Physician-administrator relationships: A delicate balance

Mackenzie Bean (Twitter) – Thursday, August 10th, 2023

Hospital administrators and physicians must maintain strong working relationships to ensure a healthcare organization is functioning effectively. However, this is sometimes easier said than done, considering the two stakeholders’ different accountabilities and perspectives.

Becker’s asked healthcare leaders to share one misunderstanding that persists between administrators and physicians. Responses were collected Aug. 8 and are listed in alphabetical order.

Editor’s note: Responses were lightly edited for length and clarity.

Irene Agostini, MD. Former Chief Medical Officer of University of New Mexico Hospital (Albuquerque). There is a persistent misconnect that we are all on the same team trying to take care of patients. For academic health centers (not-for-profit/safety net organizations), it’s a lot easier to understand this. In the for-profit world or the nonprofits (with CEOs with massive salaries), it’s a bit harder because physicians really become the moneymaking cog for the organization, which is soul sucking and creates burnout for those physicians.

Timothy Babineau, MD. Principal at ECG Management Consultants and Former President and CEO of LifeSpan (Providence, R.I.). That we are not on the same team. That physicians and administrators have different goals. That’s simply not true. It’s all about working as a team to take the best possible care of patients. But administrators and physicians have different roles to play.

Mauricio Collada, MD. Neurosurgeon at Capital Neurosurgery Specialists (Salem, Ore.). The pressures regulatory agencies place on each other, and how their seeming conflicts stem from overregulation and centralized policies. They are overwhelmed reacting to new regulations and mandates with threats to reimbursement, so [there is] little time to form useful effective alliances.

Divya Joshi, MD. Former President of Johns Hopkins All Children’s Specialty Physicians (St. Petersburg, Fla.). While aligned in intent to care, the two “camps” of physicians and administrators don’t always speak the same language. Physician focus is more on investing in tools to give them time with their patients and tools to provide cutting edge treatments, while administrators focus on growth, market share, patient volume and the bottom line. Explaining needs, drives and motivation to each other would help a lot with aligning everybody.

Sue Ann Jantz. Administrator of Cottonwood Pediatrics (Newton, Kan.). Hospital administrators know intellectually that their hospital runs 24/7, but they only work 40 to 50 hours a week, so they never see or know what happens at other times. Even if they are told about it, they still don’t know what it means to work at 2 a.m. They are asleep, and physicians and nurses know it. It’s like there needs to be two to four administrators taking 12-hour shifts around the clock.

Robbie Miller, MSN, RN. Vice President of Health Systems Integration of Healthcare Outcomes Performance (Phoenix). There are more and more clinicians in hospital leadership, but physicians believe that the decisions are being based solely off of financial outcomes in lieu of clinical outcomes. We, as clinical leaders, make every decision with a clinical mindset, but also must keep the hospital doors open.

Sean Nix, DO. Trauma Medical Director at Saint Luke’s Health System (Kansas City, Mo.). For employed physicians: Charting is part of our workday and should be considered when calculating FTE requirements.

Lisa Nellums. Credentialing Specialist at University Houston College of Medicine. We actually want and try to make your life easier, but administrative compliance guidelines must also be followed.

Marianne Schaffer. Manager of Coding and Clinical Documentation Integrity at Beacon Health System (South Bend, Ind.). One misunderstanding is that many physicians believe administrators only have CDI departments send physicians queries to make more money for the hospital. CDI ensures we are paid appropriately because the final record is a complete and accurate representation of services provided and that our quality metrics are accurately represented to the public. No hospital CEO or CFO is out on the golf course dreaming up ways to scam the payers.

Teresa Stephens, PhD, MSN, RN. Nurse Educator and Committee Chair of the Coalition for Nurse Well-Being. I believe the one (major) misunderstanding that persists between hospital administrators and healthcare professionals (physicians and nurses) is the purpose of their existence. A conflict in values drives much of the chaos, burnout and moral distress leading to many of our current crises. Healthcare professionals are usually driven by an outward-focused purpose — to improve the health and well-being of those we serve. Administrators are often driven by a purpose to increase revenue, which often leads to a sacrifice of the quality of care.”

Gary Wainer, DO. Former Chief Medical Officer of Northwestern Medicine Physician Partners. That we both have the same objectives (patient care as primary objective) as each other. Administrators rightly have their eye on the checkbook, but it needs to be done in true collaborative fashion.