As hospitalists take on more demanding leadership roles, the climb up the career ladder evolves into a juggling act: Hospitalists typically try to handle a full patient load as well as new administrative duties.
If a hospitalist continues to ascend, those administrative duties can begin to consume the schedule. The individual—and the group—could face important decisions about priorities, schedules, and money.
“Hospital medicine is only ten years old; we’re still trying to figure this out,” says Mary Jo Gorman, MD, MBA, chief executive officer of Advanced ICU Care in St. Louis and a past president of SHM. “It’s always a challenge. You identify that you have a need for someone to take charge of an administrative task, but it can take as long as a year to free up [the hospitalist’s] time so that it can get done.”
If you have found yourself in this position, you know that something has to give. “I’ve seen high-energy physicians who think that they can do it all—and they had to,” says Joan C. Faro, MD, FACP, MBA, chief medical officer at John T. Mather Memorial Hospital in Port Jefferson, N.Y. “That is not sustainable. It can’t last forever.”
The question is, how can a hospitalist effectively balance their clinical and administrative duties? Furthermore, what happens when the scales tip in favor—and to the detriment—of one or the other?
When the Juggling Begins
Hospitalists usually add “extra” duties to their normal workloads to advance their careers. Few relinquish their clinical duties as they join committees, further their training, lead a research project, or take on administrative duties.
Dr. Faro says a hospitalist should be able to “head up a focused project or serve on committees” and still be able to meet all their clinical duties. “Once you get beyond that, you need a certain amount of protected time” for administrative or project work, she says. “And when you start to have people reporting to you, you absolutely need that protected time.”
—Joan C. Faro, MD, FACP, MBA, chief medical officer, John T. Mather Memorial Hospital, Port Jefferson, N.Y.
Assigning administrative tasks to physicians who regularly see patients depends on the group structure and requires a clearly defined job description. “If a group is really going to make this work, then you have to pay people for that extra time,” Dr. Gorman says.
Ideally, HM groups have job descriptions for physicians who are called upon to see patients and handle administrative duties. Contracts should include specifications for “protected time,” as well as compensation for new responsibilities.
As administrative duties grow, something has to give. Hospitalists who want to pursue positions of leadership know that that something is hours spent delivering patient care. “If you’re a hospitalist-administrator who wants to make the leap to vice president or department chair or chief medical officer, you need to devote a lot of time to your administrative work,” Dr. Faro says. “You can’t make that leap without putting in those hours.”
So what is a reasonable division of time for, say, the director of an HM program or department? “It’s impossible to pinpoint, but I’d say roughly that [a director] should spend not less than 25% or 30% of their time, and certainly not more than 50% of their time, on clinical work,” Dr. Faro estimates.