By the time most clinicians are formally promoted into leadership, the moment for the most useful kind of preparation has already passed. This is one of the quieter inefficiencies in how healthcare organizations build their leadership pipelines. Development is typically triggered by the promotion itself, arriving after the responsibility has already landed, when what is actually needed is preparation that begins well before the title changes.
The logic behind waiting is understandable. Leadership development takes time and organizational resources, and it can feel premature to invest in someone who has not yet been formally selected for a leadership role. But this logic assumes leadership readiness is something that can be switched on at the moment of promotion, rather than something that is built gradually, through structured exposure, reflection, and practice, well before the responsibility formally arrives. By the time an organization is investing in a newly promoted leader, that leader is often already managing a team, absorbing a new set of expectations, and learning the fundamentals of leadership in real time, under pressure, in full view of the people they are now meant to be leading.
This is a difficult way to learn almost anything, and leadership is no exception. Clinical training would never accept this sequence. No one is handed responsibility for complex patient care and then given the foundational training afterward, as a kind of remedial support once problems emerge. Yet this is precisely the sequence healthcare frequently applies to leadership: promote first, prepare second, often only once the strain of the gap has become visible enough to warrant intervention.
Developing physician leaders before the promotion requires identifying leadership potential earlier and more deliberately than most organizations currently do. This does not mean formally designating people as future leaders in a way that creates unhealthy competition or resentment. It means building structures, mentorship relationships, exposure to leadership responsibilities in low stakes settings, coaching relationships that begin as a professional development offering rather than a remedial one, so that clinicians with leadership inclination or potential have somewhere to develop that capacity before it is urgently needed.
There is a particular value in low stakes exposure to leadership before the formal role arrives. A clinician who has had the chance to lead a project, chair a committee, or mentor junior colleagues while still primarily practicing clinically has already begun forming a leadership identity, in a setting where mistakes are lower cost and feedback is easier to absorb. When that same person is eventually promoted into a formal leadership role, they are not starting the identity work from zero. They are extending and formalizing something they have already begun practicing.
Coaching plays a specific and underused role here. Much of the coaching offered in healthcare organizations is positioned as support for leaders already struggling in role, which is valuable, but arrives late. Coaching offered earlier, to clinicians who show leadership inclination well before any formal transition, does something different. It creates space to explore what leadership might actually require of this specific person, given their particular strengths and blind spots, without the pressure of an already-assigned title and an already-watching team. This earlier coaching tends to produce leaders who step into formal roles with more self-awareness and less identity disorientation than those whose first real leadership reflection happens only after the promotion has already occurred.
There is also an organizational benefit that is easy to underestimate. When leadership development happens only after promotion, organizations are effectively gambling on each individual promotion working out, because there was limited prior evidence of how that person actually handles leadership responsibility. When leadership development happens before promotion, organizations gain much better information. They can observe, over time and in real situations, who is developing genuine leadership capability, who needs more support before taking on formal responsibility, and who may be excellent clinically without yet being ready for the relational and organizational demands of formal leadership. This is a far more reliable basis for promotion decisions than credentials or tenure alone.
Building this earlier pipeline requires healthcare organizations to treat leadership development as an ongoing investment in their clinical workforce broadly, not a benefit reserved for those who have already been selected into formal leadership roles. It requires structured pathways, deliberate mentorship, and coaching that begins based on potential rather than title. It requires, in short, treating leadership readiness the way healthcare already treats clinical readiness: as something built over years through deliberate preparation, not something that should be expected to appear fully formed the moment a promotion is announced.
The organizations that get this right will not necessarily promote more people. They will promote people who are considerably more prepared, because the preparation began long before the moment anyone needed it to.