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Family physician Amir Atabeygi discusses his article “Building trust in dyad leadership partnerships.” Amir explains why trust is the foundation of successful dyads, highlighting how implicit follow-through and consistent communication turn a partnership into a cohesive leadership unit. He shares practical strategies for over-communicating, maintaining situational awareness, and ensuring that each partner can speak for the dyad with authority and confidence. Amir illustrates how intentional relationship-building transforms dyads into seamless, high-functioning teams that enhance both organizational outcomes and professional satisfaction. Listeners will take away actionable lessons on cultivating trust, setting expectations early, and treating dyad relationships as central to leadership success.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Amir Atabeygi. He is a family physician, and we are going to talk about the KevinMD article that he co-wrote, “Building trust in dyad leadership partnerships.” Amir, welcome to the show.

Amir Atabeygi: Good morning. Thanks for having me on.

Kevin Pho: All right, let us start by briefly sharing your story and jump right into the article that you co-wrote.

Amir Atabeygi: Oh, sure. I work at a critical access hospital in Elma, Washington, and I am the medical director of two of our outpatient clinics with my partner Christina Mitchell, who could not join us. And she and I wrote this article about dyad relationships. I think mostly it was my idea and she jumped in with me because we have a great working relationship, but I have also seen what the other side looks like when you are under the leadership of dyads that are not so high functioning.

And I think there is no training for this. When you take on these leadership roles, you just get thrown in and you have to figure it out. So it is nice to have a little bit of a framework to go by.

Kevin Pho: All right, so for those who are not familiar with clinician administrative partnerships, I know dyads is one version of that. Let us bring everyone to the same page and explain what a dyad partnership is.

Amir Atabeygi: Sure. So generally a dyad would be a partnership between a clinician and an administrator, and you co-lead a clinic or a service line. And so I am the clinician in our partnership and Christina is more administrative, operational. And I think the point of a dyad is that you each bring unique skills to the job and sort of co-lead together and highlight your strengths and fill in each other’s weaknesses. That is what the model is supposed to be anyways.

Kevin Pho: All right. So tell us how those responsibilities are shared between you two.

Amir Atabeygi: Well, we originally started off as dyad partners for one clinic and then took over another clinic as so happens in rural health care. You just do a lot of things at the same time. But very early on I think we delineated our roles in that anything that was clinical related I would take care of, and anything that was more admin related she would take care of. And there are always things where it involves both aspects. And we started just having a great relationship in that we would communicate those things and make shared decisions together.

And part of that was we trusted each other in our competence and information sharing. And that made it real easy because we never had to think what the other one was doing. We always knew what we were doing.

Kevin Pho: So it sounds like of course, communication between you two is critical to a successful relationship. So can you share an example or a story where that dyad framework, that successful dyad framework in your case, overcame a problem or obstacle just so we can see what it looks like in practice?

Amir Atabeygi: Sure. I have a great example. As part of our expansion of our services, our hospital stood up a sleep lab in an outpatient sleep clinic and there was some staff turnover and Christina ended up having to be part of that even though it is not part of her regular work. And I think this comes down to communication and trusting each other because she was doing this work and I was not part of it. It was a totally different service line and she was just helping.

I would go by her office and she seemed really frustrated and really into it and could not figure it out. And one day I just said, “What are you working on?” And she was working on the sleep lab. She was not sure how the billing would work or where the results would go in the chart that is best viewed by the clinicians because we have never done it before. And not a lot of institutional experience. And so I was curious and she told me this and I walked in and we sat, she told me what she needed and we figured it out, I think in twenty or thirty minutes, what she had been working on for days. And that has been our system ever since.

And just that kind of curiosity and trusting each other in our areas of expertise. And just communicating, you know, being curious, what are you working on? What are you doing? And I peripherally knew she was working on that, but I did not know the details. And once she filled me in we figured it out together.

Kevin Pho: I talk to a lot of physicians on this podcast, and a lot of physicians write on KevinMD of course, and sometimes there is an adversarial relationship between clinicians and administrations. I hear you use the word trust and communication a lot. So how do you build that trust? How do you build those open lines of communication between your administrative partner?

