Span of control may be a critical structural condition for ethical leadership. According to social learning theory, emulation and vicarious learning processes are mechanisms through which ethical leaders enhance ethical commitment among employees. However, if the span of control (number of employees per manager) is too wide, ethical leadership can be difficult to practice due to a more distant relationship between manager and employees. Using a mixed method design with survey data and interviews, we analyze the relationship between span of control and ethical leadership among doctors in Danish hospitals. Survey results from the study show no statistical association between span of control and clinical directors’ self-reported ethical leadership. Interviews with employees and managers support this finding by showing how ethical guidance unfolds through social exchange relationships where employees can act as moral professionals. This suggests that span of control is not a critical structural condition for intending and perceiving a high level of ethical leadership. Span of control is indirectly relevant through the perceived distance between manager and employees. The findings thus enhance our understanding of how ethical leadership takes place in complex, professionalized public organizations. This might inspire managers to lower the organizational power distance and promote professionalism.