More physicians are looking for ways to influence healthcare beyond the patients on their daily schedules. Phoenix Children’s has just offered a timely example of what a credible next step can look like.
On September 16, 2026, the health system announced that Joshua D. Koch, MD, had been appointed to a newly created position: senior vice president, Hospital Based In Chief. The role reports directly to President and CEO John R. Nickens IV and brings several major hospital-based services under one physician executive.
The appointment matters for more than its title. It shows how a health system can turn physician interest in leadership into a role with real authority, a clear enterprise mandate and a visible path from clinical leadership to the executive team.
A timely example of the physician leadership shift
Earlier this year, HealthOp examined why more physicians are considering leadership roles. The reasons are not difficult to understand. Physicians often want a broader ability to improve care delivery, solve persistent operational problems and shape the systems that affect both clinicians and patients.
That earlier discussion focused on the demand side of the equation: why physicians want leadership opportunities and why employers need stronger development pipelines. Phoenix Children’s now provides an employer-side example. Instead of asking an experienced physician to influence multiple services through informal relationships alone, the organization created a senior role with defined scope and direct access to the CEO.
That distinction is important. A leadership title without authority can frustrate the physician and the teams that expect change. A well-designed executive role connects accountability to decision-making power, reporting structure and organizational support.
What Phoenix Children’s created
According to the Phoenix Children’s announcement, Dr. Koch will oversee:
- Critical care
- Neonatology and fetal care
- Emergency departments and urgent care
- Hospital medicine
- Radiology
- Pathology
These are not isolated departments. They are interdependent services that shape patient flow, diagnostic speed, capacity, safety and the experience of clinical teams throughout a hospital. Bringing them under one senior physician executive can create clearer accountability for coordination across specialties.
The reporting relationship is equally significant. A direct line to the CEO signals that the role is intended to participate in enterprise decisions, not simply manage one clinical division.
Why the internal advancement path stands out
Dr. Koch enters the position with a substantial record inside Phoenix Children’s. He previously served as co-director of the Center for Heart Care, division chief of cardiac critical care medicine and pediatric critical care medicine, chair of the Phoenix Children’s Medical Group Governance Council and vice president of the medical staff.
That progression gave the organization opportunities to evaluate more than clinical excellence. It could observe how he built programs, worked across disciplines, participated in governance and led other clinicians. Those experiences are much closer to the demands of enterprise leadership than a strong clinical résumé alone.
This is where Phoenix Children’s approach is especially instructive. The organization appears to have matched a broader executive need with a physician who had already demonstrated influence across clinical, administrative and governance settings. It is a strong example of the leadership pipeline described in HealthOp’s earlier article: identify potential early, provide progressively larger responsibilities and create a meaningful role when the organization is ready.
Physician leadership is expanding beyond the traditional CMO
The chief medical officer remains a critical executive position, but it cannot absorb every clinical, operational and strategic responsibility in a growing health system. Organizations increasingly need physician leaders focused on service-line integration, quality, informatics, population health, medical group operations and other complex portfolios.
Phoenix Children’s new role is one example of that evolution. Its cross-service scope is broader than a single division chief position, while its focus is more defined than an all-encompassing medical executive role. The design allows the organization to place concentrated leadership attention on hospital-based services that must work together every day.
The American Medical Association has similarly emphasized that modern physician leaders need operational fluency, data literacy, emotional intelligence and experience working beyond their own specialties. Its recent guidance also stresses the importance of mentorship, protected leadership time and exposure to enterprise strategy. Those capabilities should influence both leadership development and executive selection.
Read the AMA’s discussion of changing physician-leadership expectations.
Five role-design choices that make physician leadership credible
Health systems considering a new physician-executive position should define the job before starting an internal selection process or external search.
- Start with the organizational problem. The role should exist to achieve specific outcomes, such as improving coordination across hospital-based services, strengthening quality or integrating a growing medical group.
- Match authority to accountability. Clarify decision rights, budget influence, hiring authority and the relationships the executive will have with nursing, operations, finance and other clinical leaders.
- Set a realistic span of control. A broad portfolio can improve integration, but only if the executive has strong operational partners and an achievable number of direct reports.
- Protect time for leadership. Employers should explicitly define clinical expectations, administrative time and compensation. Adding an executive portfolio on top of a full clinical load is not a sustainable leadership strategy.
- Plan the transition below the new executive. Promoting a division chief or service-line leader can create vacancies and development opportunities elsewhere. Succession planning should extend beyond the person receiving the promotion.
When internal advancement works, and when an external search is better
Internal promotion can be especially effective when the candidate has trusted relationships, a record of cross-functional leadership and enough organizational credibility to align independent clinical groups. It also signals to other physicians that leadership development can lead to meaningful advancement.
An external search may be the better choice when an organization needs a capability it has not yet developed, a major transformation, an independent perspective or experience operating at a larger scale. The decision should follow the mandate of the role, not a blanket preference for internal or external candidates.
In either case, the candidate assessment should extend well beyond clinical reputation. Executive candidates need to demonstrate enterprise judgment, communication, financial understanding, talent development and the ability to lead through influence as well as formal authority.
The workforce lesson for Arizona health systems
Physicians considering leadership are not necessarily looking to leave medicine behind. Many want a larger platform from which to improve it. Employers that offer only an informal committee assignment or an additional administrative burden may lose those physicians to organizations with clearer pathways.
Phoenix Children’s has created a visible alternative: a senior role built around an organizational need, broad clinical coordination and direct executive accountability. Other Arizona health systems do not need to copy the title. They should study the underlying design.
The most effective physician-leadership strategy begins before a vacancy opens. It identifies promising leaders, gives them meaningful operating and governance experience, defines future roles carefully and uses an objective search process when the organization needs to look beyond its existing bench.
Build the role before beginning the search
HealthOp helps healthcare organizations define critical leadership positions, assess the available talent market and recruit executives who can lead across clinical and operational priorities.
Explore HealthOp’s Direct-to-Hire Recruiting services or contact our team to discuss a physician-executive search.
Source note: Phoenix Children’s announced Dr. Koch’s appointment on September 16, 2026. The organization did not publicly disclose the role’s compensation, clinical time allocation or detailed decision rights. Recommendations in this article are HealthOp’s employer-focused analysis.
