Developing governance knowledge and skills of physicians: importance and recommended action

The Canadian health system faces profound challenges, from emergency department closures to growing patient wait times and significant physician shortages. These systemic vulnerabilities demand robust leadership and advocacy, roles in which physicians are uniquely positioned to excel. Yet, despite their pivotal role, physicians often lack formal training in governance—the policies, processes, and decision-making frameworks that shape healthcare delivery. This commentary underscores the urgent need for governance education as a core component of medical training. It explores how governance knowledge enhances physicians’ ability to navigate organizational complexities, advocate for equitable policies, and contribute to system-level improvements. Through real-world clinical examples, the discussion highlights the relevance of governance in areas such as resource allocation, patient safety protocols, and the ethical integration of artificial intelligence into care. We propose a four-layer framework for governance education, spanning foundational knowledge, operational applications, system navigation, and mentorship. Teaching strategies are provided for each layer to bridge knowledge gaps at both individual and systemic levels. Integrating governance into medical education and leadership development equips physicians to address the increasing complexity of healthcare delivery. By fostering these skills, we can empower physicians to lead, innovate, and advocate for sustainable improvements in patient outcomes and health system efficiency.