“Building trust and transparency between practicing physicians and administrators has the potential to .... result in improved working relationships, healthier workplaces, increased personal and organizational resilience, and improved patient-physician experiences.”

— Paul DeChant, MD, MBA¹

Imagine working in a thriving clinical environment where physicians and administrators function as a cohesive team, each understanding, respecting, and supporting the other's needs and roles to advance the mission of the practice. Too often, however, the pressures of health care create an environment of friction and misalignment. Increased patient complexity, rapid technological advances, productivity demands, financial pressures, and staff shortages can derail even the best physician-administrator teams, fueling a narrative that “they don't understand us,” which can negatively affect patient care, efficiency, and professional satisfaction.

The risks from poor physician-administrator collaboration are greater than ever, as 76% of family physicians now work in employed practice settings.² Physicians who feel unheard may resist organizational changes, while administrators who feel pressured to cut costs or increase efficiency may unintentionally undermine physician morale. The truth is that the success of one is linked to the success of the other. Collaboration isn't just a “nice to have;” it's the foundation of effective and sustainable patient care.³

Bridging this gap requires intentional effort and acknowledging that perhaps “we don't understand them” is equally true. This article invites a different story — one rooted in mutual understanding and pragmatic collaboration. It explores the often-overlooked elements that physicians need from administrators and that administrators need from physicians, and it outlines practical strategies for stronger collaboration. (This is article two in a three-part series; see "Series overview".)

WHAT ADMINISTRATORS NEED FROM PHYSICIANS

The business of medicine has become increasingly complex, and administrators have the difficult job of protecting the mission and the margin to ensure long-term sustainability. Some of their specific needs from physicians include the following.

• Engagement: While physicians naturally prefer to focus on clinical care, administrators need them to also engage with issues beyond clinical care, such as shaping team dynamics, staff development, operational workflows, and the patient experience. Physicians who are informed, visible, proactive, and willing to contribute thoughtfully to broad initiatives bring the greatest organizational value. This level of physician involvement and leadership builds culture, enhances clinic performance, and boosts morale.⁴

• Understanding of organizational challenges: Administrators must manage conflict, mitigate patient dissatisfaction, and enforce system requirements while operating within constraints such as budgets, regulations, and external pressures. When physicians demonstrate that they understand administrative challenges, it fosters trust and cooperation rather than adversarial interactions.

• Professionalism and collegiality: Administrators need physicians to model professional behavior, including adherence to clinical standards, and to hold each other accountable. This helps create a culture that is safe, supportive, reliable, and respectful.⁵ Additionally, when physicians can come together and speak with a unified voice, it helps administrators better understand their unique priorities and creates a lower-risk environment to pursue initiatives that support those priorities.

• Constructive feedback: Administrators need physicians to bring feedback in the spirit of shared improvement. Constructive feedback is timely, specific, and collaborative. When physicians also bring solutions and a willingness to engage in the process of change, this shifts the dynamic from “us vs. them” to “we're in this together.”

• Commitment to quality and outcomes: Physicians' consistent commitment to quality — including participation in quality initiatives and active pursuit of success in achieving quality metrics — is invaluable to administrators. It is increasingly tied to organizational success in this era of value-based care.

• Advocacy and partnership: Administrators need physicians to advocate for their teams and patients with authenticity. When administrative and clinical voices are aligned, change efforts are more effective. Physicians' influence can shape buy-in and build momentum across the organization.

• Administrative effectiveness: Timely documentation and completion of administrative tasks are essential aspects of physicians' professional work. While administrators are responsible for making these processes less burdensome on physicians, physicians are responsible for completing the work promptly and accurately, and for being role models for colleagues and care team members. Failure to do so can cause inefficiencies, billing complications, potential regulatory issues, and unnecessary patient complaints.

Reflection for physicians: How are you doing in each of these areas? Where do you excel, and where do you need to improve?

Reflection for administrators: What is your greatest need from your physician partner? Have you shared that with them?

WHAT PHYSICIANS NEED FROM ADMINISTRATORS

A medical practice is unique compared to other businesses because it involves a group of highly trained professionals who often provide high-stakes, complex services, and the potential for error and harm can be significant. Given this context, physicians need the following from administrators.

• A supportive and responsive environment: Family medicine is challenging enough on its own. When you factor in administrative barriers, process problems, and a lack of support, it can quickly become untenable. Physicians need highly functioning and optimally efficient workflows to support their complex clinical work, and they require a responsive system where their concerns are acknowledged and acted upon swiftly. Providing adequate resources such as appropriately trained staff, necessary technology, and administrative support helps physicians focus on patient care rather than operational hurdles. Ensuring appropriate human resources, benefits, and financial and legal support is also important but often overlooked.⁶ Administrators who demonstrate that they “have the backs” of their physicians are essential to the team-building process. They can demonstrate this through practical and emotional support during times of need, but also by making sure physicians are seen, heard, and valued.

