Director’s Corner: Succession Planning

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Time to start preparing for the future.

Dear Director,


I’ve been the chair at my site for a long time. I anticipate stepping aside in a year or two. What should I be doing now to prepare to hand over the leadership reins of the department?

Succession planning is the act of making sure we always have qualified and talented employees to keep our operation (emergency department) running successfully. Our annual recruitment cycle is the first step in succession planning—making sure we have the right docs on the team if someone leaves the group or growing staff due to volume.

The medical director needs to be evaluating their group for long-term succession planning, such as in one- to three- to five-year intervals. Who is likely to retire, and what is the time frame?  How likely is it that anyone moves?  Do you have some team members who seem especially frustrated with their job or are underperforming and may elect or be asked to seek employment elsewhere? I try hard to talk to my team and understand what’s going on, and I hate when I’m surprised by someone’s resignation.


One of the hardest yet most important things leaders can do is have a clean leadership transition plan. We need a plan for the “what if” moment that might cause us to stop working immediately (trauma, illness and all the other morbid things we can think of as ER docs) as well as covering the scenario of a planned transition.

My first mentor told me he wanted to position me so that when he left, I would be the obvious choice to fill his seat. He did this with another doc at his next hospital as well. Unfortunately, both of his protégées left and took chair jobs elsewhere. For him, it was fine as he had time to find a successor at each site. But it emphasizes the point that a leadership succession plan may involve developing several people overtime to maintain some options since the interests and priorities of those you’re developing may change over time as well.

Unless your docs are employees of the institution, leadership changes (chairs as well as hospital CEOs) are considered high-risk times for the contract, no matter your thoughts on its stability. Therefore, succession planning should be an area of focus that is regularly reviewed. Succession planning is critical for developing the talent in your group, and the process serves as a way of retaining top talent.

Intentionally transitioning a major leadership position should be thought of as a 12- to 24-month process. I’ve seen this done several times successfully. Sometimes the chair, perhaps secretly, knows they’re leaving/retiring long before they officially resign and consciously elevate their replacement’s platform. Other times I’ve seen it when the chair becomes president of the medical staff and needs to allocate some responsibility to their associate director. The key was taking the time to mentor, train and develop the replacement in both instances.


Hopefully, you have an assistant director or a doc who is already involved in hospital affairs. At the very least, you probably have someone you trust to be your “administrator on call” when you’re on vacation. We all do some sort of informal succession planning on a regular basis as we take care of department and hospital affairs. But until you have to answer to the CEO about who would take over if you were to get in a car crash and be out for three months, you may not really have put the thought in to understand all of the implications and needs.

I’ve seen vice-chairs who are great at what they do, but were not placed into the chair job when it opened. I’ve also seen docs become chairs that wouldn’t have been considered for the job earlier in their career. People grow, change, get experience and develop, so career trajectories change over time.

Developing your team

As a leader, part of our responsibility is to develop and mentor your team. That means understanding their talents and skill set — including strengths and weaknesses — and providing opportunities to learn. This may mean including docs on hospital retreats at the company or hospital conferences where the director is typically the only one from the ED invited. It may also mean encouraging or sponsoring them for formal leadership training through your organization or an entity like ACEP.

As you’re developing your docs, you should also look to be placing them onto hospital committees. Committees do two things. First, it teaches or reinforces the process and culture of the hospital. They get a firsthand look into clinical issues, policies, pathways and sometimes the hospital’s dirty laundry (M&M, Citizenship, Credentialing can be pretty routine until something crazy comes through).

As important as understanding the actual work of how committees work and the commitment they require, committees also allow for professional exposure. A doc needs to be viewed as a leader outside of the ED. It’s important to have interactions with other specialties outside of the immediate clinical area. It’s also important to have exposure to the C-suite and quality team that attend these meetings. Each of us is building our professional reputations within the hospital when we attend meetings.

There are many ways within our own department meetings to provide an opportunity for your developing leader to exhibit leadership. This might entail leading projects related to safety, throughput, or quality – or routinely handling certain topics at your department meetings. Or perhaps they handle the schedule. Either way, your providers need to have confidence in your potential replacement and see them as capable.

Transparency and Cross-Pollination

People are afraid of succession planning because they think leaders are sitting in a dark, backroom anointing future kings. Instead, make it as transparent as possible. Open it up to everyone. Ask the question and see who is interested. Everyone benefits from leadership development if they’re interested. Give your team the option to state their interest.

What happens if multiple people are interested in climbing the administrative ladder? Although there may be only one person who ultimately takes over as medical director, other opportunities may present to docs in your group across your multihospital group or within your hospital system. One of my proudest accomplishments is the number of docs I’ve mentored who have become leaders at other sites. While most of them would have done great in my job, I wasn’t ready to give it up, so they found administrative positions within our group, thus cross-pollinating the culture and style I was taught and bringing it to other sites.

What Qualities Should Future Leaders Have?

There are many qualities and traits to look for when considering our replacement as medical director.

First, we must assess their overall talent and skill set as a leader. There’s medical knowledge and clinical acumen as they must be respected as a clinician and have the skill set to give opinions that other department leaders will respect.

Next is having the ability to communicate, both in written form and in large and small meetings. Emotional intelligence is critical though it can be honed with experience and self-reflection. Before my first interview to become a chair, some of the advice I was given was to show I had a vision. I didn’t really know what that meant at the time but clearly, having some component to see where you can take the ED (and having a plan to get there) is considered an essential component for a leader. This means having the imagination to see the potential of the ED as well as the creativeness to bring innovative solutions.

I also look for how hard someone is willing to work and their development potential. There are usually some scheduling perks to being a medical director or chair. Still, generally, it’s many hours and being attached to your phone or computer in the evenings, weekends and sometimes vacations. There’s a lot to say about someone’s potential, particularly if you are planning a one- to two-year transition when so much development can occur.

My brother is not in medicine, but had to lay off part of his team early in the pandemic because his industry was hit very hard. I was really interested in his process, and one of his key factors was assessing someone’s potential growth. Developing a young superstar likely is advantageous to selecting an experienced, associate director who may not have the total skill set. The final factor in identifying your replacement is asking them if they’re ready to take on the role and responsibility. If they’re not interested or they’ve said no to other administrative jobs, it’s time to move on and look elsewhere.

You’ve identified your successor

Once you’ve identified your successor, use the time before your transition wisely. There may be additional formal training necessary. If nothing else, spend the time walking through the weeds of the job on everything from schedule formation to all of the quality metrics to OPPE and credentialing. There’s a lot to learn if one hasn’t been doing it. This is also the time to share your take on the history and politics of the institution.

Finally, since building relationships is critical for our department’s success, including your successor in as many meetings as possible with nursing leadership, recruitment, other department chairs or hospital leaders will help pass the torch.


Change is inevitable. It is best managed with preparation. The value of succession planning is that it keeps our operation intact. Although you might not start counting the days until your retirement just yet, your team and the hospital administration will thank you for planning ahead.


EXECUTIVE EDITOR Dr. Silverman is Chair of Emergency Medicine at VHC Health. He also taught a leadership development course for over a decade. Dr. Silverman’s practical wisdom is available in an easy-to-use reference guide, available on Amazon. Follow on Twitter @drmikesilverman

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