Should Clinicians accept administrative jobs in hospitals?

Shaukat Ali Jawaid

While the public humiliation of healthcare professionals by politicians and bureaucrats is condemnable, the more important question arises: should clinicians accept administrative roles in public hospitals at all? Hospital administration is a thankless job, yet it is a well-recognized and established discipline. Only those who possess the necessary competence, experience, and training should be selected for such roles. Unfortunately, a large majority of clinicians believe they understand hospital administration better than others, and many fail to show proper respect even to their colleagues in basic sciences or hospital administration, often considering themselves superior—though this may not always be the case, but there are exceptions.

It is well known that some clinicians maneuver to obtain administrative roles, fully aware that their primary responsibilities—patient care, teaching, training, and unit administration—leave them with little time for additional administrative duties. Furthermore, their extensive involvement in private practice often prevents them from dedicating the necessary time to hospital administration.

Honesty alone, without competence, ability, and the requisite experience, is a dangerous shortcoming. In a country where various mafia groups have emerged—health services included—it is not always easy to effectively manage these institutions. In addition to the professional jealousy among colleagues, the active mafia groups within the nursing profession, young doctors, technicians, paramedics, and other staff members—particularly those not appointed on merit—are more interested in drawing salaries without working. When action is taken against them, they often resort to strikes. If anyone is removed for misconduct, they can get reinstated through their contacts in the corridors of power. The late Prof. Humayun Maqsood, a gentleman who was affiliated with Fatima Jinnah Medical College and Sir Ganga Ram Hospital, shared many such stories with me. Even a very senior bureaucrat, the former Punjab Health Secretary who later retired as the Chief Secretary of Punjab, once told me, “The medical profession is self-sufficient. They do not need any outside enemies.”

In another case, I remember a very pious and honorable senior professor, was appointed as the Medical Superintendent of Mayo Hospital in the late 1980s. During my visit to Mayo Hospital, he asked me to meet with him, as he had an important story to share. After my scheduled meeting with another senior faculty member, I met him at around 12:30 pm. He had already arranged tea and snacks. Eager to hear the promised news, I asked what it was. He said, “For the first time in the history of Mayo Hospital, a Medical Superintendent has returned over twelve million rupees to the health department from the allocated funds.” I inquired further, “Did you really return this amount to the provincial health department?” He confirmed, and I replied, “With due respect, Professor Sahib, this might also be the first time in Mayo Hospital’s history that such an incompetent and inefficient person was appointed, someone who failed to utilize the allocated funds.” He became furious and stood up, possibly to slap me, but I quickly left his office. It is truly unbelievable that a hospital administration could fail to use its budget—such a failure reflects poor planning.

On the other hand, I recall how Prof. Shahryar Sheikh, appointed Project Director of the Punjab Institute of Cardiology, would often visit the Civil Secretariat, especially in April and May. He managed to get unutilized funds from other institutions transferred to the Punjab Institute of Cardiology (PIC). He always had projects ready and utilized his contacts with the Sharif family to secure these funds. He would even visit Section Officers and clerks in the department to ensure that files were processed in time, without any ego problems. How many senior clinicians would do that? Unfortunately, when General Pervez Musharraf toppled the democratically elected government of Mian Nawaz Sharif, Prof. Shahryar Sheikh was also removed from his position due to his close ties with the government. Despite his excellence and rare distinction as the President of the World Heart Federation, he was subjected to a malicious media campaign and character assassination. Enquiries were launched against him by various agencies, who knew there was no case but were pressured to prolong the investigations. Ultimately, no evidence was found, and the case was closed. However, the mental agony and torture he and his family endured for many months reflect how healthcare professionals are treated in Pakistan.

The purpose of sharing these stories is to emphasize that busy clinicians should refrain from taking on administrative roles in hospitals, which are often underfunded and burdened by political interference. Let trained professionals in hospital administration handle these responsibilities. If they fail, they should be held accountable.