June 24, 2025. Sonum Tharwani.

Would we ask a chef to manage a bustling restaurant without business training? Or expect a pilot to lead an airline without management experience? Of course not. Yet, every day, physicians are expected to navigate complex healthcare systems, manage teams, and make decisions that ripple across patient care and organizational success—all without formal leadership training.

This gap in preparation isn’t just theoretical; I’ve seen it firsthand as an MD/MBA candidate. During my research, I interviewed healthcare executives across North Carolina—MDs, MBAs, and dual-degree professionals—and a common theme emerged: most physicians are thrust into leadership roles unprepared.

It’s important to recognize that every physician, regardless of formal title, is a leader. Whether coordinating a patient’s treatment plan, mentoring medical students, or managing a small clinic, physicians lead in ways that directly affect patient care and team dynamics. Leadership isn’t confined to administrative roles; it’s embedded in daily practice. Yet, without training, doctors often struggle to balance these responsibilities, leaving gaps that could be addressed with even basic leadership education.

One executive described the challenge bluntly: “We ask doctors to learn to be CEOs while they’re still learning to be physicians. It’s like flying the plane while building it.” Physicians are trained to diagnose diseases and treat patients, but when asked to navigate insurance systems, lead quality improvement initiatives, or drive organizational change, many are left floundering.

The effects of this knowledge gap ripple through healthcare systems. Projects stall because clinicians lack management skills. Teams struggle under leaders who have never been taught how to lead. Worse, the frustration of navigating a healthcare system they don’t fully understand can leave physicians burned out and disengaged.

Healthcare today is more complex than ever. Beyond clinical expertise, physicians are expected to:

• Navigate intricate insurance and payment models.
• Lead interdisciplinary teams.
• Drive operational efficiency and quality improvement.
• Manage resources amid rising costs and staffing challenges.

Yet these skills are treated as afterthoughts in most medical schools. A surgeon might spend thousands of hours perfecting technical skills but receive no formal training in team leadership, despite leading surgical teams daily. A primary care physician might oversee a practice with no background in financial management. The disconnect affects not just physicians but patients, who rely on well-coordinated care.

Some institutions are beginning to address these challenges by integrating leadership principles into medical education. For example, some schools embed healthcare delivery science into the curriculum, while others incorporate leadership development and project management training. These innovative approaches are promising but remain the exception rather than the rule.

The solution isn’t adding more years to medical school—it’s about embedding leadership training into the existing framework in practical and meaningful ways:

• Integrated Curriculum Modules: Invite healthcare administrators, financial experts, and operational leaders to teach sessions on healthcare economics, systems thinking, and project management during preclinical years.
• Team-Based Leadership Projects: Include team exercises where students tackle case-based scenarios involving resource allocation, quality improvement, or patient advocacy, helping them develop collaborative and strategic thinking.
• Real-World Exposure: Partner with hospital departments to let students observe leadership in action during quality improvement rounds or interdisciplinary meetings, providing insights into operational dynamics.
• Residency Leadership Tracks: Offer dedicated tracks within residency programs focused on quality improvement, change management, and healthcare operations, allowing physicians to practice these skills in real-world settings.

These changes don’t require overhauling the entire system but could provide physicians with tools to lead effectively, advocate for patients, and manage teams.
Critics might argue that physicians should focus solely on clinical care, leaving system management to administrators. But the most effective healthcare organizations are led by those who understand both the clinical and operational sides of medicine. As one executive told me, “The best healthcare leaders can bridge the gap between the bedside and the boardroom.”

The future of healthcare demands physicians who are not just skilled clinicians but also capable leaders. By integrating leadership training into medical education, we can prepare doctors to excel not just in patient care but in transforming the healthcare system itself. Medical schools and residency programs have a choice: continue to let physicians learn leadership through trial and error or equip them with the skills to lead from day one. The time to act is now. Patients, and the healthcare system at large, can’t afford to wait.

Sonum Tharwani, MD/MBA

2024-25 NC Schweitzer Fellow

UNC School of Medicine and UNC Kenan-Flagler Business School, Class of 2025