Doctors Can Treat Patients, But Who Will Run The Hospital? Study Flags Admin Gap

A hospital can have the best surgeons, sophisticated technology and state-of-the-art infrastructure, yet still fail a patient if its systems do not work.

Growing incidents of violence against doctors and healthcare workers, along with confrontations between patients’ families and hospital staff across States, speak volumes about the widening trust deficit and the systemic strain on healthcare delivery.

Against this backdrop, a new study has underlined the urgent need for promoting hospital administration as a specialised career pathway in India to address this emerging crisis that requires empathy, sensitivity and a deeper understanding of the pressures faced by both patients and healthcare professionals.

Published in Cureus, the study titled ‘Hospital Administration as an Emerging Speciality for Medical Graduates in India: A Cross-sectional Study' examined hospital administration as a career option for medical graduates and assessed awareness of the speciality among healthcare professionals and students.

Despite growing recognition of hospital administration at leading medical institutions, with AIIMS Delhi and new AIIMS-like institutes and other institutes of national importance setting up dedicated departments, many medical colleges are yet to follow suit.

The researchers combined interviews with 25 doctors holding administrative responsibilities with a nationwide survey involving 574 healthcare professionals and medical students.

The findings of the survey revealed that while 71% of respondents were aware of hospital administration as a speciality, only 6% could correctly identify the postgraduate qualifications available in the field. More than half, or 56%, expressed an interest in learning more about the discipline.

Academic institutions offer opportunities in teaching and institutional leadership, while public hospitals require administrators capable of managing large and complex health systems, it added.

The private healthcare sector, meanwhile, offers pathways into operations, quality management and senior executive leadership.

But awareness remains a major stumbling block, the study found, as it noted that nearly half of the survey respondents were medical students, and 46% of those providing relevant comments said they had little or no information about hospital administration.

Some were uncertain about career opportunities or questioned whether the speciality enjoyed the same professional standing as conventional clinical disciplines, as per the study.

The researchers were of the opinion that this knowledge gap should be addressed much earlier — during medical education itself.

Towards this, they recommended introducing hospital administration modules into the MBBS curriculum, exposing students to hospital support services, quality assurance, patient safety, infection prevention, accreditation, healthcare operations and antimicrobial stewardship.

The authors also asserted that hospital administration should no longer be treated as an incidental responsibility handed to senior clinicians.

For a clinician's primary responsibility is to diagnose and treat the individual patient while a hospital administrator simultaneously looks at the institution as a whole — ensuring that people, processes, infrastructure, supplies, technology and finances function safely and efficiently.

The consequences of weak administration can be serious, pointed out the study. Professional administrators, however, can help address these vulnerabilities through standard operating procedures, clinical and administrative audits, preventive maintenance, staff training, incident reporting and continuous quality monitoring, said the authors.

The message from the study is clear: India may be building more hospitals, but it needs to build a stronger cadre of healthcare leaders to run them efficiently and compassionately so that patients should not feel cheated.

Yet India's training pipeline remains disproportionately small.

The study noted that the National Medical Commission (NMC) recognises only 74 postgraduate seats in hospital administration, accounting for about 0.15% of all postgraduate medical seats. The MD programme is available at around 20 institutions, while DNB training is also offered.

The gap becomes more apparent when placed against the projected needs of the healthcare sector. The study cites estimates that India produces about 2,500 hospital management professionals annually against a requirement of more than 21,000. By 2030, the requirement could rise to around 45,000 health management professionals.

This shortage comes at a time when hospitals are becoming larger, healthcare financing is expanding, insurance penetration is increasing and patients are becoming more aware of their rights.

For medical graduates, therefore, hospital administration could offer a career beyond the conventional clinical pathway.

As per the study, those with postgraduate training can move into positions such as medical superintendent, hospital administrator, medical director and healthcare executive and even faculty members.

However, the authors made it clear that the study’s objective is not to turn every doctor into an administrator. Rather, it is to ensure that doctors who choose leadership roles receive the professional preparation required to manage increasingly complex institutions.

In fact, the need for stronger healthcare leadership has also been recognised internationally, with the World Health Organization (WHO) identifying inadequate leadership and management capacity as a barrier to efficient health service delivery.

The study has sought establishing departments of hospital administration across medical colleges, strengthening existing departments, expanding faculty and considering MD or MHA qualifications for key hospital leadership positions such as medical superintendent.

Telangana and Andhra Pradesh Governments have already moved ahead in this direction by creating departments of hospital administration in all their medical colleges.

Prof (DR) Siddharth Sathpathy, Head of the Department of Hospital Administration at AIIMS, Delhi, who was not part of the study agreed with its observation, stating that it addresses a critical but often overlooked aspect of healthcare delivery.

“Hospital administration is no longer an ancillary function; it is central to delivering quality healthcare,” he said. “The NABH standards themselves reflect this, with nearly half of the accreditation framework relating to management and administrative functions. Trained hospital administrators can therefore play a crucial role in ensuring that hospitals function efficiently, safely and in a patient-centric manner. Without formal training, administration may still happen, but it is likely to be suboptimal.”

Prof (Dr) Sathpathy said the growing presence of hospital administration departments in leading medical institutions reflects the speciality's increasing importance. Several top-ranked medical institutions, including AIIMS and other Institutes of National Importance, either have dedicated departments or are moving towards establishing them.

He also highlighted a structural gap in the public healthcare system — the absence of a dedicated cadre of formally trained health administrators. “Unlike sectors such as the Railways and other public sector organisations, which have dedicated administrative cadres recruited through competitive examinations and trained for their roles, a similar structured cadre for hospital administration has not evolved in healthcare,” he said.

The need for professional healthcare administration, he noted, is not new. The Bhore Committee had recognised the importance of healthcare administration decades ago, while AIIMS, Delhi, was among the early institutions to treat hospital administration as a distinct specialty.