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This study seeks to improve the understanding of physician leaders' leadership work challenges.

The subjects of the empirical study were physician leaders (n = 23) in the largest central hospital in Finland.

A total of five largely identity-related, partially paradoxical dilemmas appeared regarding why working as “just a leader” is challenging for physician leaders. First, the dilemma of identity ambiguity between being a physician and a leader. Second, the dilemma of balancing the expected commitment to clinical patient work by various stakeholders and that of physician leadership work. Third, the dilemma of being able to compensate for leadership skill shortcomings by excelling in clinical skills, encouraging physician leaders to commit to patient work. Fourth, the dilemma of “medic discourse”, that is, downplaying leadership work as “non-patient work”, making it inferior to patient work. Fifth, the dilemma of a perceived ethical obligation to commit to patient work even if the physician leadership work would be a full-time job. The first two issues support the findings of earlier research, while the remaining three emerging from the authors’ analysis are novel.

The authors list some of the practical implications that follow from this study and which could help solve some of the challenges.

This study explores physician leaders' leadership work challenges using authentic physician leader data in a context where no prior empirical research has been carried out.

This research paper aims to discover the elements of good physician leadership as perceived by physicians and to find out how the findings connect to the leadership theory.

The subjects (n = 50) of this qualitative study are physicians from four hierarchical levels (residents/specialising physicians, specialists, heads of departments and chief physicians). Content analysis with a constructivist-interpretative approach by thematisation was the chosen method, and it was also analysed how major leadership theories relate to good physician leadership.

Physician leaders are expected to possess the professional skills of physicians, understand how the work affects physicians’ lives and be competent in applying suitable leadership approaches following different situations and people. Trust, fairness, empathy, social skills, two-way communication skills, regular feedback, collegial respect and emotional intelligence are expected. As medical expertise connects leaders and followers, success in medical leadership comes from credibility in medical expertise, making medical leadership an inseparable part of good physician leadership. Subordinates are physician colleagues, who have their informal leadership roles on their hierarchical levels, making physician leadership a multidimensional leadership setting wherein formal leaders lead informal leaders, which blurs the traditional leader–follower boundary. In summary, good physician leadership is leadership through medical expertise combined with good manners, collegiality and traits from different kinds of leadership theories.

This study discovers elements of good physician leadership in a Finnish health-care context in which no similar prior empirical research has been carried out.