With the consolidation and growth of ever larger health systems, and the development of service-line approaches to clinical specialties, increasing numbers of academic medical centers have combined the role of department chair with that of an enterprise clinical leader. In the 2024 ADFM member survey, 63.8% of department chairs indicated that they oversee clinical operations for their departments. Integration of academic and health system responsibilities fundamentally alters these roles to one that allow leadership and influence of primary care across regional health systems, while also shifting the center of gravity of the chair role beyond the academic department. Building upon a session at the 2023 ADFM Annual Conference of the same title, this article provides updates on the experience of 3 large health systems whose chairs of family medicine or administrators also hold enterprise leadership positions and describes how those roles are shaped by and are shapers of the organizations in which they reside.

This medical school was created under the collaboration of an existing health care system, Northwell, and a university, Hofstra. A selection of clinical department leaders of the hospitals and academic leaders of various residency programs were invited to help create the new structure and curriculum for the medical school. Eventually, most of these individuals would go on to be the medical school department chairs and their physicians would become faculty. The original operational role that most had now involves academic skills. The clinical sites for the trainees and physicians vary from the large medical partner group to the federally qualified health centers, community-based clinics, hospital-based clinics and a variety of other areas that our family medicine physicians work. Due to the scale of this organization, the operations are divided into regions with administrative oversight influenced by the specialties and service lines.

This interplay between the operations of the organization and the academic mission of the medical school can at times create a tension for the academic chairs who are working to increase the academic productivity while being mindful of the clinical work that is needed to serve our patients and community. The team has managed to work with other specialties in both areas—providing Advanced Life Support in Obstetrics for the OBGYN interns annually, creating a Family Medicine Urology fellowship and then a Family Medicine ENT fellowship to help with the lack of access in these specialties in certain regions.

In the last year, the Medical College of Georgia has partnered with Wellstar, a 11-hospital system in Georgia. The transition has provided more opportunities and attention to primary care and resources for the department. This has allowed the department chair and administrator the opportunity to sell the importance of family medicine and take the lead in the expansion. Materially, they have been tasked to identify new locations to grow. To enhance the teaching mission, the team sees this as an avenue where residents can rotate in more sites, see patients of varying acuity and need, and access to increased recruiting opportunities in Georgia. The partnership between Wellstar and Augusta University has also resulted in a fruitful exchange of knowledge, benefiting both institutions. On a quarterly basis, departmental faculties showcase theirs and other academic research to Wellstar community clinicians. The rich interaction and dialogue have opened doors for conversations on new models of interventions and active learning by both entities. The diverse opportunities presented by this collaboration have generated enthusiasm among learners and clinicians alike. As the relationship strengthens, both parties envision conducting enhanced, patient-focused research studies across the state with greater ease.

In recent years, Jefferson Health as a clinical system underwent rapid expansion, growing from 3 to 17 hospitals. Jefferson Primary Care, now a 98-practice system, provides comprehensive, longitudinal, relationship-based care to 560,000 people. In 2021 the role of the Chair of Family and Community Medicine, was combined with that of Enterprise Chief of Primary Care. This synergy enhances the ability to implement research initiatives at scale; enables partnerships across 5 family medicine residency programs; and creates opportunities for dialogue across primary care leaders, physicians, and clinical teams with a great diversity of personal knowledge, organizational histories and cultures, and communities.

Furthermore, the acquisition of a health plan has transformed Jefferson into an “academic payvider,” creating further opportunities for the evolution of primary care across the system. Alignment of primary care’s areas of strength have led to greater organizational emphasis on primary care, including attention to community engagement and equity. Managing this combined portfolio requires a larger departmental leadership structure with delegation to, and thus career opportunities for, a variety of faculty members, primary care colleagues, and administrators.

In conclusion, the changing role of the academic family medicine chair and administrator requires adaptability and utilization of newer operational skills as they take on the responsibility of clinical site operations influenced by the ever-evolving health care landscape, while prioritizing the academic mission. Balancing both roles requires effective skills in leadership, strategic thinking, financial management, communication, change management, problem solving, and relationship building. Fortunately, as shown by these examples, the specialty of family medicine lends itself to adapting, evolving, and acquiring necessary skills. Leaders should create opportunities to hone their own abilities in health system management while teaching our students, residents, and faculty what they need to succeed in the future.