This tension is structural. Understanding it is the first step to working with it.
The Nature of the Gap
There is a structural gap in most health systems between what physicians want from the organization and what the organization can provide. The gap isn’t primarily about money, though money is part of it. It’s about control, information, and the different ways that physicians and administrators are accountable for outcomes.
Physicians are accountable for what happens to individual patients. Their professional identity is built around clinical judgment and the doctor-patient relationship. They operate best when they have the resources, the information, and the autonomy to make good clinical decisions.
Health systems are accountable for what happens across populations of patients, subject to financial constraints, regulatory requirements, and operational realities that don’t always align with what any individual physician would choose. Those are not bad priorities. They’re just different ones.
Why the Standard Approaches Fall Short
The standard approach to this tension is a physician liaison or a physician engagement program: a structure designed to communicate between the two sides and surface concerns before they become conflicts. Those programs are useful but they don’t close the gap. They manage it.
The gap also doesn’t close through physician leadership development programs, which attempt to bring physicians into administrative thinking. Those programs produce administrators who happen to be physicians. The physicians who don’t go through them are still operating from a clinical frame, and they’re still the majority.
The approaches that fall shortest are the ones that try to solve the gap by having one side adopt the other’s frame. Physicians don’t need to think like administrators to collaborate effectively. Administrators don’t need to think like physicians. They need to understand each other’s constraints well enough to find solutions that work within both.
What Physicians Actually Need to Hear
In Eric Cecava’s experience, what physicians most need to hear from administrators is honest information about the constraints the organization is working within. Not justifications or policy references. The actual situation: what resources exist, what the competing demands are, and what the decision-making process looks like.
Physicians are trained to work with incomplete information under time pressure. They do it every day. What they don’t tolerate well is information that feels incomplete because it’s being managed. When they sense that the full picture isn’t being shared, trust breaks down, and the gap widens.
The other thing they need is follow-through. Physician engagement programs that collect concerns and don’t act on them are worse than no program, because they create a record of promises not kept. If a physician raises an operational issue and nothing happens, the next conversation is harder than the one before it.
How to Close It Without Winning
The frame Eric Cecava tries to hold is that the goal is not to win the conversation but to find a path that works for patients, which is what both sides actually care about. Holding that frame makes it possible to have honest disagreements about means without the conversation becoming adversarial.
Closing the gap, to the extent it can be closed, requires sustained operational work: shared metrics that both physicians and administrators are accountable to, regular forums where operational problems get worked through together, and leadership that treats physician concerns as operational intelligence rather than friction.
The gap doesn’t disappear. But organizations that manage it well perform better than those that don’t. The work is worth doing even when the conversation is hard.