Purpose This study aims to examine how physicians construct their career paths into leadership and how institutional, professional and individual influences shape these trajectories. This study focuses on chief physicians to gain a deeper understanding of their lived experiences. Design/methodology/approach Empirical data contains semistructured interviews with 15 Finnish chief physicians. Using Polkinghorne’s narrative analysis, the authors constructed two composite career narratives and examined how career capital (knowing-how, knowing-whom and knowing-why) and contextual influences shape physician leaders’ careers. Findings Two ideal-typical narratives emerged. In the drifting narrative, physicians’ leadership emerges and develops reactively through coincidences, informal expectations or organizational necessity, with limited leadership-related knowing-why and unevenly developed knowing-how. In the bestirred agent narrative, negative leadership experiences, ethical concerns and a desire to repair dysfunctional environments motivate physicians to pursue leadership proactively, supported by deliberate development of leadership skills and networks. Originality/value This study offers a narrative explanation of how agency and context interact in physician leadership careers and demonstrates how different configurations of career capital can lead to various pathways into leadership. This study also makes a methodological contribution: using a narrative approach to explore the lived experiences of physician leaders’ careers is a rare method in the field. In addition, the findings provide practical insights for designing leadership development and support structures that accommodate the diverse ways physicians come to lead.
Huikko-Tarvainen et al. (Tue,) studied this question.