Op-Ed: Wayne Brackin, President & CEO of KIDZ Medical Services
There’s no doubt that administrative responsibilities have become overwhelming. Administrative expenditures at U.S. hospitals grew 87.2 percent from 2011 to 2023, outpacing the 75.4 percent growth in direct patient care spending.
As regulatory and compliance demands continue to rise, healthcare systems, hospitals, and physician practices increasingly rely on physicians to step into administrative roles. While there is an obvious tendency for the C-suite to gravitate toward physician leaders with the highest level of clinical credibility, these doctors are often very busy seeing patients, making it difficult to balance the two important roles.
While it makes sense for physician leaders to dedicate significant time to administrative tasks, withdrawing from patient care can have adverse effects. Keeping medical staff privileges, for example, requires a certain level of patient-facing volume. The loss of clinical privileges does not go unnoticed, and let’s face it, courtesy privileges are not the same thing.
Physicians are also more receptive to corrective feedback when it comes from a leader whose clinical skills they recognize and respect. Physicians will trust another respected physician more than a “suit” in management, as they may suspect that management is more concerned with business motives than with ensuring clinical quality.
This is one of the primary reasons why, once a physician administrator stops seeing patients, their credibility begins to diminish relatively quickly. Colleagues begin treating them as management, severing the connection built over years of professional interaction, patient care, and time spent in the trenches together.
To combat this erosion of trust, it might be wise for health systems to negotiate a hybrid arrangement that allows physician administrators to continue providing patient care, even if for only a relatively small percentage of time. This is particularly important for surgeons whose expertise often relies on a consistent volume of procedures and experience with the latest innovations and technologies. In another example, a renowned orthopedic surgeon found that maintaining sufficient OR time conflicted with administrative duties, so he shifted to evaluation and diagnosis while referring surgeries to younger partners—a smart compromise that preserved his expertise and clinical standing.
One of the best physician executives I ever hired was a subspecialty radiologist who chose to continue his clinical practice to maintain his standing with his colleagues and stimulate his professional development. He spent approximately 20 percent of his time providing radiology interpretations and interacting with colleagues about patients’ status. He frequently told me that when he called a physician with a report, they’d be pleasantly surprised that he was still in the patient care game. He found that to be helpful in all future interactions.
A practical solution is the dyad model, pairing an experienced administrator with a respected physician to create balanced leadership. Many people can develop the background needed to succeed in administrative leadership. Far fewer have the rare discipline required to complete pre-med, medical school, residency, and fellowship. That hard-earned credibility among peers matters, and it shouldn’t be given away lightly.
As administrative pressures mount, I’m hopeful we’re nearing a shift—one that lets us use our resources more wisely while keeping patient care at the center of everything we do.
