The "Accidental Leader": When Great Clinicians become Overwhelmed Leaders

So many leaders I work with tell me a similar story. They were good at their job. Really good. Comfortable in their clinical role and felt proud of the contributions they made to their clients. Then one day, they were encouraged to apply for a leadership role and were promoted. One day a peer, the next day a leader.

Suddenly, they were responsible for leading others and teams, managing conflict, performance management, and contributing to strategic planning. These expectations arrive quickly and with little preparation. Managing tricky conversations and dealing with interpersonal tensions is quite unexpected. Within months, the strain shows. Once they felt more confident and purposeful, but now overwhelmed and exhausted. They might even begin to question their competence and consider whether staying is sustainable.

Sound familiar?

This scenario is often described as the “accidental leader”. It is not a reflection of poor judgement or lack of effort. It is a predictable outcome of promoting people into leadership without equipping them for the role.

What remains quite unrecognised is the energetic toll this takes. When a leader operates from uncertainty and self-doubt rather than grounded clarity, everyone feels it.

Recently, someone mentioned in a training program that they had been a leader for over two decades, and they had never had any leadership development. Imagine if they had this offered to them earlier in their journey. This isn’t about that person. It’s about a broken system that does not prioritise what is evidence-based regarding leadership, while being evidence-based clinically. This is where the biggest problem lies…

What the research confirms

This experience reflects a much broader workforce pattern. Bartholomew, Adams, and Louwen (2025) surveyed 2,436 allied health professionals across Australia and found consistent gaps between how important professional tasks were perceived to be and how confident respondents felt performing them.

Leadership and Continuous Improvement emerged as one of the most pronounced training needs nationally, evident across professions, levels of experience, and work settings. (Bartholomew et al., 2025).

If you have questioned whether you are cut out for leadership, evidence suggests you are in very good company. This is systemic, not personal.

Why “learning on the job” is not enough

Here’s the uncomfortable truth. We would never expect a clinician to develop their clinical reasoning without structured learning and supervision. Yet we routinely expect leaders to develop sophisticated interpersonal and strategic skills through exposure alone.

When leadership development is left to chance, new leaders are asked to grow new capabilities while carrying high responsibility and emotional load. Over time, this erodes confidence, increases stress, and contributes to burnout.

The cost of the "sink or swim"

The consequences ripple outward. For Leaders, the weight of constant urgency and feeling unprepared creates conditions for increased stress and reduced confidence, leading to imposter syndrome. For Teams, reactive leadership undermines clarity, trust, and psychological safety. For Workplaces, we risk losing a strong clinician while gaining a leader who has not been set up to succeed.

The shift: From accidental to intentional

The evidence is clear. Leadership capability must be developed deliberately. At its core, it is about being supported to shift from reactivity to presence, from “proving’ to “improving’, from uncertainty to supported growth.

For individuals stepping into leadership roles:

• Name what feels most effortful: Is it feedback, managing conflict, or prioritisation? Being honest about where you feel stretched is the starting point for growth.

• Seek supervision that focuses on leadership practice, not just clinical reasoning. Creating space for reflection on how you lead is as important as developing your clinical skills.

• Build capability gradually. Lead small initiatives. Mentor others. Each creates a safe space to practice before the stakes and demands accelerate.

For those appointing and supporting leaders

• Invest early in structured leadership development during the transition, not when the cracks are showing

• Normalise the learning curve. When we treat leadership as something that people should just know, we create shame around the very learning that needs to happen.

• Create dual career pathways so clinicians can progress without being required to manage people if that does not align with their strengths.

• Evaluate leadership effectiveness using indicators such as retention, engagement, and psychological safety, not only output metrics.

A shared responsibility

Leadership is a distinct professional capability that requires time, training, and support.

The national evidence confirms what many workplaces already experience. Leadership capability gaps are widespread, predictable, and not a reflection of individual failure. When organisations move from accidental to intentional leadership development, they protect not only their people but the quality and sustainability of the services they provide.

The question is no longer whether leadership capability needs to be developed, but how deliberately we choose to do so, and whether we are willing to create the conditions for our leaders to thrive.

If you would like to read more….

Below is a link to the national study I refer to in this newsletter. It provides robust evidence that leadership capability gaps are widespread across professions, experience levels, and work settings. It supports a more intentional, evidence-informed investment in leadership training and supervision.

1. Bartholomew, J., Adams, K., & Louwen, C. (2025). Understanding the training need priorities of the Australian allied health workforce: A national survey. BMC Medical Education, 25, 1545. https://doi.org/10.1186/s12909-025-08141-3

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