This report describes the findings and implications from a study of Medical Directors within California’s community clinics field. It looks at Medical director’s career pathways and their current job satisfaction, the most significant rewards and challenges of their leadership position, the extent to which they share leadership with others and important sources of support and training. It is part of a larger compendium of studies that provide a snapshot of clinic leadership within the state and important implications for consideration by clinic leaders, their partners, funders and other community clinic stakeholders.