The leap from clinical practice to healthcare administration is profound. For many physicians, the decision to explore leadership is driven by a desire to have a broader impact. There is an idea of shaping systems that influence care delivery rather than individual patient outcomes. Yet, the migration from bedside to boardroom is not linear. Early experiences as a fellow in healthcare administration, leadership, and management (HALM) reveal a steep learning curve, marked by a wide array of unfamiliar concepts, high-stakes decision-making, and organizational politics.
This article reflects on those early moments of transition focusing on lessons learned, challenges faced, and skills deemed essential for success. Drawing from personal experiences, this piece offers insight for clinicians pursuing leadership paths and for administrators interested in better integrating clinical voices into executive teams.
The Business of Healthcare: A Foreign Language
Physicians are well-versed in patient safety, quality initiatives, and clinical decision-making. These areas are largely integrated in medical school and graduate medical education. But the fundamentals of healthcare business operations, such as revenue cycle, capital planning, community needs analysis, and supply chain logistics are rarely covered in formal medical training. Early administrative fellowship meetings often feel like decoding a foreign language. Acronyms are abundant during daily routine discussions: EBITDA, FTEs, ALOS, KPIs, and WHPUOS (EBITDA = earnings before interest, taxes, depreciation, and amortization; FTE = full-time equivalent; ALOS = average length of stay; KPI = key performance indicator; WHPUOS = worked hours per unit of service). Concepts such as return on investment or payer mix can be cumbersome at first.
A fellow’s initial exposure to hospital finance may include topics such as the following:
Operating margins: Understanding how healthcare organizations generate (or lose) revenue.
Service line management: Evaluating the profitability and efficiency of various clinical departments.
Budget variance reports: Analyzing why projected and actual expenditures differ.
The volume and pace of learning during this period often feel akin to the start of medical school, which many describe as “drinking from a fire hydrant.” The information is dense, layered, nuanced, and interconnected. Fellows without any business exposure must adapt quickly, relying on self-study, mentorship, and continuous curiosity to stay afloat.
Governance: Who Does What?
Another jarring transition is being thrust into governance structures without a clear understanding of how corporate decisions are made or who the key stakeholders are. Suddenly, you are sitting in a boardroom discussing multi-million-dollar strategic initiatives, business plan development, or regulatory compliance without a clear sense of everyone’s role and how each individual affects change.
Healthcare governance involves layers of authority:
Board of Directors: Sets organizational vision and oversees executive performance.
Executive leadership: Responsible for corporate and clinical management.
Clinical committees: Interface between medical practice and policy.
As a fellow, the amount of influence and voting voice may vary, but there is an expectation that the fellow will observe, learn, and contribute when asked. For many clinicians, this can be unsettling. Physicians are trained to be decisive and vocal in patient-care settings. There is a great contrast with governance, which often requires patience, diplomacy, and timing. Understanding the multitude of roles, responsibilities, and expertise amongst a leadership team is crucial.
From the Bedside to System-Level Care
The core of this transition is graduating from caring for patients to caring about systems that care for patients. At the clinical level, results of one’s actions are almost instantaneous. A treatment is successful, a patient improves, and a chart is signed. In administration, the impact is much less direct, and often delayed. A balance must be achieved between qualitative results such as compassion, recovery, and communication to more quantitative metrics such as revenue, length of stay, and utilization rates.
For example:
Instead of performing a single patient’s medication reconciliation, you may be analyzing trends across thousands of patient encounters to implement policy aimed at reducing medication errors system wide.
Instead of resolving one patient’s discharge delay, you might work with case management leaders and technology teams to redesign clinician coordination and streamline the discharge planning workflow.
This shift in approach requires a reframing of one’s purpose. One must learn to appreciate the value of influencing policy, process, and structure. Clinical expertise does not automatically translate into operational effectiveness, and humility is a significant component in making the shift. The nuance is learning how to communicate clinical priorities in ways that align with organizational goals. Success is no longer largely predicated by being the most intelligent person in the room. One must learn to ask the right questions, defer to subject matter experts, and think broadly about risk, scalability, and sustainability.
Qualities to Foster Success: Communication, Mentorship, and Learning
There are three competencies that will have a significant impact on bridging the clinical to administrative divide:
Communication: Translating clinical concerns into operational or financial language is essential. Using clinical experience to illustrate a patient safety issue as both a quality concern and liability risk can align it with executive priorities. Active listening, thoughtful questioning, and productive participation help build credibility.
Mentorship: Having mentors in both clinical and administrative roles is invaluable. Clinical or academic mentors can affirm your identity and provide a foundational perspective during times of turmoil. Administrative mentors help to demystify the ideas of executive healthcare leadership while being a liaison and advocate to the executive team. They often are able to identify individual shortcomings and areas of bias that lead to improvement and cultivate success.
Continuous learning: The fellow’s experience will be akin to their first year in residency. Instead of Harrison’s or Tintinalli’s, they will study financial statements, read leadership literature, attend business meetings, and seek feedback on leadership strategies. Knowledge can be found at the intersection of perplexity and motivation.
A Culture of Trust: The Cornerstone of Interdisciplinary Leadership
Success in healthcare administration does not depend solely on what you know. It heavily involves trust and responsibility within team dynamics. Physicians entering leadership must build meaningful relationships across a multitude of disciplines such as finance, nursing, quality, operations, and technology. There must be respect for others’ expertise to foster trust and understanding.
This trust is built through:
Consistency: Being dependable and following through on commitments.
Humility: Acknowledging when you do not have an answer.
Collaboration: Honestly inviting input and aligning with shared goals.
Administrators want to see that clinicians are willing to engage in the work of leadership. When physicians understand the operational realities of delivering care in today’s ecosystem, they become thoughtful advocates for sustainable change. This culture of mutual respect enables physician leaders to be more than just stewards of great clinical care. It allows them to influence policy, drive innovation and be the critical link between frontline staff and executive teams.
Conclusion
The journey from clinical practice to healthcare administration is one of wandering transition. It is disorienting, humbling, and invigorating. Like medical school or residency, the early days in this fellowship can feel overwhelming, with new terminology, shifting identities, and the pressure to perform. With strong communication, impactful mentorship, and a relentless effort toward learning, physicians can survive this evolution and become a transformative force in today’s healthcare landscape.
Acknowledgment: Special thanks to Dr. Matt Owens, Ronda Lehman, Nancy Rampe, Stacy Schulte, Chris Landin, Dr. Derek Davis, hospital executive leadership, and the graduate medical education teams at Mercy Health St. Rita’s Medical Center for the opportunity, continued encouragement, trust, and support.