Nearly half of physicians continue to report burnout in 2025, according to the American Medical Association.¹ With administrative burdens, long hours, and limited support still fueling dissatisfaction, healthcare organizations are rethinking leadership structures and how to engage physician leaders in actively shaping them.
Shared leadership teams — such as dyads, which pair a physician with an administrator, and triads, which add a third leader, often from nursing or operations — have proven to be effective responses to complex challenges. These collaborative structures help bridge clinical and administrative perspectives, foster mutual trust, and give physicians a stronger voice in shaping organizational strategy — all of which depend on key success factors like shared core values, mutual respect, and clear, transparent communication.² Listening to the voice of physicians can help reduce burnout because physicians feel they are being heard and able to impact decision-making with administrators.
Tom Rossi, vice president of executive search at Jackson Physician Search (JPS), and Kristin Mascotti, MD, MS-HQSM, CPE, FAAPL, market chief medical officer for CommonSpirit Health’s Greater Colorado and Kansas Market, brought these models to life in their 2025 MGMA Summit session, “Partnering with Physician Leaders to Improve Staffing and Operational Stability.” Drawing from practical experience and new leadership training initiatives, they illustrated how aligned, trust-based partnerships can move organizations beyond burnout — and toward long-term stability and engagement.
The dyad (and beyond): Evolving leadership models
While medical practice dyads have been used for years, many organizations are redefining these partnerships in broader, more flexible ways.
“What we’re starting to realize is: sometimes it’s not just a dyad, it’s how we define it,” Mascotti said. “It can be physician and nurse, physician and administrator. There’s even — as we discussed this nationally — a movement to bring operations into the model.”
This evolution has led to triads, which bring together clinical leaders with nursing or operational executives in a shared decision-making role. “A triad model is, at the end of the day — when we align clinical leadership with operational leadership, and leverage their collective strengths — that’s where the magic really happens,” she said. “But that can be a really difficult thing to do as well.”
For Mascotti, structure matters less than the synergy between dyad partners. “Think of your dyad partner — are they your most trusted person, the one you go to first to help facilitate difficult situations, mitigate problems, or collaborate effortlessly with to get strategic objectives done?” she asked. “There are tools to assess the overall functionality of dyads that can highlight areas of synergy and potential gaps to address.”
Top-performing organizations recognize that when dyad teams thrive, entire teams thrive— driving stronger outcomes and ultimately improving care for patients. As a result, many organizations are making significant investments in dyad and triad partnerships, using assessments and targeted education to maximize their effectiveness.
In addition, thinking broadly about how dyads work together across the continuum of care, a market, or facilitating inpatient and outpatient strategies for the benefit of our patients is important. Mascotti continued: “There may be a physician group that’s responsible for employing the physicians. But in the hospital, that’s where the physicians work, live, and take care of patients. How do we seamlessly collaborate across an enterprise?” This is where the benefits of closely aligned physician leaders and administrators can have a significant positive impact on an enterprise.
Dyads and triads can exist at multiple levels of an organization, from the entity level to the regional or market level — and sometimes even within a single role. “We’ve also identified multiple dyads within an organization, market, or sometimes within a position,” Mascotti said.
What ties all these models together is a deliberate effort to blend skill sets and perspectives and build the relationship. “The basic successful profile of dyads really is that clinical and operational mindset, because they do bring different skill sets to the table,” she said. “So how do we leverage the strengths that each bring to the table? What are they — and who do we need to have?”
This is where strategic recruiting of dyad partners comes into play. Recruiting for and evaluating specific dyad/triad competencies both before and after hiring is a priority and sets dyads up for success at the beginning.
Building the foundation: Trust, clarity, and equity
At the core of effective dyad and triad partnerships is trust — not just built through organizational structure but cultivated through intentional investment in the relationship itself.
