Background: Little is known about how physicians perceive their leadership identity and how this shapes their leadership behaviors. This study examines the relationship between leadership identification, leadership behavior, and leadership-related outcomes. Methods: A cross-sectional survey was conducted among consultant radiologists in German university hospitals from January to November 2023. Leadership identification, leadership behavior (task orientation, relationship orientation, change orientation, and external orientation), workload, and outcome measures (staff engagement, organizational commitment, and perceived team performance) were assessed with validated self-report instruments. Pearson correlation coefficients (r) were calculated to examine relationships among the variables. Mediation analysis examined whether leadership behavior mediates the relationship between leadership identification and outcome measures. Results: Consultant radiologists identified primarily as physicians (median = 60%, IQR: 40– 80%), followed by leaders (median = 45%, IQR: 30– 60%), with a negative correlation between physician and leadership identity (r = − 0.34, p < 0.01). Participants reported moderate to high levels of exhaustion, with feeling physically overwhelmed receiving a median score of 4 (IQR: 3– 4) on a 0– 4 scale. Notably, only 25.8% of participants reported having sufficient time for leadership tasks, despite holding leadership responsibilities for a median of 75.5 months (IQR: 31.5– 261). Conversely, leadership identity negatively correlated with workload (r = − 0.30, p < 0.05). Leadership identification significantly predicted leadership behavior (β = 0.27, p < 0.001), which, in turn, was positively associated with staff engagement (β = 0.30, p < 0.009), confirming an indirect effect (CI: 0.0014– 0.0162). However, leadership identification did not directly predict staff engagement (β= 0.001, p = 0.94). Conclusion: Stronger leadership identification is associated with lower perceived workload and greater engagement in leadership behaviors, which may serve as a coping mechanism for managing leadership-related demands. However, its impact on staff engagement operates through the leadership behaviors rather than through identification alone. Plain Language Summary: Doctors in university hospitals are often asked to take on leadership roles alongside their medical work. However, many doctors see themselves mainly as physicians and less as leaders. This can create difficulties in balancing clinical responsibilities with leadership duties. We carried out a nationwide survey of consultant radiologists working in German university hospitals to understand how they see themselves in relation to leadership, how this affects their leadership behavior, and what impact it has on their work and their teams. Over 100 radiologists completed our survey. Most participants said that they strongly identified as physicians, while their identity as leaders was weaker. Only about one in four reported having enough time for leadership tasks, and many described high workloads and feelings of being overwhelmed. Interestingly, radiologists who identified more strongly as leaders tended to feel less burdened by workload. Leadership identity was also linked to more active leadership behaviors, such as supporting team members and promoting change. These behaviors, in turn, were associated with higher levels of staff engagement. Our findings suggest that simply calling doctors “leaders” is not enough. It is the combination of identifying as a leader and actively showing leadership behaviors that makes a difference for staff motivation and team performance. Encouraging early development of a leadership identity in medical training, alongside providing time and support for leadership activities, may help doctors to thrive in these roles and improve staff engagement. Keywords: leadership, radiology department hospital, health services administration, professional role, self concept, surveys and questionnaires, cross-sectional studies, Germany, academic hospitals, leadership identity
Nawabi et al. (Sun,) studied this question.