Read Time: 12–15 minutes
Summary: What separates physician leaders who thrive at the executive level from those who struggle? Joe Mazzenga, Managing Partner at NuBrick Partners, shares 30 years of insight on the mindset shifts, unlearning moments, emotional intelligence breakthroughs, and coaching frameworks that turn good physicians into great healthcare executives.
In a candid conversation on The Fire Chief – The Chief Medical Officer Podcast, hosted by Dr. Lee Scheinbart, Joe Mazzenga, Managing Partner at NuBrick Partners, pulled back the curtain on what it truly takes for physicians to succeed in executive leadership. Drawing on more than three decades of experience working with CMOs, C-Suite leaders, and high-performing healthcare teams, Joe brings a perspective that is equal parts science, applied insight, and a message that may surprise even the most accomplished physician leaders: Clinical excellence is the price of admission, but doesn’t ensure your success as an enterprise executive leader. It’s the ticket in the door, but it won’t carry you to the top.
Why Clinical Excellence Isn’t Enough
For many physicians on the path to executive leadership, the assumption feels almost self-evident: decades of clinical excellence, expertise, and a reputation built in the trenches of healthcare should be more than enough to earn a seat at the C-Suite table. Joe Mazzenga has watched that assumption play out hundreds of times, and the reality, he’ll tell you, is far more complicated.
The physician’s identity is one of the most deeply formed professional identities in existence. It’s built over 14 to 16 years of relentless education, training, and clinical experience, and it centers on a single, powerful role: “The Expert.” The one who knows. The one who decides. The one who is trusted, above all else, is to get it right.
Stepping into an executive role doesn’t erase that identity. It demands an entirely new one to be built alongside it. And this is where most physicians underestimate the challenge.
The gap isn’t about intelligence or commitment; it’s structural. Healthcare systems have never invested in preparing their best clinicians for the leadership roles they eventually step into. As Joe points out, a frontline supervisor at Walmart receives more formal training in team building, change management, and conflict resolution than most physicians will ever see before taking on a C-Suite role.
Why Enterprise Leadership Requires a Mindset Shift
One of the most vivid ways Joe illustrates the leap from clinical to executive leadership is through the image of an aircraft carrier. On a ship of that size, there are two very different places to stand: the deck, where the action happens, and the bridge, which sits thirteen stories above it. Each view is unrecognizable from the other.
The physician is rarely explicitly told that the rules of the game have changed. The organizational assumption is that brilliance transfers. If you are exceptional in the OR, you’ll figure out the enterprise executive leadership role. In Joe’s experience, that assumption quietly derails more physician leaders than any other single factor.
The Three Behaviors That Separate Those Who Thrive from Those Who Struggle
When Joe looks at physician leaders who successfully make the transition to enterprise leadership, three behaviors consistently set them apart, none of which appear in a medical school curriculum.
1. Curiosity and the Willingness to Actually Listen
Physicians are trained to be curious, but clinical curiosity and executive curiosity look very different. In the exam room, curiosity drives rapid synthesis, gathering information quickly, arriving at a differential diagnosis, and taking action. At the enterprise level, curiosity requires something harder: slowing down, staying with the question longer, and listening deeply before concluding.
Research shows that the average physician interrupts a patient’s story within 9 to 14 seconds. That instinct, born of years of efficient clinical practice, becomes a liability in leadership conversations where people need to feel heard before they engage. The executives who earn trust fastest are the ones who resist the urge to solve before they’ve fully listened.
2. Informing the Most Underused Leadership Skill
One of the most consistent blind spots Joe encounters in physician leaders is the failure to communicate proactively. In clinical practice, physicians are trained to synthesize, document, and move on. Sharing information laterally, looping in the cardiologist, and updating the neurologist occur only when clinically necessary, not as a default habit.
Carried into an enterprise setting, that same pattern creates silos. Decisions are made without the right people being informed. Initiatives stall because key stakeholders weren’t brought along. The simple discipline of asking “who needs to know what I just learned?” and then acting on the answer is one of the highest leverage habits a new physician executive can build.
3. Speaking Up Once Psychological Safety Is Established
The third behavior is about voice, but the order matters enormously. Leaders who speak first and listen second inadvertently close down the rooms they need to open. The physician executives who build the most effective teams are those who first establish curiosity and psychological safety, then use their voice to add weight and direction once others feel genuinely included.
Unlearning Is Key When Your Greatest Strengths Become Liabilities
Perhaps the most counterintuitive insight Joe shares is that the habits most likely to hold a physician executive back aren’t weaknesses; they are strengths. They are deeply ingrained behaviors that worked brilliantly in a clinical context and now quietly undermine leadership effectiveness in an executive environment.
The Poker Face Problem
From the earliest days of clinical training, physicians learn to maintain composure at the bedside. A flat, neutral expression is a professional skill; it prevents panic, projects calm, and creates the atmosphere of safety that patients need. After thousands of patient encounters, this becomes completely unconscious.
In an executive meeting, however, that same neutrality reads very differently. Colleagues and direct reports are trying to read the room, gauge reactions, and understand whether their ideas are landing. A leader whose face reveals nothing creates anxiety rather than calm, often without realizing it.
