Does your organization have a board of directors or other parent organization that you can appeal to? It may be risky, but it seems that otherwise it will be very difficult for you to continue to lead within the organization.
I would strongly consider team, site or division based productivity rewards. I like the idea of a threshold level of productivity to earn your salary, and i also have found that quality and safety must be part of the equation. Rewarding individual providers for productivity encourages over utilization and cherry picking. Learning to function as a team and use resources efficiently is the type of behavior that healthcare organizations should reward.
While it is true that this is an increasingly common situation, that doesn’t make it easy! A tone of mutual respect and give and take is key. No one group can expect to get everything they want. Everyone will have to change. It is particularly important in a case like this for there to be a shared mission statement, but also for senior leadership to make it clear whether there is a dominant group “swallowing the other whole” or whether there is room for mutual leaning. In the examples you give, I can imagine that the less education focused group may be able to teach the academics about how to practice more efficiently, while the academics may be able to provide more educational programs (perhaps with CME) for the non-academics. Culture change is always hard but in a large organization success is usually only achieved when the lower performers are brought up and are made to feel like part of the key to the organization’s success.
Triad leadership works best in our organization when very strong leaders are selected for all three positions, and when upper level leadership makes it clear that no one person’s role is more important than another’s. There is a venn diagram of tasks/roles with discrete functions that each person is responsible for, but there is an emphasis on collaboration in the areas of intersection. While there may occasionally be cases where one person has to lead and the other two have to follow, I can’t think of why that would always have to be the same person. There may be situations where a nursing leader has more relevant experience, and others where a physician or managerial leader would have more to offer. Mutual respect is the key; choosing the right people from the start is important; and most important is a mandate from senior leadership that triad (or dyad) harmony is paramount.