Dr Sheila Adam, a senior member of the NHS executive, is shortlisted for the post of government chief medical officer. The incumbent, Sir Kenneth Calman, retires in September.
The job, once described by Sir Kenneth as the "epicentre of stress", carries a starting salary of pounds 110,000.
It involves advising the Government on all aspects of public health, including how to deal with scares such as the BSE crisis, and requires someone who combines leadership and diplomatic skills with sufficient independence of mind to challenge ministers.
Dr Adam, a former director of public health for North Thames, is thought to have all three attributes.
She is described in a recent article in the British Medical Journal as having a "modern feel", as having won plaudits for her careful handling of changes to mental health services and as someone who would make a "feisty" chief medical officer. Colleagues describe her as "passionate" about public health and her youthful dabbling in the left-wing Medical Practitioners Union could endear her to Old Labour ministers such as Frank Dobson, the Secretary of State for Health.
But her greatest advantage may be her gender. A woman in the top post in medicine would help the drive to get more women into senior positions in the public sector.
She faces strong competition. Professor Liam Donaldson, widely tipped as the favourite, is the director of the Northern and Yorkshire NHS region. He is a high-flyer with the mandarin qualities necessary to thrive in the civil service.
He is seen as having the gravitas for the job - a quality that Dr Adam may lack - but his "slightly severe attitude", as one colleague described it to the BMJ , could count against him. Dr Graham Winyard, also an NHS executive insider and Dr Adam's boss as director of the health services directorate, has extensive experience of the department of health and is seen as a capable manager.
The outsider is seen as Professor Stephen Holgate, professor of immunopharmacology at the University of Southampton.