Top-performing hospitals are typically ones headed by a medical doctor rather than a manager, according to a study currently in press in Social Science and Medicine.

The findings run counter to a modern trend across the western world to put generally trained managers–not those with a medical degree–at the helm of hospitals, according to study author Amanda Goodall, PhD. She wrote that this trend has been questioned, particularly by the Darzi Report, which was commissioned by the U.K. National Health Service, but until now there has been no clear evidence.

Goodall, a senior researcher at the Institute for the Study of Labor (IZA) in Bonn, Germany, constructed a detailed database on 300 prominent U.S. hospitals. She then traced the professional background and personal history of each leader.

The research focused particularly on hospital performance in the fields of cancer, digestive disorders and heart surgery. Goodall conducted a cross-sectional study using data from 2009.

The study showed that hospital quality scores are approximately 25 percent higher in physician-run hospitals than in the average hospital.

"Over the last few decades there has been a growing tendency for hospital boards to appoint managers as CEOs. These findings raise some warning signs over that trend," Goodall said. "According to the latest data, outstanding hospitals tend to be those run by somebody with a medical degree. I was surprised by the strength of the pattern. It seems that age-old conventions about having doctors in charge–currently an idea that is out of favor around the world–may turn out to have been right all along."

Barry R. Silbaugh, MD, CEO of American College of Physician Executives, commented on the findings: "We are watching Goodall's research carefully because it seems to finally provide a real evidence-base for physician leadership. This is something we have long supported."

Goodall stressed that more research would be needed before cause-and-effect could be truly understood. "This is an intriguing pattern but these snapshot results for a single point in time do not prove that doctors make the best heads of hospitals, although they are consistent with that claim. More research following a range of hospitals through time is urgently needed," she said.

The full report can be accessed here.