Health systems depend on legal counsel for everything from physician agreements and regulatory compliance to middle-of-the-night operational crises. How that legal function is organized, and how in-house and outside counsel work together, has a direct impact on the quality and speed of the advice reaching executive teams.

In this episode, Jim Burke and Steven Pratt speak with Susan James, a healthcare attorney who has moved between in-house general counsel positions and law firm practice multiple times over a career spanning decades. She is now at Hall Render, where she is also partially seconded to a health system building out its legal function.

The conversation covers what in-house counsel gains from being physically embedded in operations, how general counsel should evaluate when to send work outside and select the right attorney, the distinction between treating outside counsel as a partner versus a commodity, what health systems lose when legal departments centralize or go fully remote, and the tension between the in-house standard of good enough and the law firm pursuit of precision. Susan also shares firsthand accounts from on-call rotations that illustrate why proximity to the client matters.

Whether you manage a health system legal department, serve as outside counsel to health systems, or lead an organization that relies on both, this episode offers a practical perspective from someone who has operated on each side.