In healthcare institutions, is having physicians in leadership roles an advantage? A scoping review

Background Healthcare systems are increasingly challenged by rising demand, financial constraints and organisational complexity, intensifying the need for governance models that effectively align clinical quality with operational and economic performance. Medical leadership has been proposed as a strategy to bridge clinical expertise and managerial decision-making; however, evidence regarding its impact on healthcare performance indicators remains heterogeneous. This scoping review aims to examine the relationship between medical leadership and clinical, financial and organisational outcomes in healthcare institutions, while identifying essential leadership competencies and implementation barriers. Methods A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines and the PRISMA-ScR criteria. Literature searches were performed across major databases (PubMed, Web of Science) covering the period from 2000 to 2025. Eligible studies included quantitative and qualitative research analysing clinical, financial or organisational performance indicators in healthcare institutions under medical, non-medical or hybrid leadership models. Data were extracted using a standardised framework and synthesised narratively. Results Twenty-three studies met the inclusion criteria. Medical leadership was consistently associated with improved clinical outcomes, including lower risk-adjusted mortality, higher patient satisfaction and enhanced patient safety. Organisational benefits were also reported, particularly in professional engagement, retention and perceived leadership credibility. Evidence regarding financial performance was mixed, with some studies reporting higher operating costs in physician-led institutions, while others demonstrated neutral or context-dependent financial effects. Leadership training, organisational culture and governance structures emerged as key moderating factors. Conclusion Medical leadership appears to confer advantages in clinical quality and organisational performance, although its impact on financial efficiency remains inconclusive. Effectiveness is strongly influenced by formal management training, institutional support and collaborative governance models. These findings support the integration of leadership and management education into medical training and highlight the need for further research exploring hybrid leadership models and contextual determinants of performance.