The Lone Expert Identity
Medicine trains physicians to be the authority in the room. The Attending often has the final word. The surgeon is the captain of the OR. That model is appropriate, even necessary, in clinical settings. But it doesn’t scale to enterprise leadership, where success depends on operating simultaneously as a peer, a collaborator, and a team builder and toggling across many styles of leadership to be effective.
At the executive level, every leader sits on two teams at once: the team they lead and the team of their peers. Learning to navigate both leading and following, to be the expert and the student, is a rewiring that takes time, intention, and often outside support.
What Physician Executive Coaching Looks Like in Practice
For physicians entering or newly appointed to a CMO role, the idea of executive coaching can feel abstract. Joe calls his approach contextual coaching development anchored in the leader’s actual environment, real-time challenges, and organizational culture, rather than generic leadership theory. In practice, it’s far more systemic and far more practical than most people expect.
Phase 1: Pre-Coaching Alignment – Before the first session, the coach connects with the physician’s sponsor or manager to understand what success looks like in this role, where the leader’s strengths lie, and where intentional development could have the greatest impact. This alignment is foundational, ensuring that the coaching work is tied to real organizational goals rather than just personal development in the abstract.
Phase 2: Building the Foundation – Early sessions focus on building the relationship and understanding the leader’s why, what drives them, what they’re navigating, and what they find most challenging in the role. A personality assessment is introduced early to surface emotional intelligence, values, and derailers: the behaviors that tend to emerge under stress and quietly undermine effectiveness.
Phase 3: Contextual Observation – This is where contextual coaching becomes most visible. Joe describes sitting in on real leadership moments, team meetings, and difficult conversations to observe firsthand the kind of atmosphere the leader creates. No one creates the weather in a room like a leader, and most leaders have no idea what weather they’re actually generating. All leaders need to be reminded that they are the thermostat in the room, the environment, or the culture, lowering and raising the temperature.
Phase 4: 360-Degree Feedback – A small group of colleagues, direct reports, and peers is asked for a focused set of questions: What would make this leader even more effective? What should they start, stop, and continue? What are these leaders’ highest and best use? The feedback is synthesized into a development plan that drives the remainder of the engagement, typically two coaching sessions per month over a 6 to 12-month journey.
The result, when it works well, reaches far beyond the office. Joe recalls a CEO approaching him after a holiday party to share that a recently coached CMO’s wife had sought him out specifically to say that the coaching had changed their marriage.
Becoming Bilingual: What CEOs Actually Need from Their CMO
The relationship between a CMO and a CEO is one of the most consequential dynamics in any healthcare system and one of the most frequently misunderstood. Many physician executives enter the role of thinking primarily as a clinical leadership position. The most effective ones come to understand it as something more nuanced: a translation role.
CEOs and physicians speak fundamentally different professional languages. CEOs think in terms of strategy, financial performance, market position, and organizational culture. Physicians think in terms of clinical outcomes, patient safety, and medical staff dynamics. When those two worlds don’t connect, the health system pays the price in culture, in performance, and ultimately in the quality of care delivered.
The CMO who becomes indispensable is the one who learns to operate fluently in both worlds. That means understanding what keeps the CEO up at night, not just clinically, but strategically and financially. It means framing solutions in the language of the enterprise, not just the language of medicine. And it means knowing when to push, when to listen, and when the most valuable thing a CMO can offer is not an answer, but a better question.
The Four Pillars of the EQ Framework That Every Aspiring CMO Should Know
If there is a single theme that runs through everything Joe Mazzenga has observed over thirty years of working with physician executives, it’s this: emotional intelligence is the determining factor. More than credentials. More than clinical experience. More than advanced degrees or years of leadership titles.
Emotional intelligence, or EQ, is not a soft skill. It’s a set of highly learnable, highly practical competencies that determine how effectively a leader reads situations, influences people, manages themselves under pressure, and builds the kind of trust that makes teams perform at their best. Joe describes it through four foundational pillars:
- Self-Awareness: The starting point for everything else. It is the holy grail of the EQ construct. A leader who doesn’t understand their own tendencies, triggers, and blind spots cannot effectively manage any of the rest. As Joe puts it, if you don’t get to first base, you’re never getting home.
- Self-Management: The ability to regulate your own reactions, especially in high-stakes or high-conflict moments. This is the difference between a leader who de-escalates a tense situation and one who, without realizing it, pours fuel on it.
- Social Awareness: Reading the room and understanding what others are experiencing, what they need, and how to adjust your approach to build connection rather than distance.
- Relationship Management: The full expression of EQ in action: building teams, coaching people, sustaining influence across an organization, and bringing genuine optimism and energy to difficult work.
The good news is that EQ can be developed. It is not a personality trait you either have or don’t; it grows through coaching, intentional feedback, and the kind of honest self-reflection that most high-performing physicians have never been formally asked to do.
Why Feedback Is the Most Underutilized Leadership Tool
Joe closes with a challenge that is both simple and, for most physicians, genuinely difficult: seek feedback. Not the polished, diplomatic kind. The real kind is the last ten percent that people hold back because they’re not sure how it will be received.
