Who Should Run the Hospital?

A couple generations ago, a good percentage of hospitals were run by physicians; now, less than 5% of hospitals have a physician in charge. Instead, there has been a trend to hire those with business or management savvy, and we started favoring MBAs and degrees in hospital administration. But who should run the hospital? The purpose of a hospital, I would venture to simplify, is to provide medical care to patients and a community. But the inner workings of a hospital are highly dependent on its financial acumen, internal organization, and relationship to outside entities like regulators and insurance companies. A leader does not need to know how to diagnose pneumonia, start an IV, or interpret the latest clinical trial. Indeed, medical knowledge is less useful than communication skills, financial strategy, decision making, operations assessment, human resources management, or information technology know-how. But we must not forget the patient. And that's why my absolutely biased opinion is to favor the physician leader. Doctors do not forget the patient. They don't let other goals - financial, regulatory, marketing, strategy - take priority to patient care. Our 7+ years of medical school and residency training ingrain within us that responsibility and privilege of caring for the patient in a way that is not reinforced in business school or graduate training. Physician leaders are truly rare and few doctors have all the other essential qualities of running a hospital, but that simply means we have to train and encourage more physicians to pursue leadership positions.