1. Clinicians as healthcare
administrator
Dr. H. Sudarshan Ballal MD
Medical Director & Chairman Medical Director - MHEPL

2. Gist of talk
 Introduction
 Ingredients of a successful hospital
 Advantages and disadvantages of clinician administrator
 Difficulties in transition
 Ideal situation
 Conclusion

3. Who should lead the Hospital?
OR
MD MBA
A billion dollar question

4. Introduction
In the early 20th century, many hospitals were run by clinicians.
Today the vast majority of them are run by non-clinicians like
MBA‟s & MHA‟s.
The debate, clinician vs. non-clinician as an administrator of a
hospital was succinctly covered by the Fortune Magazine in
1970 and the Editorial declared……………
"The time has come for radical change ... The management of medical care
is too important to leave to doctors who are, after all, not managers to
begin with."

5. Introduction
However, the pendulum now seems to be swinging more towards
the „Clinician Leader‟ as many believe that HEALTHCARE IS TOO
IMPORTANT TO BE LEFT TO NON CLINICIANS

6. Ingredients of a successful hospital
• The most important person in the healthcare industry is „THE
PATIENT‟ and the big question is how do we attract and take
good care of this VVIP.
• In my opinion the ingredients neeeded are
• Doctors
• Service
• Infrastructure & Support system
• Brand name

7. Can clinicians afford not to be administrator of
hospitals
Clinicians used to run hospitals.
Now they run behind administrators with concerns which the
administrators think are outrageous demands and for more….
money, space and people.
They used to take care of patients the way they were trained.
Now they are told how to take care of patients by people who
never entered the portals of any medical college.

8. Can clinicians afford not to be administrator of
hospitals
Clinicians are told they “DO NOT SEE THE BIG PICTURE”.
The big question really is, CAN THEY AFFORD NOT TO BE
TAUGHT TO SEE THE BIG PICTURE

9. Disadvantages & advantages of
a clinician being administrator

10. Disadvantages of Clinician-administrator
• Not well versed with the complexities of
business & financial issues of today's
health care business
Case Mix

11. Disadvantages of Clinician-administrator
• 'God complex' still exists and fail to
understand the changing equations of doctor
/ patient relationship, new business
development needs & strategies.
• May favor investments based on personal
preferences rather than on hospitals
business interests.

12. Disadvantages of Clinician-administrator
• Resist change (HIS)
• Egoistic – feel they are a cut about the
rest. Need not follow the rules applicable
to the rest of the employees.
• Valuable clinical time may be lost for
Administration issues (A constant patient
complaint)
• Very difficult to hire a 'Star clinician' but a
lot easier to hire a Administrator. Busy
clincians find it difficult to change their
practice locations frequently.

13. Disadvantages of Clinician-administrator
 Becoming unpopular with colleagues as a result of difficult
service decisions made. Being considered a „TRAITOR TO THE
PROFFESION‟.
 Being in the position of having to critically appraise colleagues‟
clinical practice and take action when necessary.
 The job can sometimes be overwhelming, with the possibility of
burnout or ill-health if not tackled appropriately in time.
 Problems in being accepted by non-medical managers.

14. Advantages of a clinician-administrator
 Understands patients better since they are their life line.
 Understands doctors better. Doctors would be more
comfortable and will have more trust in dealing with a fellow
clinician as administrator.
 Continuity of service (very difficult for a busy clinician to
change locations)
 Will understand the procedures better and could have valuable
contribution in coming up with feasible business strategies and
expansion.

15. Advantages of a clinician-administrator
 Being in a position to attract resources for developments.
 Having a major influence on developments and setting of
standards of clinical care.
 Financial incentives and awards.
 Gaining status within the trust.
 Working on the broader canvas of the organization.

16. Difficulties in transition
from clinician to administrator
 Major conflict is between having to give priority to the objectives
of the organization versus the objectives of individuals.
 Difficulties with respect to lack of knowledge about the concepts of
management and lack of knowledge about technical matters, such
as statistics and finance.
 Coping with conflicting demands.
 Dropping the traditional case-by-case approach and adopting a
global view of the organization.
 Loss of acceptance by clinical peers, combined with lack of
acceptance by new managerial peers.
 Experience and formal training in management.
 Major political dimension to management.

17. Ideal administrator of a hospital
Is it necessary to be a MD/MHA of MBA to be a hospital
administrator?
Probably not.
 There are many fine hospital executives who possess neither
degree. But I do think that all administrators should be
required to work closely with a panel of the hospital's
clinicians, focusing on how they can collaborate to improve
patient safety and health. Clinicians also should have a say in
how hospitals invest their surpluses.

18. Ideal administrator of a hospital
Is it necessary for a hospital administrators to be licensed?
 Hospital administrators should be licensed. Doctors are
licensed, Accountants are licensed, dentists are licensed.
Common sense dictates that someone running a hospital
should be required to pass exams showing, not just that he or
she knows something about "management and
administration," but that he/she has a solid grounding in what
matters to patients-how to reduce errors and lift the quality of
care.

19. Ideal administrator of a hospital
 In my opinion, there seems to be a barrier between the
medical fraternity and hospital administration.
 It really does not matter who the administrator is as
long they take the medical fraternity along with them in
the decision making process.
 Ultimately we all work for the most important person in the
health care scenario “THE PATIENT”.

20. The Gap between Clinicians & Managers

21. Mending The Gap!

22. Conclusion
 The vast majority of hospitals today are led by non-clinicians.
This is in sharp contrast to the turn of the 20th century, when
most of the hospitals were clinician led.
 As the pendulum swings back towards the clinician leader,
there is a strong and appropriate opportunity for clinicians to
reinsert themselves into a leadership role.
 In fact the time has perhaps never been more appropriate than
today.

23. Conclusion
 In the current health care system that is complex, troubled,
and challenging, the clinician leader brings in a unique set of
skills to the business of medicine.
 The successful physician leader, however, must understand the
business of medicine as well as or better than the practice of
medicine.
 Training, developing, and equipping our future clinician leaders
with the necessary skill sets will be one of medicines' many
challenges in the future.

24. Conclusion
 In conclusion, I feel it really does not matter who runs the
hospital as long as there is no feeling of Us vs. Them but
everyone should work as „WE‟ the team.

25. THANK YOU