-based leadership roles for physicians. Their CMO for care delivery, Dr. Brendan Lloyd, put it simply: physicians shouldn't be limited to full-time permanent positions, and the system wants to find places where physicians can contribute in a less traditional role.

The example that stuck with me was a busy obstetrics hospitalist. Providence needed someone to help prepare for CMS billing and coding changes. She took it on as a defined, temporary leadership piece. By their own account, she likely would have said no to anything longer.

That's the whole story, isn't it? She wasn't uninterested in leading. She was uninterested in the version of leading we usually offer.

We keep asking for all or nothing

Here's what I see in a lot of hospitals, especially the smaller ones. A chief, deputy chief or medical director role opens up. The job description asks for a big chunk of someone's week, indefinitely. The admin stipend is often less than what that physician makes seeing patients. And the unspoken deal is that you step away from the clinical work you trained for, take on the complaints and the budget meetings and stuff like that, and hope it works out.

Then we're surprised when the same two or three people put their hands up. Or nobody does, and the role gets handed to whoever didn't say no fast enough.

I worked with a Canadian hospital where a chief of staff role had lacked presence and visibility for a while, and physician behaviour had slipped in several areas as a result. The fix wasn't a bigger job description. It was finding the right person internally — someone who would actually address it — and supporting them properly. There are usually more of those people on your medical staff than you think. They just aren't raising their hands for the all-or-nothing version.

What a shorter ask can do

Providence says the approach has brought in physician voices it had been missing, built a deeper pool of potential leaders, and helped them match people to roles that actually fit. That last part matters to me. A six-month project is a pretty low-risk way for a physician to find out whether they like leading, and for you to find out whether they're good at it — before either of you commits to the chief of staff seat.

A few places I'd start:

Physician well-being. Not another wellness program. A physician with time and a mandate to look at what the job is actually like — scheduling, charting load, the stuff that sends people home tired.

Technology and AI. Every hospital is trying to figure out where these tools fit. You want a clinician in that room who uses them, not just a vendor. AI is a tool in the hands of people, and you need the right people holding it.

A defined project. Accreditation prep, a new clinical program, a regulatory change like the one Providence used. Clear start, clear finish, clear deliverable.

Be honest about the hard parts

Providence is upfront that the traditional obstacles haven't gone away, and I appreciated that. Before you try this, I'd get clear answers on four things:

1. Funding. Where does the money for the protected time come from, and is it secure for the full term?
2. Clinical coverage. Who picks up the shifts or the patients, and are colleagues okay with it?
3. Patient access. If a busy physician steps back two days a month, what happens to the wait list?
4. Colleague dynamics. How do you make sure peers see it as a leadership opportunity, not favouritism?

And one more from me: support them. A short-term role doesn't mean short-term development. Most physicians have never been trained to lead, and a six-month project is exactly when a little coaching and some honest feedback make the biggest difference.

One question

If you asked the physicians on your medical staff for six months instead of six years, who would say yes?

I'd bet it's a longer list than the one you have now. And somewhere on it is your next chief of staff.

Take care of the people that take care of us.

Kevin

Source: "Why Providence created temporary physician leadership roles," Becker's Hospital Review, September 3, 2026.