Training rewards the opposite skill
Medical education selects for individual performance under evaluation. It rewards being the person with the answer. Leadership requires being the person who makes it safe for someone else to have the answer, which is a different instinct entirely.
The first months in a leadership role are uncomfortable for exactly this reason. The behavior that earned the position is not the behavior that succeeds in it.
Authority you actually have
New physician leaders often overestimate their positional authority and underestimate their convening authority. You may not control compensation or staffing, but you can decide what gets discussed, in what order, and with whom in the room.
Use it deliberately. A standing thirty-minute meeting with one metric, one problem, named owners, and five minutes for anything unsafe will change a department faster than a reorganization.
Feedback between equals
Peer feedback fails when it arrives late and general. It works when it is specific and prompt: describe the observable behavior, then its effect, then the request. Three sentences, within forty-eight hours.
Delay converts feedback into grievance. If you have missed the window, let it go and catch the next instance. Saving up examples for a review conversation reads as a case being built, and people respond accordingly.
The loneliness is structural
You will hear less. Colleagues filter what they tell someone who participates in evaluation decisions, and that filtering is rational, not personal. The fix is not to insist on being treated as a peer; it is to build other channels — skip-level conversations, anonymous input, and a peer group outside your own department.
Find two other physician leaders at similar stages and meet monthly. Most of what is hard about the role is not confidential, and almost none of it is unique.
Key takeaways
- Convening authority — what gets discussed and by whom — is usually stronger than positional authority.
- Deliver peer feedback within 48 hours, in behavior-effect-request form, or let it go.
- Build deliberate channels for information you will no longer receive informally.
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How to cite
Vejayan PD. Leading Peers You Were Trained to Compete With. On The Beat MD. Published July 29, 2026. Available at: https://www.onthebeatmd.com/insights/leading-peers-you-competed-with
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This material is educational and is not medical, legal, or financial advice. It does not create a physician-patient or attorney-client relationship.
© 2026 Priya D. Vejayan. All Rights Reserved. Except as permitted by applicable copyright law, reproduction, distribution, or commercial use of original content requires written permission.