From Practice to Purpose: Cultivating Leadership in Psychiatry

In the ever-changing field of health care, effective leadership remains a critical factor in organizational success and patient safety. While often used interchangeably, leadership and management represent distinct roles within health care systems. Management typically involves directing processes and maintaining order to achieve specific goals, while leadership focuses on influence, motivation, and personal impact. As John C. Maxwell states, “Leadership is not about titles, positions or flowcharts. It is about one life influencing another.” This view aligns closely with the interpersonal nature of health care, where leadership is measured not just by formal authority, but by the ability to inspire and guide others.

While the roles are different, both leadership and management are essential to sustaining complex health care organizations. According to John Paul Kotter, DBA,¹ effective management involves coping with complexity, ensuring systems function efficiently, allocating resources appropriately, and maintaining order. Leadership, by contrast, involves coping with change, a task that has become increasingly vital in the volatile and competitive health care landscape of today. For instance, during times of crisis such as the COVID-19 pandemic, health care systems depended not just on clear protocols and resource allocation, but on leaders who could motivate exhausted teams, communicate with transparency, and remain flexible in the face of uncertainty. This capacity to lead through disruption separates leadership from routine managerial duties.

Importance of Leadership in Psychiatry

Health care is increasingly shifting from a physician-centered to a team-based, patient-centered model. Psychiatrists must adapt to leadership roles that require collaboration, shared decision-making, and an openness to new approaches. Leadership in psychiatry involves aligning teams, organizations, and communities around shared goals, while balancing clinical priorities with systemic needs. During the rollout of electronic health records, for instance, resistance often stemmed from disruptions to workflow. Successful leaders listened to concerns, provided training, linked changes to improved patient outcomes, and fostered trust through empathy and communication.²

Motivating psychiatrists can be uniquely challenging since many are not formally employed by the organizations where they practice and often prioritize patient care over organizational loyalty. Effective leadership taps into intrinsic motivators such as purpose, respect, peer recognition, and professional standards, alongside extrinsic motivators like performance-based financial incentives. When physicians believe in the meaningfulness of a change, even small incentives can motivate them; however, if they doubt its value, no amount of financial reward will guarantee success.

Leadership Skills

No two leaders are the same, and effective leadership often requires adapting one’s style to the situation. However, as Daniel Goleman, PhD, emphasizes, emotional intelligence remains essential across all contexts. While technical and cognitive abilities may qualify someone for a leadership position, Goleman calls these “threshold capabilities”: necessary, but not what sets great leaders apart. Emotional intelligence includes 5 key components: self-awareness, self-regulation, motivation, empathy, and social skills.³ These qualities help leaders communicate authentically, build trust, and foster collaboration. This is similar to the behaviors Paulette Ashlin, MA, identifies in her book, Leading: The Way, that are essential in distinguishing outstanding leaders. These are integrity, humility, self-control, and moral vigilance to prevent “moral licensing,” or, essentially, allowing previous good deeds to justify future poor choices.⁴

Self-aware leaders understand their emotions and limitations, seek feedback, and know when to delegate or take calculated risks. Those with strong self-regulation act with composure rather than impulse, building trust and modeling adaptability during change. Motivation drives leaders to aim beyond expectations, guided by internal drive and purpose rather than external rewards.³ Meanwhile, empathy, increasingly vital in collaborative and global health care environments, allows leaders to recognize and respond to the emotional needs of others, an essential skill in psychiatry and team-based care. It fosters stronger communication, trust, and retention, especially when teams are diverse or under pressure. Social skills, often misunderstood as simple friendliness, is the ability to build rapport, manage relationships, and influence others in constructive ways. It reflects the culmination of all emotional intelligence domains.³ Leaders with strong social skills can inspire teams, handle conflict diplomatically, and move people toward shared goals.

