Under the surface, health care leadership is a stagnant pond filled with ever deepening chasms between the two rival schools – clinicians and managers.  Clinical leadership is no longer about advocating for individual patients, especially about expensive interventions and hospital stays where there is little likelihood of these clinical decisions ever being substantiated by research.

Leadership at best is about patient outcomes, quality measures, budgets and, at worst, bullying and whistleblowing.

At a time when leadership is flattening across most large organisations, it is time for health care to follow suit.

Top tier clinicians, who are seeking to improve things for themselves and their patients, have nowhere to go to – except to embrace leadership. For top tier women clinicians, inequities still exist in salaries and non-clinical pathways to promotion are becoming more of an attractive option. However, promotional and leadership opportunities up the financial chain come at the risk of losing clinical value. Fortunately, the technical aspects of transitioning from managing patients to leading staff and manipulating budgets is not hard.

Dealing with the loss of the vocation of individual patient care, which is the hallmark of female-style caring, is less easy for clinical leaders. A recent workshop held at Harvard beaconed a way forward. Harnessing personal power and social media networking were spotlighted as 21^st century leadership activities.  They signal a new way of looking at leading which involves networking, visibility and enlisting widespread support. New pathways need to be developed for sharing leadership according to the situation and the skills required.

Hierarchical and static leadership leads to poor leadership. Our Webwaves are replete with stories of avoidant leaders, hostile leaders, harassing leaders, bullying leaders, non-inclusive leaders, and even embezzling leaders. At a time when leadership is flattening across most large organisations, it is time for health care to follow suit.

Clinical care is especially suited to flatter structures such as groups where leadership is shared according to skills, particularly where tasks can’t be rigidly defined such as the care of patients with multiple problems, where protocols and single leadership is inappropriate.

Leadership in health care should not be the final destination for our best women clinicians any more than it is for men, but rather a means to an end – to provide the best health care we can.