Leading When You’re Not the Boss: Academic Medicine Edition

How to influence without a title—and why it matters

In academic medicine, some of the most influential people don’t have “chief,” “director,” or “chair” in their title. They lead from the middle—shaping decisions, mentoring colleagues, and improving systems—without formal authority.

Here are 10 ways to lead when you’re not the boss, with stories adapted from real situations across surgical specialties.

1. Model the Behavior You Want to See

People notice what you consistently do, even more than what you say. A new faculty member began performing bedside procedures in a way that broke each step down for the learner, explaining decision points and encouraging questions in real time. Over time, residents gravitated toward this approach, asking others to teach the same way, and eventually colleagues began adopting it as well because it clearly improved efficiency and confidence in the learners. Modeling doesn’t have to be flashy—it can be about showing professionalism in a difficult patient encounter, maintaining composure under stress, or balancing teaching with efficiency in the operating room. When others see an approach that works, they copy it, and soon your behavior has set the standard for the group.

Takeaway: Your habits set the tone for those around you—consistency and visible results make others want to follow your lead.
Self-reflection: What behaviors do I want others to adopt, and am I demonstrating them consistently?

2. Find the Gaps and Fill Them

Change often starts when someone notices what’s missing and quietly fixes it. In one surgical service, patients recovering from certain operations were not being evaluated consistently for airway complications. A faculty member developed a formal screening protocol for the ICU, trained the speciality and ICU care team, and documented the improved outcomes.

Takeaway: Solving overlooked problems positions you as a resource and builds your reputation as someone who makes things better.
Self-reflection: Where do I see unmet needs in my practice or department that I could take the lead on addressing?

3. Lead Through Teaching

Teaching is one of the most direct ways to lead without a formal role. Faculty who regularly create clear, effective learning experiences build trust and influence. For example, a surgeon developed a set of realistic simulations for emergency airway assessment and intubation, then invited faculty and trainees from multiple specialties to practice and learn from each other. The model was so effective it became a required part of the training program.

Takeaway: Every time you teach, you influence the skills, attitudes, and future practices of your learners.
Self-reflection: How can I make my teaching so effective that others naturally seek me out as a resource?

4. Champion Collaboration Across Departments

Cross-specialty collaboration creates new solutions that wouldn’t exist in silos. For example, an orthopedic surgeon partnered with physical therapy, sports medicine, and radiology to create a multidisciplinary clinic for complex joint injuries. This improved patient access to coordinated care, streamlined rehab protocols, and opened new opportunities for joint research.

Takeaway: Building bridges across specialties multiplies your impact and makes you part of larger institutional wins.

Self-reflection: Who in other departments could I partner with to create a shared win for patients, learners, or research?

5. Use Service Roles Strategically

Service roles—on committees, working groups, or professional organizations—are often where early decisions are made. An early-career faculty member joined a national surgical education committee, gaining early access to curriculum changes being discussed. She brought those ideas back to her institution and helped modernize resident education before it became a mandate.

Takeaway: The right service opportunities give you influence, relationships, and early access to changes that shape your field.
Self-reflection: Which committees or professional groups align best with the influence I want to have?

6. Bring Data to the Table

A strong case for change is built on evidence, not just opinions. For instance, in one general surgery division, junior faculty were frustrated by delays in starting cases due to limited OR block time. Instead of voicing vague complaints, a faculty member tracked three months of data: case delays, turnover times, and the number of procedures that had to be bumped. When the information was presented to leadership, it showed a clear pattern of under-resourced block allocation compared with case demand. Armed with this data, the division successfully negotiated for additional block time at a second location, which reduced delays and improved surgeon and patient satisfaction.

Takeaway: Decisions move faster when you present objective data that supports your case.

Self-reflection: What data could I collect now that would strengthen my case for a change I want to see?

7. Mentor, Even Informally

You don’t need to run a formal mentorship program to have influence. I made the decision to “adopt” a class of residents in my department. We met regularly over a beverage outside of work, spent time together at conferences, and I met with them individually to review their goals. That consistent, personal attention created strong bonds within the group, led to multiple national abstracts, and fostered a stronger research culture. Just as importantly, the residents felt supported, which increased both their motivation and their output.

Takeaway: Personal attention inspires commitment—when learners feel valued, their motivation and productivity rise.
Self-reflection: Who could I support informally right now to help them take their next step?

8. Speak Up in the Right Moments

Meetings are opportunities to demonstrate leadership, even without a formal role. On one general surgery service, faculty were growing increasingly frustrated with delays between cases, but no one had proposed a clear solution. A junior faculty member suggested piloting a new turnover protocol during a departmental meeting. Because it was presented as a small, low-risk trial, the group agreed. The pilot was successful, and within a few months the protocol became standard practice across the operating rooms.

This wasn’t the result of dominating the conversation or speaking the most—it came from offering a thoughtful, actionable idea at exactly the right moment. Over time, colleagues began to seek out that faculty member’s input, even in discussions outside their primary area.

Takeaway: Influence comes from being strategic, not loud. Offering practical solutions at the right time builds credibility and shapes outcomes.
Self-reflection: Am I identifying the moments where one clear, constructive idea could change the direction of the discussion?

9. Be the Connector

Sometimes the most powerful way to lead is by bringing people together. A faculty member once introduced a rehabilitation specialist and a basic science researcher who were tackling similar problems from different angles, and that connection led to a funded grant, new clinical protocols, and publications neither could have achieved alone. But being a connector doesn’t always mean launching major projects—it can be as simple as linking a resident with a faculty mentor in their area of interest, or introducing a junior colleague to a national leader at a meeting. These small introductions often change career trajectories, generate collaborations, and strengthen your own reputation as someone who makes good things happen.

Takeaway: Acting as a connector creates value for others while positioning you as a trusted and influential colleague.
Self-reflection: Who in my network could I introduce to one another that might create new opportunities for both?

10. Volunteer for Visible Wins

Leadership without a title is often about choosing projects that make a noticeable difference. In one surgical division, a junior faculty member volunteered to lead the redesign of patient education materials. The effort unified resources across clinics, reduced patient confusion, improved satisfaction scores, and showcased the faculty member’s ability to deliver institutional-level improvements. Wins like these don’t have to be massive—taking on a residency wellness project, piloting a new approach to M&M conference, or leading a small quality-improvement initiative can all raise your profile. The key is picking projects that solve a real problem and are visible to others, so your contributions are recognized and build momentum for future opportunities.

Takeaway: Visible projects demonstrate your leadership potential and open doors to bigger roles.
Self-reflection: What project could I step into right now that would create both meaningful impact and visibility?

Final Thought

Leadership in academic medicine is not defined by titles—it’s defined by actions. Some of the most influential faculty are those who lead from the middle, shaping culture, improving systems, and mentoring others without waiting for a formal role. By modeling the right behaviors, filling gaps, teaching effectively, building collaborations, using data, mentoring informally, speaking up strategically, connecting colleagues, and volunteering for visible projects, you can create meaningful impact right now, no matter where you sit in the hierarchy. These habits build trust, expand your influence, and often lead to formal leadership opportunities—but even if the title comes later, the influence starts today.

Call to Action: Look back at the ten strategies in this list and choose one to act on this month.