[Medical leadership and accountability in hospital governance]

Hospitals are facing increasing challenges that call for strengthened governance. As central actors in care delivery, physicians must take an active role. Through three illustrative cases (Mayo Clinic, Hospital Clínic de Barcelona, Assistance Publique-Hôpitaux de Paris) and a literature review, this article shows that physician-led hospitals often perform better. However, a gap remains between clinical training and management requirements. By aligning the CanMEDS framework with institutional needs, four key competency areas have been identified. These can be acquired through postgraduate training (Certificate/Diploma/Master of Advanced Studies), shared leadership roles, or mentorship. Strengthening medical leadership in governance is not an option-it is a strategic imperative.