Medicolegal Issues

Administrative Ambition


Interested in a promotion? If you have your eye on an administrative career, go ahead and think big—because the opportunities for today’s hospitalists are there for the taking, with some planning and the careful acquisition of skills, experience, and training.

“Any hospitalist who has any desire to be a leader, whether in a medical practice or in a hospital, has numerous opportunities,” says Patrick Cawley, MD, chief medical officer of Medical University of South Carolina (MUSC) Medical Center in Charleston. “If you’re willing to step up, you can attain that leadership position.”

Plan Your Path

Ambitious hospitalists must consider the administrative positions available to them in the long run.

“Within a hospital medicine practice, you have just one director,” says Joan C. Faro, MD, FACP, MBA, chief medical officer, John T. Mather Memorial Hospital, Port Jefferson, N.Y. “So people working in the ranks need to be creative and come up with ideas on gaining experience, such as creating a QA position.” She advises hospitalists to look at the job description and the performance measures of the director’s position to see what expectations come with the job.

The promotion to director may involve switching practices. “If you want to move quickly, you have to be able to move [to a different group],” explains Dr. Cawley. “In a local community, there will be others ahead of you. If you’re willing to move to a less-than-ideal location, you can find better opportunities.” For community-based hospitalists especially, the director’s position is a necessary one before moving higher up the administrative ladder.

“You need to be managing some people before you become a CMO [chief medical officer] or administrator,” explains Dr. Faro. “You really have to show that you can do some significant work. In academia, you can do this as a division chief or something like that.” As the director of a hospital medicine program, she says, “you can broaden your scope and move higher up into hospital administration.”


Hospitalists and Burnout: The Jury’s Still Out

According to an article in the January issue of Resident & Staff Physician (“Hospitalist Careers: A Field of Growing Opportunity”), the possibility of hospitalist burnout is still in question. “Many skeptics suggest that a hospitalist career is suitable only for young physicians,” say authors Robert M. Wachter, MD, professor and associate chairman, department of medicine, and chief of the Medical Service, University of California, San Francisco (UCSF), and Niraj L. Sehgal, MD, MPH, assistant professor, department of medicine, and medical director, UCSF at Mount Zion. “They have a difficult time envisioning a mid- or late-career hospitalist.” But there is little evidence of burnout, the authors say, citing a 2001 study that found 13% of hospitalists met the criteria for burnout and another 25% were at risk for burnout—rates that compare favorably with other medical specialties. At the time this study was published, the authors had speculated that the relative novelty of the hospitalist specialty could, in part, be responsible for the relatively low burnout rates.

How to chair a committee

When tasked with leading a committee, you may not be able to choose the members. However, you can assess their skills and interests, then match each to appropriate tasks based on individual skills, interests, and willingness. Pay special attention to the motivation and personal goals of each person. Keep in mind, too, that the more dissimilar the contributions, the more likely committee members will feel that their work is necessary.—JJ

First Steps

How do you move from working hospitalist to director or department head? Start small.

“You can start with easy committee assignments,” says Dr. Cawley. “Even while you’re getting leadership training, you can be building those skills on the job. Start with small projects, such as small committee roles or quality management projects. You can then move up, but consider that you’ll need new skills as you do. Before you chair your first committee, you’ll have to brush up on how to run a meeting. You can progressively take on larger, broader roles.”

Enlist the help of your own leaders to help you get started.

“You could go to your CMO or your medical director—if they’re in a position to help—and ask what you need to do to get to the next step,” advises Dr. Faro. “You don’t need formal training at this point; test the waters, find what you’re interested in and make sure that leading change is something you enjoy before you [invest in] formal training.”

Dr. Faro was working as an internist in an academic medical setting when she discovered an affinity for leadership. “I went to my dean and asked to be put on committees,” she recalls. “I also worked in a volunteer capacity and did committee work for the local chapter of the American Heart Association. I ended up chairing a number of committees over the years. It just seemed to happen naturally because I enjoyed it. After these experiences, I knew I had a talent for working with disparate groups and getting things done.”

As you concentrate on committee work and project work, focus on building clinical and administrative skills.

“The most important things are having the right skills and experience,” stresses Dr. Cawley. “In my opinion, experience will count for more than skills, because people tend to assume that your skills improve as you gain experience. Experience is more important than an advanced degree, with the caveat that degrees are one way that leaders can prove themselves. Having that MBA or MPH doesn’t hurt, and it shows that you’re serious; it requires some dedication to earn that.”

The white paper online

“A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction,”

is available for download at under the “SHM Initiatives” section. The white paper, prepared by SHM’s Career Satisfaction Task Force in December 2006, details the four pillars of job satisfaction. Find more information on guiding your career at SHM’s Career Center ( Browse opportunities and post or view resumes.

Leadership Training A Must

If your committee and project experience assures you that you want to pursue a leadership path, says Dr. Cawley, “you really need leadership training. Now, is that an MBA or simply selective reading and coursework? That depends on what you want and how you want to go about it.”

However you decide to educate yourself, that leadership training should emphasize certain skills.

“You definitely need formal negotiation skills training,” says Dr. Cawley. “You should also train in how to deal with a physician who’s disruptive. You’ll need a little bit of financial training, and then leadership training itself—what is a leader and what are the expectations of a leader? These are the basics.”

Dr. Faro adds that communication skills and presentation skills are important for leaders. “These are things that physicians think they know— after all we all feel we communicate well and we need to talk to our patients—but there’s a difference between teaching your patients about medications and engaging an audience,” she warns. “It’s also important to understand your management or your leadership style.”

Leadership training is easy to find. “Every single organization has now recognized that being a leader is something that requires training,” Dr. Faro points out. Physician leadership training is offered by the American College of Healthcare Executives, the American College of Physician Executives, the American College of Physicians, and SHM.

Opportunities Abound

In the growing field of hospital medicine, opportunities for advancement are growing as well. “Within just a few years, you’d be surprised what level you can reach,” says Dr. Cawley.

“There is a lot of potential for leadership within hospital medicine groups, and for moving from leading a group to a leadership role at a hospital,” says Dr. Cawley. “But the leadership chasm [in healthcare today] extends to every area where physicians are providing care.

“To me, it’s all about opportunities, skills and experience. With these, you’ll find that the sky’s the limit.”

Dr. Faro believes hospitalists are in a perfect position to rise to administrative positions. “You are, by definition, working in an institution,’’ he says. “Hospital medicine is replete with opportunities for leadership—opportunities to start a team for quality endeavors, an IHI [Institute of Healthcare Improvement] campaign, look at medication reconciliation, DVT prophylaxis, or glucose control. There are so many right things for physicians to be doing in a hospital setting. In any hospital today, there are going to be opportunities.” TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

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