I’ve been asked some version of this question all year:
“How long do you have left?”
Not by inmates. By health system CEOs.
As I’ve traveled across the U.S. and Canada, I’ve heard the same weary blend of humor and resignation from executives who have carried their organizations through COVID, workforce disruption, payer pressure, and now another round of reimbursement headwinds.
Just when it looked as though operating margins were inching back toward black, along comes sharper scrutiny of the 340B program and projected double-digit increases in government-subsidized insurance coverage, among other provisions—all while reimbursement stays flat and salary and benefit costs climb.
You don’t need to be an actuary to see where that leads: more reasons for healthcare leaders to sleep less and think about retirement more.
Many of our most experienced leaders stayed longer than planned, out of duty—“I can’t leave the board or the community right now; we’re still digging out.” Months became years, the issues grew harder, and now we face a wave of exits from people who carry institutional memory and the trust of their communities.
Is there a bench waiting in the wings? Maybe.
Our young professionals are brilliant—spend an afternoon in a graduate health-administration class and you’ll leave encouraged—but the path to the C-suite has narrowed. Post-2019 flattening trimmed leadership layers, leaving fewer opportunities to grow into senior roles.
This isn’t just a healthcare issue. When the media reports on air-traffic controllers burning out due to stress and regulation, every hospital CEO nods and says, “Yep. That’s us, too.”
The burden sits on leaders who are smart, committed and deeply invested in their people—yet increasingly dream of grandkids and golf instead of balance sheets and budget hearings.
So, What Should We Do About It?
As healthcare leaders wrestle with exhaustion, succession and uncertainty, the solution isn’t found in longer hours—it’s found in deeper engagement.
In “Be the Best Part of Their Day: Supercharging Communication with Values-Driven Leadership,” I argue that communication isn’t a “soft skill.” It’s a performance multiplier. When leaders communicate in ways that are personal, intentional and mission-anchored, three good things happen:
- Current leaders feel less isolated.
- Emerging leaders are pulled in, not shut out.
- The organization becomes more resilient than the environment.
Here’s what that looks like.
- 1. Engage and Connect at a Personal Level
When leaders are exhausted, the first casualty is presence. We get efficient, not available.
Yet personal connection is what transfers confidence. A five-minute hallway conversation, a handwritten note or a quick text to a rising manager can refill emotional reservoirs across an organization.
Connection slows the exit spiral. People are less likely to leave when they still feel seen by the person at the top. It also signals to the next generation, “You belong here.”
Every act of authentic attention becomes a handoff of culture—and that’s how you lead beyond your own tenure. - 2. Engage with Intent Through Multiple Mediums
Great leaders don’t just talk more; they talk with purpose.
Intentional engagement means using every interaction to align, not just inform. In an era of flattened structures, every word carries multiplied weight.
That means:- Cadenced updates explaining not just what is happening—policy shifts, payer trends, labor costs—but why it matters locally.
- Multi-channel communication (email, short videos, leader talking points) that reach the night shift as effectively as the boardroom.
- Mentoring through narration. Don’t just announce decisions—explain your reasoning. That’s succession planning in real time.
If you don’t narrate leadership, your successors won’t learn leadership.
- 3. Be Mission-Focused Through United Leadership
Rural and community hospitals, in particular, thrive when leaders stay mission-anchored and united.
When every decision ties back to purpose, leaders rediscover stamina and teams rediscover meaning.- Frame tough choices in terms of community outcomes: “We’re protecting OB, ED and primary care access in this county.”
- Align boards, executives and physicians around a single future statement: “This hospital exists so our neighbors can receive world-class care close to home.”
- Celebrate behaviors that reinforce dignity and access, not just cost control.
When the mission becomes the magnetic north, even change feels like progress.
For Boards: Five Immediate Steps
- Name the risk. Make leadership succession and retention a regular board agenda item.
- Map emerging talent. Identify 10 people you can’t afford to lose—and invest in them.
- Re-fund leadership development. Flattening saved money but starved the pipeline. Reverse that.
- Protect the CEO’s energy. Require rest, delegation and visible succession plans.
- Signal continuity. Tell the community: We’re planning for transitions because we plan to be here.
If You’re a Leader Wondering, “How Long Do I Have Left?”
You’re not weak or selfish for asking that question—you’re human.
But before you go, consider the difference between leaving and leaving a legacy.
- Identify three people who carry your values forward.
- Give them access—to conversations, challenges and decisions.
- Tell your story publicly. Let the community see the confidence you have in the future.
That’s how you remain “the best part of their day,” even when you’re no longer in the big chair.
This Isn’t About How Long You Stay
The wrong question is, “How long can we keep weary CEOs hanging on?”
The right question is, “How quickly can we build values-driven communicators who will keep rural and community hospitals thriving long after we’re gone?”
We already know what works: engage personally, engage with intent and lead through mission.
So, how long do you have left?
Long enough to develop the people who will make sure your hospital does.
David L. Schreiner, PhD, FACHE, is a nationally recognized speaker, consultant and former hospital CEO whose leadership journey spans more than three decades in rural healthcare.