By Patricia Sellers
February 24, 2012

Johnson & Johnson

watchers–and many insiders too–were betting that Sheri McCoy would be the health-care giant’s next CEO. This week, the guy, Alex Gorsky, got the job instead.

What happened?

The contest to succeed chief Bill Weldon, which started in earnest two years ago, was extremely close between the two vice chairmen, according to my sources close to J&J. While some have speculated that the board favored Gorsky, 51, because he’s grounded in sales–while McCoy, 53, began in R&D–the debate ran deeper than this. It mattered greatly to the board, as it turned out, that J&J has had product recalls and manufacturing problems galore. Gorsky’s No. 1 strength is viewed to be execution. While he and McCoy jockeyed for the lead in the race, his talent played best into J&J’s prescription for its next CEO.

J&J needs a tough boss, and Gorsky, who will take over in April, is trained in that regard. A West Point grad, he spent six years in the U.S. Army, serving as an Army Ranger. Starting in pharmaceutical sales in 1988, he earned his MBA at Wharton while climbing the corporate ranks. He left J&J to lead Novartis’

U.S. pharma unit, returned, and went on to head the medical device and diagnostics business, his current job. In that business, which brought in revenue of $25.8 billion last year, he earned points for digging into manufacturing and supply-chain troubles.

If J&J were not so riddled with execution problems, McCoy might have won the race to the top. She leads the bigger businesses–pharma and consumer, which generated combined sales of $39.3 billion last year–and also oversees IT. But her main strengths are seen to be a collaborative style and finesse at culture-building. A mother of three sons, she talks openly about juggling career and family and urges managers to pay attention to both. Trained as a chemical engineer and entering J&J through the labroom 30 years ago, she moved into marketing and then ran baby products, wound care, and surgical care. Overseeing 60,000 employees today, she ranks No. 10 on Fortune‘s Most Powerful Women list.

Given the circumstances, will McCoy leave J&J to become a CEO elsewhere? She’s not talking. (“As you might imagine there is a lot happening right now and I am not in a position to connect. But I very much appreciate you reaching out,” she wrote to me in an email last night.) Some imagine that she would be a candidate to lead medical-device maker Stryker

or Avon Products

, whose board is looking to replace CEO Andrea Jung. Makes sense, and she may well consider such gigs if she’s determined to be a Fortune 500 CEO.

But the reality is, McCoy’s current charge at her lifetime employer is a much bigger job than she would have at either of those companies. She’s known to get along with Gorsky, her new boss, so McCoy may end up deciding that she is most powerful right where she is.

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