As a hospitalist, you wear many hats. Add a leadership position to your title, and you will be fitted for many more.
I have balanced a management hat and a patient care hat as a medical director for a few hospital medicine groups. I typically worked a full clinical load, just like members of my team, and somehow found non-clinical time–too often stealing from family time–to manage administrative responsibilities that ranged from scheduling to QI projects.
While these duties were important, my non-clinical time often got squeezed, taking a back seat to my clinical schedule and the critical needs of our patients. Somehow, it all got done.
Whether this is the norm, I can’t say, but I do see signs of change and a new crop of leadership that seeks protected administrative time and a lighter clinical load.
One of the drivers, I think, is that group leaders are becoming leaders in their hospitals, gaining a growing acceptance in the vital hospital committee structure. Because of our role at the center of patient care, we’re often asked to champion QI and patient safety projects. As a result, the leaders in our specialty are having just as positive an impact on patient quality and safety in administrative roles as when they wear their clinical hat.
All of this raises the question: As our group responsibilities grow and we take our seat at the hospital leadership table, can we swap out some of our clinical work–and will hospitals and hospital management groups let us make that trade?
In my leadership days, our bottom line benefited from my ability to handle my management role in addition to seeing a full patient census. To do otherwise would mean a less experienced, less efficient doc would take on some of my clinical duties, and my group would generate less revenue at greater cost.
Or at least, that was the short-term view. A broader perspective on protected administrative time might prove out differently. Allowing hospitalist leaders to truly lead can be an investment in patient care and medical staff relationships that pays dividends down the road. Group leaders who fully insert themselves in the vital functions of the medical staff and hospital become indispensable, and generate stability for the group, respect for the team, and help in recruitment, retention and satisfaction for the service.
More importantly though, leading QI teams affects the quality of patient care. Hospitalist groups and hospitals have to realize that hospitalist leaders’ insights into process improvement can prove more valuable than their ability to bill for their clinical services.
What, then, is the right balance of clinical and administrative duties? Most program leaders do not want to give up their clinical practice altogether as they have made a large investment in time and money in developing these skills and do not want them to rot on the vine. The traditional alternative, though, is not acceptable either and represents the other end of the spectrum: full time clinical and administrative duties “on the fly.”
I have seen several models of protected administrative time in action and there is one that stands out to me as superior. In this model, the hospitalist group leader works a traditional work week, Monday thru Friday, and gives up the block schedule of seven-on/seven-off.
That leader picks up a small but manageable number of patients each day (say, 8-10) and then has several hours of built-in administrative time available during the day to devote to non-clinical activities. The benefits of such a schedule allow for:
- On-site medical leadership that is present during normal business hours and able to intervene with issues that arise as they happen, minimizing their impact and avoiding delays in rectifying these situations.
- The presence of an overflow mechanism so when the stuff hits the fan, the leader can pick up an additional few patients and help maintain correct physician to patient ratios (as long as this is the exception and not the rule).
- The ability of the leader to maintain a semblance of lifestyle quality, trading the seven-on/seven-off schedule for one in which weekends are free and holidays are covered.
- The availability of the group leader to actively and fully participate on committees and in QI projects and to become a true champion of quality and patient safety.
- Time for on-site mentoring of new or younger physicians.
No matter how your program chooses to do it, the movement is afoot. Be proactive. Work with your hospital and/or group to ensure that you’re allowed to move your program to the next level, and help them see the value in you participating in non-clinical activities.
I think our message as leaders should be that we don’t mind wearing multiple hats. But we’d prefer not to balance all of them on our head at the same time.