Amir Atabeygi: I think it has to be very intentional. And right from the start. I think if you have never been in a dyad, you should almost have a dyad charter, if you will, and write down what each person’s role is, who is responsible for what kinds of decisions, and what decisions are co-managed.

Just some clear expectations, but the trust part I think just comes over time. You have to trust each other to follow through, and I think over time, if you do things that you say you are going to do and you get results, or if you ask for help, I mean, no one is going to know how to do everything perfectly. But that is the other part of the communicating is you stay open with each other and say, “I do not know how to do this,” or, “I need help with this project.” And one, that is communication. Two, that builds trust because you know the other person will come to you if they need something.

And I think dyad relationships that are adversarial fall into this pitfall of thinking they are each doing a job when a dyad is two people doing one job. You should think of it as you are sharing this job, which parts of it are you responsible for, and which part of it are you responsible for jointly? And so, you consider writing that down if either of you has been in a dyad or things seem to be having some friction. Just making the rules clear can be very helpful.

Kevin Pho: How common is that dyad framework when it comes to various clinic offices? Is that the pervasive leadership framework today?

Amir Atabeygi: That has been my experience. I have been with three large health care organizations over the years, and that has been the model that has been in place in all of them. So it is quite common.

Kevin Pho: And you have seen some relationships earlier on do not work. Give us some examples. And of course you do not have to name names, but what would a dysfunctional dyad relationship between a clinician and an administrator look like?

Amir Atabeygi: I think the biggest thing comes down to the one partner does not know what the other one is doing or the decisions they have made. And depending on who you talk to, you get different answers. And one of the big things Christina and I focus on is we are both on the same page. No matter who you talk to, you will get the same answer if you have a question because that is how we have just been together in our dyad relationship. But it causes chaos when you have a leadership team and one gives you a different answer and the other one gives you a different answer.

And so people sometimes, just like small kids and their parents, they will pick and choose who they go ask things for, depending on what they want. And that is where mistakes happen or miscommunication happens and people get different messages. And so I think that is probably the most common thing where you see friction from is unclear expectations and just not communicating or getting a clear message from your leadership team.

Kevin Pho: And of course, in that scenario, when you have that dysfunction and friction and poor communication, that spreads downwards and affects the morale of the entire staff, right?

Amir Atabeygi: It does, but information obviously flows downwards. So one person comes talk to you and someone else talks to the other partner, and then information flows down from there in two different paths. And suddenly you have half your clinic doing one thing and half doing the other thing. And everyone is confused and does not know what the right answer is. And so that affects the people and your clinic operations. And that ultimately though, it comes back on you because now you have to fix the problem. And so you have really just made more work for yourself.

Kevin Pho: Now you said that there was not any playbook for physicians to step into these leadership roles, let alone a dyad role. So for those physicians who are entering this position for the very first time, just based on your experience, what are some tips that you have for these physicians?

Amir Atabeygi: I would. So it depends on your dyad partner. If you and your dyad partner are both new to the role, that could be, I think maybe a good thing you do not have any preconceived notions or bad habits. If your partner that you are starting with is more experienced, that could be something to lean on.

But when you start off, I think, like I was saying you should have clear roles and even consider writing them down for each other. And that way I think the expectations are clear. And once you get clear expectations and even write down like, we are going to meet one hour a week on this day, and that is our set meeting day, but it is written down so you have something to reference and that kind of thing. I think just clarifies a rule and make things a lot easier and you just go from there. It is building steps.

The first step is what is your role? What are you going to do from day to day? How often are we going to meet? What are our deliverables? What are our metrics that we are responsible for that we want to work on? And just having two or three things to work on in your role, in your clinic, leadership board, wherever you are that narrows your scope at the beginning. And when you get little, small victories, you can build on that. Whereas if you come into this kind of work and you say, “I am going to fix this entire clinic,” that is not realistic. You cannot just start off from there. So, small goals, clear roles, and just writing down expectations can be a great way to start.

