If You Stepped Away Tomorrow, How Would Your Leadership Legacy Be Remembered?
Every pediatric chair, chief and administrator will eventually leave. Some retire after decades of service. Others accept new opportunities, return to research, or simply decide it’s time for a new chapter. The question isn’t whether a transition will occur. The question is whether the department will be stronger because of the leader—or vulnerable without them.
Based on twenty-five years exclusively in academic pediatric executive search, I can attest that effective succession planning is perhaps the most critical attribute of high impact leadership teams. Sadly, with faculty workforce challenges, declining reimbursement, growth pressures across all missions, and the countless daily demands placed upon child health leaders today, preparing the next generation can easily slide to the bottom of the list.
And yet, the strongest departments rarely leave leadership transitions to chance. They intentionally build leaders and prepare for succession years in advance.
Do You Have a Long-Game Strategy?
Leaders spend tremendous energy recruiting exceptional faculty, expanding programs, strengthening research portfolios, and improving care. Each is essential, but leadership stewardship extends beyond today’s accomplishments. We all must ensure that someone is prepared to continue—and improve upon—the work after we are gone.
In many ways, succession planning is the ultimate expression of servant leadership. It requires setting aside personal legacy in favor of institutional legacy. Great leaders understand that their greatest accomplishment will not be the programs they created, but the leaders they developed.
Mentorship Matters
Outstanding future leaders do not emerge by accident; they are intentionally developed. Successful department leadership teams are intentional in their faculty engagement, seeking to identify those who naturally demonstrate curiosity, emotional intelligence, integrity, resilience, sound judgment, and the ability to influence others. They have learned that leadership potential appears long before someone is qualified for the title.
Once identified, individuals should be given structured opportunities for professional growth. Committee leadership, strategic initiative oversight, national committee membership recommendations and active participation in budgeting and clinical operations are a few critical ways to support those who will be the future of our programs. Real wisdom, and more importantly the confidence to lead, requires experiences obtained outside the classroom. A continued escalation of experience, mentorship, feedback, and increasingly challenging opportunities is the secret sauce.
Succession Planning Mistakes Observed in Failed Leadership Tenures
- Waiting until leadership vacancies become imminent before identifying successors.
- Assuming exceptional clinicians or researchers will naturally become exceptional leaders.
- Failing to provide meaningful leadership development experience for emerging leaders.
- Keeping strategic decision-making concentrated in your department’s cabinet.
- Viewing succession planning as a replacement exercise rather than an ongoing organizational strategy.
- Neglecting to include succession planning in the annual evaluations of department leadership
Personal Succession Planning Observation
For many leaders, succession planning begins only after the thought of “retirement” and/or “stepping down” enters the conversation. Unfortunately, for many, these words have a negative connotation which leads many in academic child health into a spiral of frustration, burnout and self-preservation. Effective leadership development and succession planning are the vaccines that prevent the deterioration of departments and the leaders who serve them. It’s what allows all to enthusiastically transition to their next chapter knowing the program is in great hands.
Faculty rarely remember buildings and recognition as much as they remember great leaders. The leaders who have the greatest long-term impact don’t simply build excellent departments; they build leaders capable of taking those departments even further. That is a legacy that compounds long after the name is removed from the office door.
A question to ponder as we look to the 2026-27 academic session. “If I, or any leader in my department, stepped away tomorrow, who would be ready—and what have I done to prepare them?”
The answer will provide a clear measure and guidance on the succession planning and leadership development efforts necessary for the future success of your department.
Wesley Millican
Past Posts
I had the opportunity to attend the 2026 PAS Meeting in Boston and to connect with many new and old friends. This year’s meeting felt different and more serious in a very important way. While scientific discovery and innovation remained central themes, many of the most urgent conversations centered around the sustainability of children’s healthcare. From medical students to emeritus thought leaders, the future viability of the specialty was on the tip of the tongue.