• Shared vision and alignment: Too many organizations create a vision without physician input and collaborative planning, and then they wonder why physicians aren't “on board.” When the administrator-physician dyad is able to co-create the vision, goals, and desired outcomes, each will be more invested in achieving them. A shared understanding of how organizational and financial factors affect day-to-day operations and patient care decisions can mitigate frustration and foster engagement.

• Respect and trust: Physicians need administrators to treat them as valued partners, rather than just “providers” or employees. Physicians have insights into clinical operations and workflow that administrators cannot know. Respecting these insights is critical, and it shows up even in small ways — how leaders frame meeting agendas, how they seek input, and how they follow up on concerns.

• Clear and timely communication: Physicians need administrators to communicate not just the “what” but also the “why” behind decisions. When communication is clear and proactive, and when administrators invite dialogue, they show that they respect the clinical team's role and perspective. This open communication allows physicians to anticipate, adapt to, and even lead change, whereas a lack of transparency can breed mistrust and frustration.

• Autonomy with accountability: Physicians want freedom to use their expertise with appropriate accountability. They are more likely to engage when they have a say in how performance metrics and policies are developed and interpreted.⁷ Effective administrative leaders establish guardrails, not cages, providing structure while allowing clinical judgment and personal practice style to flourish.

• Recognition and appreciation: Like all health care professionals, physicians thrive when they feel recognized and appreciated. Administrators should regularly acknowledge clinical excellence, not just through words but through actions such as awards, recognition events, and even simple gestures of appreciation. Acknowledgment of a job well done should be personal and specific, and it does not have to be done publicly to have deep meaning and impact.

• Opportunities for professional development: Supporting physicians' professional growth — through CME activities, leadership training, and involvement in governance — can increase engagement, loyalty, and performance. Training should be practical and targeted to the needs of the individual, the organization, and the changing health care landscape, such as financial education or training on the application of the latest information technology tools.

Reflection for administrators: How are you doing in each of these areas? Where do you excel, and where do you need to improve?

Reflection for physicians: What is your greatest need from your administrative partner? Have you shared that with them?

SIX STRATEGIES FOR STRONGER COLLABORATION

Understanding one another's needs, as discussed above, is a good starting point for successful physician-administrator dyads. But these relationships also require intentionality. The following strategies provide a framework for strengthening collaboration.

1. Clarify roles and decision boundaries: Take time to explicitly discuss your partnership and roles, defining where each person takes the lead and where decisions are made jointly. Write this down in a shared document or decision grid to minimize confusion and ensure accountability. Incorporate job or task shadowing, particularly early on, to deepen understanding of roles.

2. Create a rhythm of collaboration: Establish routine meetings, such as a weekly 15-minute touch point, a monthly agenda-driven review of shared priorities, a quarterly strategy session, and an annual retreat to stay aligned on the vision, monitor goals, and deepen trust.

3. Practice mutual respect: Model transparency and respect in all interactions. Publicly acknowledge each other's contributions, creating accountability and camaraderie. Assume good intent as a default stance, and promptly address any friction in the physician-administrator relationship.

4. Implement structured feedback loops: Be deliberate about incorporating bidirectional feedback as part of your meetings, and invite informal feedback as well. Doing so supports open dialogue and early identification of problems and can accelerate professional growth. Additionally, monitor how well you are working as a team by soliciting feedback from others, using assessment tools such as 360-degree feedback.⁸

5. Establish shared performance metrics: Co-develop and regularly review meaningful metrics to ensure clarity, transparency, and collective accountability for outcomes. These should include practice-based metrics (e.g., clinical outcomes and patient satisfaction) and those related to the performance of the dyad (e.g., staff and physician satisfaction). Use these metrics not only to create accountability but also to guide improvement.

6. Agree on a conflict resolution process: Conflicts will inevitably arise. Establishing a clear, structured process for resolving disagreements swiftly and fairly ensures transparency and reinforces organizational trust. Key elements may include leading with curiosity⁹ and seeking first to understand, discussing conflicts directly but in private, and then involving a trusted third party to mediate as needed.

CHOOSE PARTNERSHIP

In this time of challenge and transformation in health care, we cannot afford for physicians and administrators to work against each other or even to simply coexist. This article is a call for both physicians and administrators to choose partnership. Learn each other's needs, align around a shared mission, and take intentional steps toward real collaboration. The truth is, we are better together.