• Joseph P Castlen, David J Cote, Wouter A Moojen, Pierre A Robe, Naci Balak, Jannick Brennum, Mario Ammirati, Tiit Mathiesen, Broekman Marike L D MLD Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosu, and World Federation of Neurosurgical Societies Ethics Committee and European Association of Neurosurgical Societies Ethico-Legal Committee.
• Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
• World Neurosurg. 2017 Jun 1; 102: 420-424.

IntroductionMedicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form between physicians and administrators.AnalysisThis situation is based on perceptions from both sides that physicians obstruct cost-saving measures and administrators put profits before patients. In reality, increasing patient populations and changes in health care are necessitating action by hospitals to prevent excessive spending as health care systems become larger and more difficult to manage. Recognizing the cause of changes in health care, which do not always originate with physicians and administrators, along with implementing changes in hospitals such as increased physician leadership, could help to ease tensions and promote a more collaborative atmosphere. Ethically, there is a need to preserve physician autonomy, which is a tenet of medical professionalism, and a need to rein in spending costs and ensure that patients receive the best possible care.ConclusionPhysicians and administrators both need to have a well-developed personal ethic to achieve these goals. Physicians need be allowed to retain relative autonomy over their practices as they support and participate in administrator-led efforts toward distributive justice.Copyright © 2017 Elsevier Inc. All rights reserved.

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