Three themes consistently surfaced across sessions, coffee breaks, the exhibit hall and in awardee acceptance speeches:
- Addressing pediatric workforce shortages
- Medicaid reimbursement reform
- Pediatric faculty compensation shortfalls
It became increasingly clear throughout the meeting that these three issues are no longer separate conversations or initiatives. They are deeply and intimately intertwined. The common sentiment centered on a belief that without significant progress on faculty compensation, workforce and Medicaid solutions, while critical, would likely fall short of transformational change needed in academic pediatrics.
Workforce Themes: Recruitment pipelines are shrinking, burnout remains high with increasing signs of moral injury, retirements are accelerating, and the gaps in access to care for children continues to widen.
Medicaid Themes: Reimbursement continually fails to reflect the complexity of pediatric care, the time-intensive nature of family-centered medicine, care coordination requirements, behavioral health integration, and the growing needs of children with medical complexity. Attendees spoke candidly about how inadequate reimbursement affects hospital margins and missional reinvestments, faculty hiring, outreach programs, and competitive compensation.
Physician Compensation: The “Tie That Binds” Everything Together
If there was one conversation that felt impossible to avoid at this year’s meeting, it was faculty compensation. For years, pediatric compensation discussions occurred quietly in hallways rather than on main stages. This year, the topic was in your face and much appreciated. Without public awareness of the gravity of the situation, change is not possible.
Leaders engaged openly around the widening compensation disparities between pediatrics and adult medicine, their challenges recruiting academic pediatric subspecialists, increasing package competition between institutions, and the limitations of traditional RVU-based compensation models in many subspecialties. It was clear our current compensation models are failing us in attracting the next generation of physicians to the specialty.
Medicaid reimbursement and pediatric faculty compensation are inseparable. Pediatric departments cannot sustainably recruit and retain the subspecialist to build divisions and programs for kids while operating within historically underfunded reimbursement models. It was clear at PAS that compensation is not simply a budgeting issue anymore—it is an access-to-care national crisis.
Lights in the Darkness: Despite the many challenges discussed, my time at PAS also showcased tremendous innovation, collaboration, and resilience. So many great leaders and minds across academic child health seeking positive change for kids. I was particularly encouraged by:
- the national recognition of pediatric workforce challenges,
- increased openness around the need for compensation reform,
- advancements in AI-based digital health tools and recognized efficiencies,
- seeing the recognized need for deeper collaboration between children’s hospitals, universities, and policymakers.
- a continued emphasis on leadership development, mentorship, and recognition of emerging voices in pediatrics.
- Last but not least, a special shout out to Child Health Advisory Council Executive Board Member, Danielle Laraque-Arena, recognized as a George Armstrong Lecture Awardee. Well-deserved!
As a proud sponsor of PAS, AMSPDC and AAAP, we are in a unique position to see positive changes that will surely lift all organizations and pediatricians diligently working for brighter futures for our Nation’s children. We were honored to participate in so many thoughtful conversations at this year’s PAS meeting and believe the future is challenging, but very bright!
Wesley Millican
It is increasingly clear that 2026 will be a pivotal moment within the academic child health leadership continuum. Escalating workforce shortages, rising burnout, national policy changes and increasing financial pressures are rapidly reshaping the strategies and tactics leaders must embrace for meaningful advancement across all missions. While solutions are complex and challenging, 2025 has shown us leadership opportunities for high impact.
As we move into the new year, I look forward to sharing perspectives and learning alongside colleagues who are navigating this rapidly changing environment.
Based on what we are seeing, high-impact leaders in 2026 will consistently demonstrate four core behaviors:
1. Be Proactive
Evolving beyond traditional university and HR faculty recruitment and retention practices—many of which remain adult-medicine centric—is required this year. Effective leaders will proactively engage in rethinking faculty talent strategies early in 2026 and will seek to formalize innovative best practices and programs in partnership with their children’s hospital colleagues. Relying solely on advertisements and limited in-house resources will be futile and will continue to drive escalating faculty shortages and retention challenges.
