Doctors make the best managers, study indicates

BMJ 2011; 343 doi: (Published 29 July 2011) Cite this as: BMJ 2011;343:d4870
  1. Zosia Kmietowicz
  1. 1London

Hospitals run by doctors outperform those run by managers, indicates a study in Social Science and Medicine (doi:10.1016/j.socscimed.2011.06.025).

Amanda Goodall, a senior research fellow at the Institute for the Study of Labour in Bonn, looked at the top 100 US hospitals in three specialties—cancer, digestive disorders, and cardiovascular care and surgery—as ranked in 2009 by the well established US News and World Report league tables, which look at performance in 16 specialties. She then ascertained whether the hospitals’ chief executive officers were doctors or professional managers.

She found that a qualified doctor was the chief executive in 51 of the top 100 cancer hospitals, 34 of the best 100 hospitals for digestive disorders, and 37 of the top 100 cardiac hospitals. And of the 21 hospitals given an “Honor Roll”—those that performed well in at least six of the 16 specialties—16 had chief executives who were doctors.

The study also looked at mean quality scores of the highest ranked hospitals and found that these were higher for those led by doctors in all the specialties investigated—by between 30% and 40%.

To check that the best performing hospitals were not driving the result, Dr Goodall removed the 52 hospitals that appeared in two or three of the three top 100 lists. Of the remaining 160 hospitals, those that performed better were disproportionately led by doctors.

Other research has shown that only 235 (3.6%) of the 6500 hospitals in the US have a medically trained chief executive. Finding out who runs hospitals in the United Kingdom is difficult, said Dr Goodall, but, if these figures are anything to go by, doing a similar study in the UK would not provide sufficient data.

But although the study looked at US hospitals, Dr Goodall said the results are equally applicable to the UK. “My instinct would be to say that in general medics playing a bigger role in the management of health service has got to be a good thing,” she told the BMJ.

Assessing the performance of doctors in managing health services, however, can be done only while ensuring that other factors remain the same—such as the money available, she added.

Dr Goodall said that the next step is to conduct longitudinal studies to see whether doctors improve hospitals’ performance. She added, “Other important variables, such as a CEO’s [chief executive officer’s] tenure and the level and number of years of clinical experience that each CEO had obtained, could also be included.

“If it can be shown that physician leaders improve hospital performance, then the ensuing empirical question to be addressed is why and how this happens—by examining the transfer processes through which hospitals are influenced by their leaders’ actions.”


Cite this as: BMJ 2011;343:d4870

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