Finding a significant administrative role is not an all-or-nothing proposition for working hospitalists, although directors of group practices sometimes struggle for their colleagues’ recognition of their need for dedicated administrative time.
Doctors face two significant crossroads as they gain progressive administrative responsibilities. For those with demanding executive positions, it may become necessary to give up clinical practice—a painful choice for doctors who have devoted years to mastering medical care. Physician executives eventually may also face the need to obtain a management degree such as an MBA or a master’s of health administration—or else find other, less time-consuming ways to learn essential management skills.
Patrick Cawley, MD, is a hospitalist who has not given up clinical work, even while his administrative responsibilities have grown. In his current position as executive medical director of Medical University of South Carolina (MUSC) Medical Center, Charleston, clinical duties take up about 30% of the job. He is just a couple of courses short of completing an MBA from the University of Massachusetts.
“Basically, I’m the hospital’s chief medical officer,” says Dr. Cawley. “A chief medical officer attends a lot of meetings. Most of my day is spent interacting with different people in the hospital—other administrators or one-on-one with physicians. My purview is quality, patient safety, and clinical effectiveness—providing the strategic vision for those activities and some level of detail in working projects through the system.” The role is part cheerleader and part task-master, he says, requiring skills in communications, negotiations and conflict management.
“There’s no doubt that I’m having trouble carving out 30% of my time for clinical work,” admits Dr. Cawley. “You end up missing a meeting here and there, and that’s not good. I know I’ll have to decrease my clinical time eventually.”
For now, however, Dr. Cawley is able to find clinical time in two- to three-hour increments, primarily for teaching and rounding with residents.
“Chief medical officers argue about this all the time: Should you be practicing medicine or not?” he says. “My personal take is that I prefer to do some clinical work. It keeps me involved in the day-to-day problems of physicians and the operations of the hospital. I don’t think I’ll ever give it up completely. For physician leaders, it’s important to be respected clinically, and it gives you a step up in professional relations.”
Dilemmas and Downsides
Research by Timothy Hoff of the University at Albany, N.Y., and others suggests that physician executives who continue to see patients part-time are happier in their jobs, says Winthrop Whitcomb, MD, a hospitalist at Mercy Medical Center in Springfield, Mass. Dr. Whitcomb is a member of SHM’s Career Satisfaction Task Force, which is also studying the issue. Also, when clinical commitments shrink, it can be a challenge to remain current with clinical skills, medical literature, and advances in healthcare technology and computerization.
“There is a danger in dropping out of medicine and pigeonholing yourself too early in your career—especially if you are taking an administrative job for the wrong reasons, such as temporary job frustrations,” warns Dr. Whitcomb. “It’s very hard to come back to clinical practice after giving it up.”
SHM’s Career Satisfaction Task Force is developing a career satisfaction self-assessment tool that would help working hospitalists make clearer assessments of the dilemmas of considering a career change.
Physician executives need to be clear on their loyalties as well as their stakeholders, adds Dr. Wellikson, who gave up his clinical practice in 2000. “At the end of the day, my value to my company was not in taking care of patients,” he says. “Yes, you need to keep yourself real in your relations with other doctors—but seeing patients is not the only way to do that. We don’t need Lee Iacocca building the cars he sells, even though he started as an automobile engineer.”