October 1, 2019
3 min read

STS News, Fall 2019 — A great majority of cardiothoracic surgeons have formal financial ties with health systems. Be it through a professional service agreement or a fully employed arrangement, the surgeon-administrator relationship is more crucial to the delivery of health care now than it was in the past. STS Workforce on Practice Management member Heather Smith examines this relationship.

Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management

Heather Smith, RN, MJ
Business Director, Divisions of Cardiovascular, Thoracic, Vascular, and Transplant Surgery
University of Pennsylvania, Philadelphia

Just as a good physician-patient relationship can improve patient outcomes, a good physician-administrator relationship can improve the work environment and ease employee burnout.

As a result, the importance of cardiothoracic surgeons and their administrators working as part of a team cannot be underscored enough. 

A high-performing team comprises people who share a common goal, a pathway to achieve that goal, and trust among team members. That trust is built in part by understanding each other—knowing what matters and why, as well as being able to openly communicate, particularly at times of disagreement.

The relationship between cardiothoracic surgeons and administrators has evolved over time. In the past, particularly in the traditional, non-academic private practice setting, there was no formal relationship. Surgeons practiced at the hospital, and administrators primarily were responsible for the smooth functioning of the physical plant and the employees. Surgeons may have practiced at multiple hospitals; in fact, hospitals often competed for a surgeon’s “business.”

In order to survive and thrive in today’s employment environment, surgeons and administrators must learn about the other’s world and help educate each other.

With the advent of surgeon employment by hospitals and health systems, the relationship has progressed to one where there is much more interaction, which the surgeon may perceive as an intrusion. If the relationship has not been developed into one with the components of a high-performing team, it can contribute to surgeon and administrator dissatisfaction and burnout.

Continuous conflicts can threaten the surgeon-administrator relationship and a healthy working environment. Surgeons may find themselves facing myriad questions about their practice, which they are unaccustomed to answering. Sometimes, these questions are asked by someone who seems to have no knowledge of a surgeon’s world and makes a surgeon feel as if he or she is being measured only in terms of work relative value units (wRVUs) or case numbers. This can lead to frustration and may make the surgeon feel ill-prepared to function as a business leader. On the other hand, administrators may be frustrated if they can’t get answers or may feel intimidated by a lack of clinical knowledge that hinders their ability to communicate with surgeons.

Education Helps Improve the Relationship

In order to survive and thrive in today’s employment environment, surgeons and administrators must learn about the other’s world and help educate each other. Understanding the language, as well as the thought and decision-making processes the other uses, should inform how questions are asked and answered. More surgeons are obtaining MBAs and many administrators have clinical backgrounds, but formal education will not be the norm in most cases. The ability to explain the finance of health care in a way that is meaningful to a surgeon must be in every administrator’s repertoire. Administrators must make time to learn about the surgeon’s clinical practice, and the surgeon must help. A deep understanding of what patients, families, hospitals, and practice plans demand of surgeons is necessary.

As the surgeon and administrator develop a stronger and more respectful relationship where both parties complement each other’s strengths and weaknesses, the benefits will become more apparent and include an enhanced surgical practice, achievement of organizational goals, and a healthy work environment, which will lead to better outcomes for our patients and our health care systems.