Medicolegal Issues

He’s on HM’s Fast Track


 

William Ford, MD, FHM, was just three years removed from residency when he assumed his first HM leadership role. His qualifications were impressive, but because he was just in his early 30s, his soon-to-be bosses needed some convincing that he was right for the job.

But Dr. Ford—now medical director at Cogent Healthcare and director of the HM program at Temple University in Philadelphia—quickly proved that ability, attitude, and work ethic mean as much as, if not more than, a lengthy résumé. “I don’t think you need a title to lead or a position to lead,” Dr. Ford says. “You need the will to lead.”

Q: You spent a little more than a year in private practice before you became a hospitalist. What motivated you to make the switch?

If you’re a true leader, you’re never satisfied with the way your boss is running the program. If you really have the qualities to lead a group, you always think you can do better.

A: I really enjoy the mix of responsibilities. There’s a lot more to HM than just treating the patient. You’re actually treating the hospital. And, ultimately, it’s more fast-paced. I like the ability to be on the cutting edge of medicine, and just being in a hospital keeps you on your toes from a medical perspective.

Q: Your first two clinical sites—Lehigh Valley Hospital in Allentown, Pa., and Union Hospital in Elkton, Md.—are more suburban settings. What made Temple the right fit?

A: I trained at Drexel University (also in Philadelphia), and I wanted to get back to the urban setting. I find that environment to be very challenging.

Q: How so?

A: The biggest challenge is the socioeconomic problems. Eighty percent of our patients are on Medicare or Medicaid. … In a nutshell, the challenge comes down to basic access to care.

Q: How frustrating is that for you?

A: It’s very frustrating, and it angers me. If I write a prescription for a patient, there’s a good chance the person won’t take it. If I tell them they need follow-up treatment, there’s a good chance they won’t get it. It’s not that they don’t want to. Maybe they can’t afford the co-pay, or maybe, if they haven’t been monitored by a primary-care physician (PCP), they can’t get an appointment for three months. I know we, as a group, can care for patients much better if they would follow up with our instructions. But because of the hoops they have to go through, whether for economic reasons or access reasons, many of them are coming back to the ED.

Q: What keeps you going in spite of those challenges?

A: The patients. They are a very grateful population. They know they are underserved, and they are appreciative of the care.

Q: Temple partnered with Cogent Healthcare in 2006 to manage its hospitalist program. Were you excited about being able to put your stamp on a program and really help it develop?

A: That was enormously appealing. If you’re a true leader, you’re never satisfied with the way your boss is running the program. If you really have the qualities to lead a group, you always think you can do better. … I was intrigued by the opportunity to start a group in a major teaching center that, for the first time, was outsourcing its hospitalist program and trying to solidify its teaching mission.

Q: How quickly has the program grown?

A: We’ve grown from four physicians to 27, and we treat about 15,000 inpatients annually.

Q: What advice would you give to the director of a program experiencing similar growth?

A: Be very stringent on the doctors you choose. For a lot of groups, retention/recruitment is the No. 1, No. 2, and No. 3 problem. We’ve been fortunate we haven’t made many bad hires. But the time and effort it takes to get rid of a bad hire can really end up bogging you down. I’d rather have everyone pull up their bootstraps and work a bit harder and take an extra few months to find the right person than go ahead with a bad hire simply to have another body.

Q: Were there other keys behind the program’s success?

A: There are several. I owe a great deal of the success of the program to the great doctors I work with. I received tremendous support from the department of internal medicine when I arrived, and that ensured a smooth transition. Another big component is good communication.

Q: What role has communication played?

A: Hospitals are very siloed. One group doesn’t speak to another. We’re taught to stick our head in the sand, fix the problem, and move on to the next problem. That gets you crucified in the world of HM. As hospitalists, we have to be the glue that brings all these silos together. In our profession, to be a good leader, you don’t have to be the smartest or best clinician. But you do have to have the attributes of communication and teambuilding. The key is to meet people and talk to them. Try to get to know every key hospital administrator. Don’t just write an order and go away; talk to the nurse. If you forge relationships and try to get the group more fully implemented, it will be more likely to reach its full potential.

Q: At 35, you are slightly younger than the average U.S. hospitalist, yet you’re nearly three years into your first true leadership role. Has your age ever been an issue?

A: Initially, it was a hindrance. It took four months for Temple to interview me. The biggest negative they gave to Cogent was, “He’s so young.” In any other field, 35 would not be considered a child. We’d be in the workforce for 13 years, and we’d be considered middle or senior management. Medicine in general is steeped in, “If you don’t have gray hair, you’re not able to sit at the table.” In our specialty, you can. … It doesn’t have to hinder you, but you have to be willing and able to do the right things. If you are, you will be noticed.

Q: You consider HM program marketing and branding one of your specialties. Why are those efforts necessary?

A: If you don’t market yourself, you’ll die, particularly in a competitive market. Whether you are at an academic center or a small community hospital or even a larger hospital, you could have two or three hospitalist groups all vying for the same patient volume. You need to give yourself a differential advantage.

Q: How do you do that?

A: You have to get out and meet people and shake some hands. You have to meet all of your customers, and you have to find out if they are happy or displeased. You have to communicate with them. You have to think about your customers, and they’re not just the patients in the bed. Your customers also are your administration, your PCPs, your subspecialists. … It’s no different than a vendor selling fax machines. We are a business, and if doctors don’t think that, they’re very naive.

Q: You’re also a big proponent of team-building within groups.

A: Definitely. That’s the foundation. Groups are going to coalesce differently. In my group at Lehigh Valley, we all had a Fourth of July party. We were never so close as after that one experience when we shared dinner together. It may be as simple as that. At Temple, I had all 25 of us meet and go over a teambuilding exercise to understand what values people have and why they come to work. I asked them to tell me something I didn’t know about them. I heard everything from “I changed my name when I was 5” to “I played basketball in college.”

You’re more willing to cover for a colleague if he or she is sick if you get to know them on a personal level. And if that happens, you’re less likely to leave, and that decreases turnover. On top of everything else, you become a group. You see group buy-in and goal recognition, and you start to see those goals attained.

Q: On top of your administrative duties and teaching responsibilities, you’re still doing 10 clinical shifts per month. Why?

A: It’s hugely important for two reasons. No. 1 is respect among members of your team. No. 2 is knowledge of your service. It’s not until you get your hands dirty that you can really understand what physicians in your group are going through and figure out ways to make life better. And at the end of the day, we’re all still physicians. TH

Mark Leiser is a freelance writer in New Jersey.

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