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  • Writer's picturePaul DeChant MD, MBA

Crossing the Administrator Clinician Chasm

Updated: Nov 15, 2019

What will it take to bridge the administrator clinician chasm? And does this really matter? In my humble opinion, the distrust between upper management and front line clinicians is the most important issue driving burnout today.

As an update on the progress made on reducing clinician burnout over the past two years since our book on the subject was published, there have been a number of positive changes.

Unfortunately, we have yet to truly move the bar on reducing burnout, or so it seems from a variety of surveys as well as blog posts and articles in healthcare circles.

One of the most important problems driving burnout is the disconnect between administrators and physicians. We have made minimal progress on crossing the administrator clinician chasm.

The bigger issue here are the administrators, not the clinicians. Why do I say this?

Firstly, I have a unique perspective. I've been both a clinician and an administrator (who as CEO of a 300-physician medical group was seen as having "gone to the dark side" by the docs), and now work as a consultant and executive coach in healthcare provider and payer organizations.

Secondly, leaders need to lead. Clinicians experiencing burnout may approach the clinician-administrator relationship with some degree of cynicism. A leader's job is to meet the physicians where they are and offer a way to make things better.

Of note, I received a comment on last week's post from a physician leader that shocked me. I had recommended my favorite first step to improve administrator-clinician relationships -- administrators shadowing clinicians.

This physician told me that he was mentoring an MHA fellow who had shadowed him. But her MHA program faculty discouraged her from doing so. They informed her that she would receive no credit toward her degree for her time shadowing a physician, stating there was no need for her to have clinical experience in order to be a hospital administrator.

It's getting harder to shock me these days, but this one did so big time. In what other industry would the leadership assume that they don't need to understand operations in order to run a company? Especially a company is generating billions in net revenue and, as Peter Drucker famously stated, "Healthcare is the most difficult, chaotic, and complex industry to manage."

If indeed this is a common approach in business schools, discouraging MBA/MHA students from learning how operations work, it's no wonder that there is such deep mutual distrust causing the administrator clinician chasm.

I'm curious:

Have you seen similar opinions among business school faculty, or among working administrators?Have you had positive or negative experiences with administrators shadowing clinicians, either as an administrator or as a clinician?Do you have thoughts about how to make shadowing work better? What are your thoughts on crossing the administrator clinician chasm?



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