There’s a seductive logic in healthcare that says you can grow your way out of almost any problem. Build a new program, launch a new service line, put up a new building. Momentum, the theory goes, creates its own return
Salim Hayek, MD, doesn’t buy it.
“There’s a mantra that you can grow yourself out of anything. I don’t think that’s true in healthcare,” said Dr. Hayek, chair for the department of internal medicine and chief transformation officer at The University of Texas Medical Branch. “Whenever you’re reliant on an environment that is unstable and you’re investing significant dollars in growth, that growth is highly dependent on the payer and reimbursement.”
Dr. Hayek arrived at UTMB in 2024 as part of a new leadership team tasked with expanding the institution’s reach across Southeast Texas. The ambition is real — UTMB is actively growing, hiring, and building. But his approach to that growth is methodical in a way that guards against the instinct to move fast.
His framework is simple: before investing in expansion, assess the risk of each strategy, then ask whether the foundation is strong enough to support it. That foundation, in his view, isn’t primarily financial. It’s human.
“Are our services operating the way they should be? Are our physicians deployed the way they should be? Do we have a situation in which our physicians trust leadership?” he said. “Especially in times of change, that trust component in academic health systems is critical.”
Academic medicine has a structural distrust problem. Faculty have seen administrations come and go, watched priorities shift, and learned to be skeptical of transformation initiatives. Earning their confidence requires giving them genuine ownership of the change process.
“I have invested heavily in establishing a relationship of trust with our faculty so that they know that change is coming and that we are there not just to support them, but that they’re part of that change,” he said. “They’re part of the planning. They’re part of the vision building, and they’re part of the execution.”
The approach is deliberately unsexy. Dr. Hayek is candid that foundation-building doesn’t generate headlines the way new programs or capital projects do. But he’s watched enough health systems stumble to be convinced of its necessity.
“We’ve seen that across the nation, programs that are just faltering because you have people leaving, investments that just haven’t yielded the return,” he said.
For 2026, that philosophy is being tested against genuine uncertainty — regulatory changes, NIH funding questions, and reimbursement volatility all live variables. Dr. Hayek’s answer isn’t to pause, but to sequence: stabilize first, then build. The new subspecialties, the new tools, the fancy programs — those come after the foundation has proven it can hold them.
“Although it’s not always the sexiest thing, I think it is what is going to save us,” said Dr. Hayek. “Then it’s going to allow us to do exciting things like building programs, adding specialties and new tools and gadgets. All that comes after you’ve built a solid foundation.”
There is a lot of momentum to add technology and AI-driven tools to improve operational workflows and clinical outcomes. The rapid technology development adds another level of unpredictability to healthcare’s evolution, and many leaders are focused on short-term growth as a result.
“What I’m looking forward to in a year is a significant return on investment on our development of AI referral triage,” said Dr. Hayek. “We want to see the sickest patients get seen first and get the care they need. We want to see the right downstream utilization and we want to see surgeons busy doing what they do best and our specialists seeing the right patients while primary care providers continue holding the line in terms of the foundational care for these folks. I’m excited to see what kind of impact these strategies will deliver.”
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