Most physician leaders have spent their careers in environments where feedback flows in one direction. They evaluate, they assess, they direct. The idea of actively inviting others, especially peers and direct reports, to evaluate them runs counter to deeply ingrained professional habits. But, in Joe’s experience, it’s one of the most powerful accelerated executive growth available.
The leaders who break through are not the ones who never make mistakes. They are the ones who have built the self-awareness and relational trust to hear hard things, sit with them, and act on them without defensiveness or deflection, with a genuine commitment to becoming a better version of themselves. As Joe puts it, the only appropriate response to honest feedback is two words. Thank you.
Key Takeaways for Aspiring CMOs
1. Clinical credibility opens the door; EQ keeps you in the room. Most physicians assume that years of clinical experience will naturally lead to executive success. It won’t; at least not alone. The skills that make a great physician and the skills that make a great executive leader are fundamentally different. The ones who thrive long-term invest as seriously in emotional intelligence and relational/leadership skills as they did in clinical expertise.
2. Enterprise leadership demands a broader vantage point. As a clinician, your focus is deep and narrow: mastering your specialty. As an executive, your job is to see across the entire organization and lead people far outside your area of expertise. That shift in perspective doesn’t happen automatically. Start building the habit of thinking at the enterprise level before you step into the role.
3. Identify what you need to unlearn. The habits that made you an exceptional physician, staying emotionally neutral, being the lone decision-maker, and solving problems fast, can quietly work against you in the executive suite. The most self-aware physician leaders are the ones who identify these patterns early and intentionally rewire them for leadership.
4. Seek feedback like your career depends on it, because it does. Most physicians spend their careers evaluating others rather than being evaluated themselves. Actively and consistently inviting honest feedback, especially the uncomfortable kind, is one of the most powerful accelerants of executive growth. Build a culture around you where people feel safe telling you the truth.
5. Seek contextual coaching, not generic leadership advice. Not all executive coaching is created equal. A coach who understands physician culture, healthcare systems, and enterprise dynamics will get to work immediately. One who doesn’t will spend your time and your organization’s investment on orientation rather than development.
The Bottom Line
Joe Mazzenga has spent 30 years observing physicians step into executive roles, some of whom soar and others who struggle. The difference, in his experience, is rarely about intelligence, credentials, or clinical track record.
It comes down to this: Are you willing to take off the hat that got you here? Are you curious enough to listen before you speak? Are you humble enough to ask for the last ten percent? Can you be curious and vulnerable and acknowledge what you don’t know? Ultimately, the axiom rings true in most instances: “What got you here won’t get you there.”
The transition from physician to enterprise leader is one of the most demanding identity shifts in professional life. It doesn’t happen by accident, and it doesn’t happen in isolation. But for those willing to do the work with the right support, the right framework, and the right people in their corner, it’s entirely within reach.
Interested in leadership development support for your physician executives? Learn more about NuBrick Partners’ executive coaching and leadership development programs at NubrickPartners.com. To explore how Furst Group and NuBrick Partners’ integrated SuccessPath model supports CMO recruitment and transition, visit FurstGroup.com.
Frequently Asked Questions
Q: What is the biggest mistake physicians make when transitioning into a CMO role?
A: The most common mistake is assuming that the confidence and competence built over a clinical career will transfer automatically to executive leadership. The skills required to lead at the enterprise level, managing up, building team culture, navigating organizational dynamics, and sustaining influence across functions are largely distinct from clinical expertise and require intentional development.
Q: How long does it typically take a physician to transition effectively into a CMO role?
A: There is no universal timeline, but most structured coaching engagements for new physician executives span six to twelve months. The first 90 days are particularly critical, and organizations that invest in structured onboarding and coaching support during this window see significantly better outcomes than those that expect leaders to figure it out on their own.
Q: What is contextual coaching, and why does it matter for physician executives?
A: Contextual coaching is a development approach grounded in the leader’s actual environment, their team dynamics, organizational culture, real-time challenges, and stakeholder relationships. For physician leaders, it’s particularly valuable because it reduces the time spent explaining healthcare context to a coach who lacks that background, allowing the work to focus on development rather than orientation.
Q: What is the role of emotional intelligence in CMO success?
A: Emotional intelligence, comprising self-awareness, self-management, social awareness, and relationship management, is consistently identified as the primary differentiator between physician executives who thrive and those who struggle. It can be developed through coaching, intentional feedback, and structured practice. It’s not fixed, and it’s not destiny.
Q: How do Furst Group and NuBrick Partners support physician executive transitions together?
A: Through their integrated SuccessPath model, Furst Group identifies and recruits top physician executives, while NuBrick Partners provides leadership assessment, coaching, and development support from the search process through the first six months in the role. This end-to-end model is designed to accelerate transition success and reduce the risk of early executive derailment.
To learn more about Joe Mazzenga and the NuBrick Partners team, visit NubrickPartners.com. Follow Furst Group and NuBrick Partners on LinkedIn.