2. Be Present
Faculty are under extraordinary stress and dealing with unprecedented levels of burnout and moral injury. Leaders achieving impact in these areas are viewed as “present” by their faculty in both clinic and hospital settings. Visibility, engagement and accessibility matter more than ever.
3. Be an Advocate
Competitive compensation is an absolute requirement for effective recruitment and retention strategies. All strategies for solving current workforce issues will be a risk if competitive compensation remains unsolved. In 2026, pediatric subspecialty compensation will need to be at or above the 50% for faculty and 75% for leaders. Determined diligence and advocacy with health system and university partners is the only path for getting there. Medical Students and undergraduates are watching!
4. Be a Delegator
Leadership styles are evolving from top-down toward greater delegation and autonomy. Such cultures appear to me to be healthier and suffering from fewer retention challenges, especially with mid-career and younger faculty. The intentional creation of opportunities for growth and development, even in small measures, will be critical.
We believe academic pediatrics can make real strides forward in 2026 but we must be diligent and look forward to seeing the innovative solutions that will evolve from the efforts of effective leaders who understand that strong leadership is no longer optional and is essential to protecting patient care, supporting faculty wellbeing and sustaining the academic mission for the next generation.
Wesley Millican
In our work partnering with children’s hospitals, schools of medicine and pediatric departments across the country, I’ve had a front-row seat to a talent acquisition shift that can no longer be ignored. Pediatric workforce dynamics are changing rapidly and compensation strategy has quickly become the most consequential – and often misunderstood – lever in faculty talent recruitment and retention. What once was a slow-building concern is now an urgent, system-level imperative and will be a pre-process priority for all applicants. The top three themes shaping the compensation debate include:
- Shrinking Leadership Pipelines
The most consistent theme heard from pediatric department chairs and division directors centers on “the rapidly declining pools of fully qualified faculty leadership candidates.” Training pipelines in pediatric subspecialties are narrowing, which leaves little hope for enhanced future pipelines. The result is predictable but increasingly acute—longer time-to-fill, more declined offers and heightened competition among institutions for a limited pool of talent.
- RVU Based Compensation Mismatch
Another recurring theme is directed at how poorly traditional RVU-based remuneration frameworks translate to competitive compensation for many pediatric subspecialties. Our highly cognitive, consultative specialties continue to feel undervalued in comparison to their procedural based specialty colleagues. What we often hear from leaders is their physicians are incredibly busy but the numbers and compensation don’t reflect it. It is rarely a performance issue and we must find a better model.
- Painful Costs of Underpayment
The tendency still exists in many health systems to support below-market compensation as a starting point or a negotiation strategy. Choosing to be proactively competitive and innovative in your compensation strategy is now mission critical. Faculty who believe they are undervalued are experiencing burnout and frustrations at higher levels and are highly susceptible to the recruiting advances of neighboring and national programs. Every departure triggers a cascade: search costs, interim coverage, lost revenue, onboarding delays, team disruption, and, in many cases, increased burnout.
We’re at a critical inflection point. Pediatric subspecialty care will not survive within outdated compensation cultures. Health systems that fail to adapt and invest risk deepening child health workforce shortages, limiting access, and a continual undermining of their long-term sustainability. Organizations that are taking a proactive, market-aligned approach to compensation are gaining a clear competitive advantage, not just in recruitment, but in stability, quality and performance.
Looking ahead, compensation is no longer a downstream financial decision. It is a core workforce strategy. Aligning pay with market realities is essential to attracting top talent and retaining our experienced faculty.
Leadership candidates asking about compensation are typically not asking for themselves. They are attuned to the workforce shortages and know what it will take to add faculty. If you are below market, the best applicants will not engage for fear of future years of failed recruiting due to compensation and resources. The stakes are high and the window to engage and innovate with our institutional partners is today.
Wesley Millican