You have done the work. You have the track record. And you are still waiting for someone to tell you it’s your turn.
That permission is not coming. And in this episode, I want to talk about what it actually costs you to keep waiting — and what it looks like to stop.
This is about self-authorization. And it may be one of the most important skills no one teaches us in medicine.
Why Women Physician Leaders Wait — and What It’s Actually Costing You
Let me start with something the research confirms.
Women tend to wait until they feel one hundred percent qualified before stepping into a new role. Men tend to leap at sixty or seventy percent.
That gap is not a confidence problem. It is a permission problem.
Women are waiting for a signal that never arrives.
But here is what I want you to hear: if you are thinking about that role — the department chief position, the committee leadership, the program you have been turning over in your mind — it is very likely that you have already been taking steps toward it. You are a great listener. You are compassionate. You care deeply about your team. You have the capacity to keep learning, and that makes you an exceptional leader already.
The question is not whether you are qualified. The question is whether you are willing to authorize yourself to move.
And the cost of not moving is real. It is not just a missed title or a missed opportunity. When years tick by and your actions don’t reflect what you actually value, you start to lose something quieter and more damaging: trust in yourself. Trust that you will actually follow through on what matters to you. That loss is gradual, and it is degrading. It chips away at your confidence over time in a way that is hard to name until one day you realize you’ve been drifting.
From Drifting to Tethered: A Physician Leader’s Path to Self-Authorization
I remember that drifting feeling very clearly from my early attending years. I had completed training, I had arrived, and suddenly — there was no curriculum. No prescribed next step. And I had so many conversations with my husband about this restless, untethered feeling, like I was moving but not in any particular direction.
What I did not do was haphazardly apply for every leadership role that came across my desk. Instead, I found one project I cared about deeply — improving pediatric asthma care — and I started taking tiny steps. I arranged the first multidisciplinary team meeting. I sought out relationships. I built the skills that would later qualify me for much larger roles. I didn’t ask for permission first. I chose a direction that aligned with my values and I moved.
That self-authorization is what helped me feel connected instead of adrift. It was not reckless. It was intentional.
And it wasn’t just my career where I had to learn this. Self-authorization doesn’t clock out when you leave the hospital.
I always said health was a priority, but my actions were not saying the same thing — especially during the busiest seasons of my life. Twice I finally took the reins. Once when I committed to training for a half-marathon despite genuinely challenging circumstances at the time. And again when I decided the only time I could consistently exercise was five-thirty in the morning before anyone else in my house was awake. That took a major mental shift. But I have been at it for over a year now. Not because someone gave me permission. Because I stopped waiting for the conditions to be perfect and started moving anyway.
A Framework for Self-Authorization: Notice, Align, and Move
So how do you know when to move? How do you tell the difference between self-authorization and just being impulsive?
For me, it comes down to three things. I call it Notice, Align, and Move.
First: Notice. There is usually an internal signal that something has to change. For me, it is an uncomfortable feeling I have learned to recognize over time — a low-grade restlessness that will not quiet down. It is not something I am willing to live with long term. If you feel it, do not talk yourself out of it. That discomfort is information. It is directing you somewhere. Start there.
Second: Align. Before you act, ask whether the step in front of you is connected to what you actually value. Not what you think you should want. Not what looks impressive from the outside. What actually matters to you. Self-authorization is not about leaping impulsively — it is about making choices that are in alignment with who you are trying to become. When values are clear, the next step gets quieter.
Third: Move. And here is the part we most often skip — you have to actually take the step. Not the whole staircase. One step. It might be setting up a meeting. Committing to a morning. Sending the email you have been drafting in your head for three weeks. Small, tethered, intentional movement. That is what builds the trust in yourself back up over time.
Your Next Step as a Woman Physician Leader
You have already been the person who figures it out. You have done it in your training, in your clinical work, in your family. The only thing left is to stop waiting for someone else to make it official. That authority has always been yours.
If you are sitting with that restless feeling right now — if there is a next thing you keep circling back to but haven’t moved on — I want you to do one thing this week. Just notice it. Name it. Write it down if that helps.
If you want a partner in figuring out what that next step actually is, I would love to work with you. Apply at womenmdleaders.com/work-with-stephanie.