As Goleman notes, emotional intelligence enables leaders to connect authentically and communicate effectively, laying out the foundation for sustainable leadership.³ In line with this, Kotter highlights the importance of articulating a shared vision, involving others in shaping how it is achieved, and reinforcing it through coaching and recognition. Ultimately, successful organizations create leadership opportunities across the hierarchy, spreading responsibility, and empowering more individuals to lead through change.¹

Preparing for Leadership: Pathways and Growth for Early-Career Psychiatrists

In the United States military, leadership training begins on day 1, and all members are expected to develop these skills. In health care, preparation should similarly start early, combining formal education with exposure to real leadership challenges.⁵ For early-career psychiatrists, the path to leadership begins with purposeful networking, targeted mentorship, and careful selection of initial leadership roles. Finding a mentor is often the most important first step. This involves identifying respected senior colleagues who demonstrate both professional excellence and the behavioral traits outlined by Ashlin: integrity, humility, and self-control.⁴ Approaching potential mentors can be as simple as expressing interest in their work, seeking advice on a clinical or academic project, or asking for periodic check-ins.⁶ Professional organizations such as the American Psychiatric Association, subspecialty societies, and regional conferences offer structured opportunities to connect with leaders in the field. Academic environments and collaborative research groups also provide natural mentorship settings.

Identifying the right leadership position early in one’s career requires balancing opportunity with developmental readiness. Initial roles should provide meaningful responsibility while still offering support and guidance from experienced leaders. Good entry points include serving on hospital committees, such as quality improvement, ethics, or diversity and inclusion, where participants gain exposure to governance, policymaking, and consensus-building. Coordinating resident education initiatives or wellness programs can build skills in organization, communication, and team motivation. Leading a targeted quality improvement project allows for measurable impact while fostering skills in project management, data analysis, and stakeholder engagement. Community outreach and advocacy roles, such as organizing mental health fairs or contributing to policy campaigns, strengthen public communication skills and broaden professional networks.

What makes these roles particularly well-suited for early-career psychiatrists is their blend of structure and flexibility. They allow new leaders to contribute meaningfully while observing seasoned professionals, receive feedback in real time, and develop the behavioral competencies required for higher levels of responsibility. By engaging in these positions, early-career psychiatrists "behave into leadership," practicing the core skills that will serve them throughout their careers. Over time, the combination of mentorship, progressive responsibility, and reflective practice creates a strong foundation for advanced leadership in psychiatry.

Concluding Thoughts

Leadership in psychiatry is defined not by rank but by consistent behaviors that inspire confidence, build collaboration, and drive meaningful change. Leaders lead by building trust, creating alignment, and empowering others to contribute confidently, rather than by giving orders. Developing as a leader involves more than acquiring knowledge; it requires active practice in setting a clear, relevant vision, engaging others, and making decisions that balance strategic goals with human needs. In psychiatry, alignment comes from open communication, consistent actions, and making space for contributions from all levels. When junior staff feel heard, respected, and trusted to act, they become more willing to innovate and take initiative. Combining emotional intelligence with Ashlin’s emphasis on integrity, humility, and moral vigilance equips psychiatrists to cultivate this environment from the earliest stages of their careers. By intentionally selecting meaningful roles, seeking strong mentorship, offering feedback, celebrating small wins, and maintaining a commitment to personal growth, early-career psychiatrists can not only navigate change but actively shape the future of mental health care for the benefit of patients, colleagues, and society.

Dr Gonzalez-Cabrales is a PGY-2 psychiatry resident at Atrium Health.

Dr Baijal is a psychiatry a PGY-3 resident at Atrium Health.

Dr Rachal is an associate professor of psychiatry and academic chair for the Department of Psychiatry at Wake Forest University School of Medicine. He also serves as the medical director for the Behavioral Health Charlotte campus.

References

1. Kotter JP. What leaders really do. Harv Bus Rev. 1990;68(3):103-111.

2. Lee TH, Cosgrove T. Engaging doctors in the health care revolution. Harv Bus Rev. 2014;92(6):104-111,138.

3. Goleman D. What makes a leader? Harv Bus Rev. 1998;76(6):93-102.

4. Ashlin P. Leading the Way: Behaviors That Drive Success. iUniverse; 2016.

5. Swensen S, Gorringe G, Caviness J, Peters D. Leadership by design: intentional organization development of physician leaders. Journal of Management Development. 2016;35(4):549-570.

6. Sambunjak D, Straus SE, Marušić A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296(9):1103-1115.