“It’s interesting, because as we dive a little deeper into this topic, some of the work we’ve done on helping dyads achieve effective outcomes within the organization, but also on understanding what makes those outcomes possible in the first place,” Mascotti said. “What we’re learning is actually the more the dyad understands about their own strengths and weaknesses — and that their skill sets may be complementary — the better off we are.”
She added, “That’s what we’re starting to learn about the ‘secret sauce’ — it really comes down, in a nutshell, the amount of trust and the dyad/triad relationship itself.”
Rossi agreed: “These are some of the things that we’ve seen successful dyads doing — balancing assertiveness and responsiveness and creating that lens that allows the clinical team to truly be part of these discussions and part of the solution.”
But trust alone isn’t always enough. Clear roles and equal footing are essential.
“Sometimes when a dyad is formed, there’s an unspoken assumption about who’s really in charge (with the presumption that it is the physician) — and that can undermine the partnership from the start,” Mascotti said. “I’ve heard from nurses and administrators that when working with physicians it can feel like, ‘Okay, I’m here to help, but you’re the one really going to do the work.’” This is not the presumption that the most successful dyads employ.
“That’s why we emphasize level-setting expectations and role clarity from the beginning,” she added. “If we’re building effective dyads or triads, both partners need to come to the table as equals, ready to do the work together.”
A certification to formalize the ‘secret sauce’
Rossi and Mascotti emphasized that building trust within leadership teams isn’t left to chance. It requires structure, self-awareness, and a shared commitment to growth. As Rossi noted, alignment between clinical and operational leaders goes beyond titles and job descriptions — it’s about developing relationships grounded in accountability, mutual support, and problem-solving.
That foundation is embedded in an upcoming joint interprofessional leadership certification program from the American Association for Physician Leadership (AAPL) that Mascotti helped design.
“There are two pillars,” Mascotti explained. “One is that behavioral aspect that I talked about where we actually look at each other’s strengths and weaknesses to understand the total combined synergy of the dyad as well as our weaknesses.”
When both dyad partners share the same weaknesses, Mascotti noted, it can limit their effectiveness. On the other hand, complementary strengths can have an immediate positive impact on teams in terms of performance and cohesion.
The second pillar focuses on process improvement, framed through a familiar clinical lens. “The program is structured around learning process improvement through similar steps in an H&P so that clinicians can really identify with the process— it’s pretty easy for them to do,” she added.
Mascotti also highlighted the groundbreaking nature of the program’s approach: “It’s the first time a physician-only organization has invited nurses and other colleagues to the table,” she said. This inclusiveness signals a national shift — and a recognition of the value of interprofessional leadership education.
Even as a facilitator, Mascotti expects to gain new insights. “I think we’re actually going to learn as much from the participants as we [facilitate] the program,” she said. “So, [I’m] very excited about this. We’re going to learn a lot.”
Communication and activation: The next frontier
The next layer of effective dyad leadership is what the speakers described as “activation” — the moment when trust evolves into true engagement and ownership.
Rossi pointed to joint MGMA-JPS research on what physicians value most in leadership relationships.3 “The number one thing that came together was two-way communication with management and administration,” he said. “That was really, by far, the biggest one.”
- Developing the Next Generation of Physician Executives, an MGMA and Jackson Physician Search whitepaper, is available free online.
Delivering that kind of communication requires more than surveys or top-down messaging. Mascotti shared examples from her own experience: “We went directly to departments — coffee talks, small groups, walking the halls,” she said.
To foster transparency and demonstrate responsiveness to medical staff concerns, the team implemented a Physician Feedback Action Tracker. “We visibly tracked concerns and followed up,” she explained. “If we couldn’t act, we explained why, and that closed-loop feedback built trust.”
When trust turns into engagement, the shift is unmistakable. “You know when it happens,” she said. “They stop waiting for direction and start leading the charge. That’s physician activation.”
One example she highlighted was a physician leadership program launched directly in response to clinician feedback. The content — particularly around hospital financials — was eye-opening for participants.
