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The purpose of this paper is to seek clarity on the factors that increase acceptance of a leadership identity and influence a physician leader to participate in the leader role at a higher level.

To explore the direct and mediating effects of positive psychological climate (PPC) and role endorsement (RE) on physician professional participation (PP) in leadership, a survey was disseminated to members of the American Association of Physician Leadership.

Findings show that positive relationships support the individual in acceptance of a second identity as a leader, therefore, to a higher level of PP. The double mediation with PPC and RE found in this model warrants additional meaning toward the cultivation of positive relationships.

A broader understanding of physician leadership may benefit from a more comprehensive collection procedure other than self-reported data, including one in which data is collected in a 360-degree feedback format.

Role endorsement serves as a mediating mechanism to PP (citizenship behaviors) for both PPC and social intelligence competencies. These data indicate that the presence of role endorsement for physicians changes their degree of participation and impacts their own role identity. This immediately helps to direct development efforts for physicians during their transition from physician to physician leader.

This study confirms the mediating relationship of REupon the PP of physician leaders, with both implications for practice and a broader understanding of the nature of physician leadership.

Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues.

Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory.

These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis.

Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale.

These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role.

This work points to a broader and more fundamental need – a modified mindset about the nature and value of physician leadership.

This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer and organizational level in the creation of their own leadership identity.