Leadership transition is an event every medical group will face — sometimes on a predictable timetable, sometimes without warning. One day it’s a retirement announcement after decades in practice. Another day it’s an unforeseen incident that instantly reshapes decision-making and stakeholder confidence.  

In his upcoming member-exclusive webinar, Robert Bush, FACMPE, retired chief executive officer of Austin Diagnostic Clinic, will share lessons from his popular session at last year’s Leaders Conference: succession planning is less about org charts and more about readiness — knowing who can step in, for which roles, and with what support, when the moment arrives.  

Our Feb. 17, 2026, MGMA Stat poll finds that only one in three (33%) medical groups have a succession plan for leadership positions, while 60% do not and 8% were unsure. The poll had 302 applicable responses. 

This points to very little change since our July 2024 poll that found only 36% of groups reported a succession plan for leadership positions. 

That readiness matters because leadership, at its core, is alignment. Bush’s framework ties leadership to four essentials medical groups live by: maintaining quality patient care, building a stable practice environment, driving operational efficiency, and managing risk. When a leadership transition introduces uncertainty in any of those areas, the impact shows up fast — internally with staff confidence and performance, and externally with patient experience and operational reliability.  

Why leadership change occurs (and why it’s rarely “clean”) 

Bush groups the drivers of leadership change into four common triggers: retirement, a new opportunity, restructuring, and unforeseen incidents. Some transitions are planned, giving the organization time to prepare. Others are emergent, forcing decisions under pressure. Both types require structure, because even a well-intended change can stall if the practice doesn’t have a shared plan for what happens next.  

Common challenges 

Transitions create predictable friction points. In his Leaders session, Bush highlighted four that show up repeatedly: 

1. Resistance to change 
2. Unclear or inconsistent communication 
3. Impact on patient care 
4. Lack of resources or support  

These challenges are operational for the practice and can be personal for staff. The emotional impact of change — uncertainty, skepticism, and anxiety — can spread quickly when staff don't understand what's changing, why it’s changing, or how decisions will be made. Staff may try to fill in the blanks themselves, and the story that spreads is rarely the one leadership wants.  

A practical succession-planning process that scales 

Bush outlined a six-part succession planning process designed for real-world use: 

1. Develop a plan 
2. Evaluate the current situation 
3. Identify key positions 
4. Identify internal talent 
5. Document 
6. Transition  

In your practice, the “evaluate” and “identify” steps are where the work becomes tangible. Bush encouraged practices to widen the lens beyond the CEO/administrator role and identify mission-critical positions that keep performance steady, such as section chiefs and department heads. From there, the process becomes a talent review: assess internal and external candidates, evaluate capabilities and potential, and then build future leaders through visible development plans.  

MGMA offers several resources and tools to make that work easier: 

• A Professional Development and Succession Planning Toolkit, including a Professional Development Dashboard template, a Talent Grid Profile, and a succession planning template to help track incumbents, projected retirement timing, urgency of replacement, and candidate readiness in time horizons. 
• A Physician Succession Planning Playbook. 

Taken together, these tools reinforce a key point: a succession plan isn’t a document you file away. It’s a plan you refresh regularly enough to trust when you need to enact it.