“This was completely new information to our physician leaders,” she said. “And once they understood this big ‘why’ in terms of budget [specifics] and reimbursement,” it was then that the attendees started asking how they could help.
From there, things accelerated. “They decide it’s important clinically, and they decide they’re going to make the change,” she said. “It takes a little while to get there, but you know the moment it happens. Suddenly they’re running with it, and now we just support their momentum.”
“That’s not just engagement — that’s ownership, activation,” she added. “It’s very different from physician alignment, which feels told. Physician activation is intrinsic and ... with outcomes.”
Recruiting with intention, and sustaining commitment
Rossi emphasized that physicians are motivated to step into leadership for many reasons, but the strongest driver is having a voice in decision-making and organizational culture.
“The biggest piece was having that voice in organizational decisions and then building and sustaining culture that the physicians can be a part of, that the clinical staff can be a part of, and that the whole hospital team can really rally around,” he said. “If you can get there, then you really do have an opportunity.”
He added that identifying potential physician leaders may be easier than expected. “If you’re not sure who to think of in terms of possible physician leaders in your organization, they’ll step forward,” he said. “The ones that want to have a voice — they’ll let you know, and they’ll become part of the solution.”
That mindset also shapes how physicians evaluate prospective employers.
“These candidates are really interested to hear from physician leaders for several reasons,” he added. “For one thing, physicians like to talk to physicians more. They’ve been through the same training... And [peers] also give them a picture of what they might become someday.”
Mascotti echoed this, recalling how physician candidates often pull her aside with candid, pressing questions: Do we have a voice? What happens when we need something? Will we be supported by administration? How does this really work?
She stressed the importance of building relational chemistry from the beginning. “I think the dyad model is vital here, as we’re looking at not only the physician leader but bringing in that dyad during the interview process to make sure you’re getting potential synergy between the two leaders.”
Rossi agreed that recruitment must be viewed as the beginning of a long-term continuum. Onboarding, exposure to leadership opportunities, and sustained development all influence whether physicians feel engaged or disconnected.
“If we’re not developing enough physician leaders, we’re missing the chance to stabilize the entire organization,” Mascotti added.
Conclusion
The foundation beneath every successful physician-administrator partnership includes voice, trust, and long-term investment in leadership through building trusting relationships.
Mascotti emphasized that developing physician leaders is essential. “Even if there are formal leadership academies, there may not be enough physicians going through them to meet the need,” she said. “We really have a paucity of physician leaders.”
Leadership development, she stressed, must be treated as a continuous investment — not a one-time checkbox — if organizations want to retain and empower physicians. It’s not just about career growth; it’s also about protecting physician well-being.
“One of our physician leadership programs actually came out of a wellness program,” she said. “Because for the physicians, the burnout is real. If you don’t have leadership and a voice, that actually leads to burnout.”
Rossi agreed, noting that while there’s no universal blueprint, the core principles are consistent. “There’s not one model,” he said. “There are many ways to try to create [the trust and communication] that’s so needed.”
“We’ve seen different tactics used in different settings that have been very, very beneficial,” he emphasized.
Together, the speakers’ message was clear: The path forward isn’t rigid, it’s relational. Whether through formal leadership programs, dyad partnerships, or grassroots physician activation, organizations that invest in shared interprofessional leadership today will be better equipped to meet tomorrow’s challenges.
Notes:
- Berg S. “Which physician specialties are seeing a drop in burnout?” American Medical Association. May 13, 2025. Available from: https://bit.ly/4mQl8Hs .
- Cortese DA, Smoldt RK. “5 success factors for physician-administrator partnerships.” MGMA. Sept. 23, 2015. Available from: https://www.mgma.com/dyad-partnerships .
- “Developing the Next Generation of Physician Leaders.” MGMA and Jackson Physician Search. October 2024. Available from: https://www.mgma.com/phys-executive24 .
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