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Better together: Most healthcare leaders report using a dyad leadership model

MGMA Stat - October 31, 2019

Professional Development

Leadership Development

Nathan H. Comstock MBA, FACHE, CMPE

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: “Do you currently utilize a physician and administrator (dyad) leadership team model?” In response, the majority (77%) answered “yes,” while 23% reported “no.” Respondents who answered “yes” were then asked, “How is your organization's experience with dyad leadership?” Here are some of the responses:
  • “Used at each practice location and works very well for continuity of information and building trust.”
  • “Wouldn't do it any other way. Physician leads monthly Board meetings and presents to the Board the agenda items. Practice Administrator runs the practice and meets weekly with physician leader to discuss operations.”
  • “Very good. A necessity in today's physician practice environment.”
  • “Successful. The dyad keeps appropriate skills and decision-making separate. Regular and transparent communication is key.”
This poll was conducted on October 29, 2019, with 1,303 applicable responses.

Health systems and physician organizations face many complex challenges. To respond and proactively plan for these challenges, an organization’s management structure must support its culture, demonstrate financial stewardship and have strong leadership.

It is not surprising that 23% of respondents indicated that they do not have a dyad leadership team model in place today; changing management structures is hard work and culturally sensitive, which is why so many organizations are hesitant to do so.

Dyad leadership, in its simplest form, is a partnership. It’s the union of an administrative leader and a physician leader, forming a best-of-both-worlds structure. While the term has reappeared over the last five to 10 years, the model is not new. Dyad leadership dates back to 1908 at the Mayo Clinic when Will Mayo, MD, recruited Harry Harwick to help him manage their growing business and operations.1

Often a health system executive will say, “I have had a physician leader before and it didn’t work out well.” In a way, they’re right. Simply designating a leader, regardless of clinical or administrative roles, does not guarantee success. Likewise, simply having a dyad structure does not resolve leadership and structural voids.

Recruiting your physician dyad counterparts should take as much time and effort as recruiting your administrative leaders. After all, these individuals will spearhead clinical strategy, act as change agents and advocate for initiatives to their physician peers. But there is a set of shared attributes for leaders that will increase the likelihood of success:2
  1. Effective communication
  2. Enjoy working as part of a high-performing team
  3. Able to solve complex problems
  4. Respected by their peers.
Dyad leadership has proven to be an effective and differentiating leadership model. Research indicates that there are three critical success factors for high-performing dyads.
  1. Role definition: Each leadership role has disciplined scoping and explicit delineating of responsibility.
The most effective dyads delineate roles. They do not duplicate work; rather, they are advocates and supporters of each other. Communication is critical, and both parties must understand their share of the common work.
  1. Accountability: Leaders are held accountable for specific, measurable goals — some shared, some separate, but always complementary.
High-performing dyads are held accountable to goals and performance toward those goals. This is standard practice for administrative leaders. Performance management goals for clinician leaders are less common but increasingly adopted. Within the dyad structure, goals should be individual and shared and always complementary.
  1. Authority: Leader must have sufficient latitude and power to make critical decisions and enact necessary changes.

The most important success factor deals with authority. Each dyad leader must be able to make decisions in the areas they are accountable.

Practical application

What does a dyad leadership model look like in practice? High-performing groups embed dyad leadership throughout all levels of the organization.
Optum recently worked with an organization that established dyad leaders at the executive level, at the specialty administrator level and at individual practice sites. This deep dyad implementation established a consistent structure across the organization. It created opportunities for physician leadership and development, and it positioned the physician enterprise to succeed in a rapidly changing, complex environment. Most important, this structure exponentially multiplied the number of clinical champions across the organization’s practice sites and specialties and created leadership teams to handle difficult conversations and obstacles.


1. Cortese D, Smoldt RK. “5 success factors for physician-administrator partnerships.” MGMA Insight. 2019.
2. Trandel E. “Advocating for dyad leadership at your organization? Use our slides.” Advisory Board. March 26, 2015.

Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at:


About the Author

Nathan H. Comstock
Nathan H. Comstock MBA, FACHE, CMPE
Manager Advisory Services, Optum

Nathan H. Comstock, MBA, FACHE, CMPE, brings more than 15 years of experience to his role as manager of Advisory Services at Optum. In this role, Comstock works with physician organizations and health delivery systems to improve their strategic direction, operational efficiency and financial performance.
Comstock also works with health systems on strategies to align the physician enterprise with key service lines. His specific areas of expertise include pediatric services, service line design, medical group governance and management structures, market demand analytics, ambulatory operations, patient access, finance, physician compensation, as well as value-based care strategies focused on ACOs, CINs and MACRA.
Prior to joining Optum, Comstock was part of Advisory Board’s consulting and management team. He also previously served as an orthopedics, sports medicine and spine administrator for Emory Healthcare in Atlanta.
Comstock is a fellow of the American College of Healthcare Executives (ACHE) and is a Certified Medical Practice Executive (CMPE). He has an MBA and a BA in Sociology from Emory University.


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