Kevin Pho: So give us an example of how you interact with your dyad partner, Christina. And what is your typical day like and how do you balance that with what you do clinically? How often do you interact with her? Do you have set meetings several times a week? So just go into more detail in terms of how often you interact with your dyad.

Amir Atabeygi: Well, when we started off it was easier. We managed one clinic and so we shared an office and we would talk daily. And so we managed an urgent care clinic at the beginning. And after that we also took over a walk-in primary care, medication assisted treatment, behavioral health clinic. And so, she spends a lot of her time at that clinic, and I spend a lot of time in the urgent care clinic. That is where I do my clinical work.

And we have set meetings every week where we will meet for thirty to sixty minutes and just review what has been going on and what we are working on. But also just informally we have what we call them catch up sessions where she will come to my office or I will go to hers and we will just sit maybe fifteen, twenty minutes and just go over things that have happened in the last few days. And then there are the normal things, text or talking on Microsoft Teams, which is always, I think great for everyone who uses it.

But I think people have come to expect that we are sort of like one person. When she goes to meetings that I do not get invited to, she will ask them if I can go, and if they say no, she will say, “It does not matter, I am going to tell him everything anyways.” And she will tell, everyone knows this by now. And so I think there is an expectation that whatever I know and she knows, the other person knows. And so we were very intentional about that. But at least for sure one, once a week we meet. But practically speaking, it is almost every day or every other day.

Kevin Pho: Now, is there any confusion among the staff in case they have an issue or if they want to give feedback in terms of who to turn to because there are obviously two leaders in the clinic?

Amir Atabeygi: There can be. I think that comes down to clarifying your roles. And so if someone comes to me with a question that is more her expertise, I will say, “You should talk to Christina about that. She will give you the right answer.” And we each know our role and we each know what we are good at and what are not our strengths.

And that is very helpful. And it is open. She is the first one to say, “I am not clinical, I do not know this.” And then tell me about it, or the other way around. And I will say, “I do not know how to do this. Can you help me?” And that kind of openness really makes it easy because just your job gets a lot easier. I think the hard part about dyads is the upfront, if there is friction that makes your day-to-day work hard, but also just makes more work for you having to fix problems down the road or things of that nature. So having clear roles has been the biggest thing because we just tell people, “You should talk to Christina about that,” or she will tell you, “You should talk to Amir about that.”

Kevin Pho: How long does it normally take for a dyad relationship to kind of hit all the gears and feel comfortable?

Amir Atabeygi: I would say that depends. If you have been with an organization for a long time and you move into a leadership role, I think there is less catching up because you just know how the organization works. So it could be maybe even a month or two. If you are joining a new organization, probably three or four months, I think, just to know the ins and out of how the organization works, who the people are, and just how to get established. That sounds about right.

Kevin D. Pho: We are talking to Amir Atabeygi. He is a family physician. Today’s KevinMD article is “Building trust in dyad leadership partnerships.” Amir, let us end with some take home messages that you want to leave with the KevinMD audience.

Amir Atabeygi: Being part of a great dyad relationship makes the work very easy. And if you are going to do that kind of work, invest the time upfront to set up a great relationship. It does not just happen by accident. It is intentional. You have to make it happen. And so, having these clear roles and just expecting good communication and just being open with your dyad partner can really make things smooth. And then once the leadership team is working smoothly, the clinic will just kind of work smoothly after that because people will see you working together and then as you set an example for the clinic or whoever you are managing, it just kind of flows down even unintentionally. They just see you doing it.

And so that kind of modeling can be great. And if you are unlucky enough to experience a bad dyad relationship that is leading you, then as frustrating as it was for me, consider getting into that kind of work and what do they say is, “Be the change you want to see.” And so it does not have to be friction, it does not have to be hard. It takes work upfront, but I think it is worth it.

Kevin Pho: Amir, thank you so much for sharing your perspective and insight and thanks again for coming on the show.

Amir Atabeygi: Thanks for having me on. I appreciate it.