Every time a medical organization (provincial or national) changes leaders, we tell ourselves that this time will be different. This time they’ll get it. They’ll navigate politics without being consumed by them, inspire their colleagues and move the needle on our most urgent problems. And yet, the same patterns keep repeating.
We’ve had leaders who treated the role like a farewell tour – delivering ceremonial speeches while urgent policy files gathered dust. We’ve had leaders so steeped in academic prestige that they mistook governance for scholarship, spending hours refining position papers while ignoring the messy business of building coalitions or fixing key core business competencies.
One leader from a renowned academic institution – brilliant clinician, decorated researcher – could not run a focused meeting. Agendas sprawled, decisions drifted and strategic priorities stalled. Their organization’s prestige opened doors, but inside those rooms, nothing happened.
Another leader with an arm’s length of honorary degrees filled the calendar with events and photo ops. The press releases were flawless; the outcomes flaw filled.
These aren’t failures of character. They’re failures of preparation – predictable when we choose leaders for where they trained, what province they’re from or which specialty they represent rather than the competencies that the job actually demands.
Instead, think of the physician who recently took on a national role after years serving on many non-profit boards, armed with true governance credentials like an ICD.D or C.Dir designation. Education and experience together. They could run a board meeting efficiently, cut through the noise and hold the organization accountable to results. Within two years, they launched a three-year strategy, secured millions in funding for innovation and published a public dashboard so members could track progress themselves.
Or the community-based physician – not an academic star, but a seasoned board chair from the co-op sector – who, when crisis struck, calmly activated a plan, kept the board locked on decisions and communicated with such clarity that trust in the organization grew during the storm.
Neither fit the traditional “prestige” profile. Both delivered.
What we have is a competency problem, not a representational problem.
The CMAJ and Canadian Family Physician remind us that system-level change requires leaders who grasp the complexity of policy, funding, workforce and care delivery.
Harvard Business Review tells us the most valuable competencies are universal — strategic clarity, communication, adaptability, trust-building.
When those skills are absent, we all pay the price. We’ve watched national bodies freeze in crisis because leaders couldn’t decide – or couldn’t explain a decision in a way members would follow. We’ve watched bold reforms collapse because no one could build a coalition big enough to pass them.
If we want our national medical organizations to shape health care – not just react to it – we need leaders who can:
- Think in systems: understand the ripple effects of every policy change.
- Prioritize without apology: protect a few strategic goals from political drift.
- Communicate with influence: turn evidence into stories that move people.
- Build safe cultures: treat dissent as a strength, not a threat.
- Adapt under pressure: make decisions in uncertainty and still carry the room.
A weak communicator can sink a year of advocacy in one interview. A conflict-averse leader can let destructive compromises slide into policy. A leader without governance skills can get lost in ceremony while the system burns. We’ve seen it. We’ve lived it. We can’t keep doing it.
Next time we choose a leader for a high-profile medical organization, we must start with one question: What will it actually take to lead this organization where it needs to go?
And we must answer with competencies, not categories – including proven governance experience, and yes, ICD.D-level or C.Dir training when possible.
Governance is not ceremony. Advocacy is not just a statement. Leadership is not just holding the title – it’s delivering the change physician members expect. And the public expects.
Canada’s health-care system is at a crossroads. We can’t afford another cycle of polite disappointment. It’s time to choose leaders who can see the whole system, act decisively and bring us together in service of something bigger than ourselves.
A competency framework for national medical leadership
- Strategic Systems Leadership
Purpose: Drive long-term change in a complex, multi-jurisdictional health environment.
Key Behaviours:
- Maps system interdependencies (policy, funding, workforce, patient flow) before acting.
- Identifies three-five strategic priorities and protects them from drift.
- Anticipates unintended consequences of decisions.
Past accomplishments:
- Led multi-stakeholder initiatives to measurable outcomes.
- Demonstrated ability to simplify complexity for decision-makers.
- People & Culture Leadership
Purpose: Build trust, foster psychological safety and unify diverse voices
Key Behaviours:
- Communicates with clarity across governments, clinicians and the public.
- Invites and values dissent; resolves conflict constructively.
- Mentors emerging leaders, builds bench strength. It is not about them.
Past accomplishments:
- Track record of retaining high-performing teams.
- Examples of collaborative wins across jurisdictions or disciplines.
- Evidence & Improvement Leadership
Purpose: Ensure decisions are grounded in data and drive measurable improvement.
Key Behaviours:
- Comfortable and responsive with performance metrics, equity indicators and financial data. Even if data is not supportive of decisions.
- Turns measurement into improvement – not punishment.
- Champions evidence-based policy and program design.
Past accomplishments:
- Created or used dashboards, scorecards or evaluations to improve outcomes.
- Sunsetted legacy programs when evidence warranted.
- Public Impact Leadership
Purpose: Represent the profession and patients with credibility and influence.
Key Behaviours:
- Negotiates effectively with stakeholders while preserving relationships.
- Articulates the “why” in a way that inspires action.
- Upholds ethical standards and public accountability.
Past accomplishments:
- Policy wins or funding secured through negotiation.
- Public trust maintained or increased during controversy.
Preferred Qualifications
- Proven board governance experiences in a complex organization.
- ICD.D designation (or equivalent) credential.
- Demonstrated results in environments requiring cross-sector collaboration.
Selection Red Flags (Indicators the candidate may lack readiness)
- Emphasis on ceremonial roles or academic prestige without governance outcomes.
- Inability to describe past failures and learning from them.
- No evidence of leading through uncertainty or crisis.
Bottom line: Choose leaders for what they can do, not where they come from (especially academic, research or geographic).
The right competencies will carry the profession – and the health system – forward.
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Previously Published on healthydebate.ca with Creative Commons License
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