The Power of Listening: What ABFM Diplomates Told Us About Administrative Harms in Family Medicine

One of the many goals of qualitative research is to explore the innate variability of human meaning and experience. There are various ways to illicit such variation, including how a researcher structures their interviews or focus groups. Put simply, there are three basic approaches to asking questions: (1) do not deviate from the set questions and do not ask additional questions, (2) ask follow-up questions or prompt for more information, or (3) let the participant completely guide the interview. For my research with ABFM, I follow the middle road – I write down my questions, focused on a broad topic, while leaving space for gathering more information. Sometimes I do fall into the participant-led approach; some statements are too interesting and informative to let go, even if it doesn’t directly relate to the current research project.

For example, in 2025 I interviewed 27 ABFM Diplomates about the meaning of professionalism. My questions were extremely open ended (literally – “when you hear the word professionalism, what comes to mind” and “what does professionalism mean to you”) which serves to gather information about a specific topic, but on the participants’ terms. One issue that continually came up (and which I followed participants’ lead on) is encompassed by the phrase “administrative harms.”

Administrative harms, originally introduced by Drs. Chang and Liang in 2011, was later defined by Dr. Burden and her colleagues in Colorado as “the adverse consequences of administrative decisions within health care [that] directly influences patient care and outcomes, professional practice, and organizational efficiencies.” This term provided a useful framework for understanding what we heard from interview participants. Namely: physician input was dismissed or devalued by administration, physician time and activity was strictly structured by administration, and administrative decisions created a workplace environment that did not support basic biological needs.

There were variations across practice types, of course, which have different degrees and amounts of administrative pressures. And there were some participants – and manuscript reviewers – who did not experience administrative harms, or disliked the term and its implications. This phenomenon and its inherent variation is a prime example not only of a particular way to approach interviews, but of the power of qualitative research to uncover and explore human experiences.

To read more about what we found, including direct quotations from ABFM Diplomates and broader contextualization of administrative harms, read the article, Family Physicians’ experiences of administrative Harms, in Family Practice.

Annie Koempel serves as a Qualitative Scientist for the American Board of Family Medicine.