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To the Dark Side & Back


Michael-Anthony “M-A” Williams, MD, FHM, thought he had his future mapped out. After completing his residency in 1999, he joined Inpatient Services, PC (ISPC), in Denver with the intent to practice for a year and use his experience as a bridge to a fellowship or other professional opportunity.

The plan changed, however, when the IRS informed his HM group it owed $450,000 in unpaid payroll taxes, and banks began threatening to freeze accounts. After the dismissal of the group’s business manager for malfeasance, Dr. Williams offered to help. He took over as the practice’s financial officer, reconstructing two years’ worth of records and negotiating a compromise with the IRS.

The successful crisis resolution left Dr. Williams reassured that ISPC had a viable business. It also laid the foundation for his journey into HM leadership. He took over as the practice’s president in 2003. Four years later—after helping grow the practice from 16 physicians and 46,000 annual patient encounters to 38 physicians and 84,000 annual encounters—he helped orchestrate a merger with Tacoma, Wash.-based Sound Inpatient Physicians. He now serves as Sound’s executive director of business development.

“When I became financial officer, I didn’t know what P&L stood for,” Dr. Williams admits, referring to the common business jargon for a profit and loss statement as an example. “It really was an education from the ground up. But the reason I got involved in reconstructing the books in the first place was because I was interested in how the business of hospital medicine worked. That experience has served me well.”

Question: When you took over as president of ISPC, did you have a sense the growth would be so rapid?

Answer: We didn’t necessarily plan to continue to grow, but every time we turned around at a hospital, more primary-care doctors were asking us to take over their patients. It’s not something we actively sought. The business came to us. Before long, we realized the growth probably wasn’t going to stop.

Q: What prompted the merger with Sound?

A: It came down to infrastructure and support. We knew more growth was coming, and we were in a position where we needed more professional leadership. I wasn’t going to be in a position to do the president’s job forever, and we didn’t have other physicians necessarily clamoring for the opportunity. At the same time, we were very cautious. We wanted to make sure we merged with the right group that was physician-led.

Q: Three years into the partnership, what have the benefits been?

A: It has brought a lot of stability. There’s not that month-to-month worry the partners may have had about cash flow and how the business is functioning and what our health insurance premiums are doing, which were constant discussions before. And we have much stronger relationships with our hospital partners. That has allowed our doctors to get off the encounter treadmill. The biggest impetus for joining Sound was to provide a better workday for the hospitalists, because we kept seeing the encounters climbing higher and higher against our wishes.

Q: Have there been any unforeseen challenges?

A: The biggest challenge for those of us who were partners was ceding some control. It’s been a tradeoff. It’s been worth it to lose some control but gain a better workday and a little more stability.

Q: What advice would you give to someone whose group is going through an organizational change?

A: Thoroughly explore all of your options. Don’t be afraid to take a step back, take a pause and say, “Is this the right decision?” or “Why are we doing this?” Beyond that, make sure whoever you’re thinking of joining forces with has a philosophy that fits with yours. It doesn’t matter how much money is offered if, philosophically, you can’t come to terms.

Q: After the merger, you spent 18 months as chief medical officer of Sound’s Rocky Mountain Region. How hard was it to balance that role while caring for patients?

A: Incredibly hard. I used to joke I was two-thirds clinician and two-thirds administrative. It was a tremendous time commitment, but I always had a strong belief I could never be an effective physician leader without continuing to see patients in the hospital. I wanted to lead by example, but I also wanted to understand what my fellow physicians were going through on a day-to-day basis.

Q: In September 2008, you reverted strictly to clinical practice. Why did you make that choice?

A: I wanted to be able to have one job, not two. I wasn’t prepared to let go of clinical practice, and there was the issue of my time commitments as a physician leader. I have two young boys, and I wanted more time with my family. As trite as that may sound, it’s completely true.

Q: What did you learn in your leadership role that helps you as a practicing hospitalist?

A: It is imperative for working physicians to understand how the business works, and how it doesn’t work. I try to share—especially with younger physicians—all of the things that go into running a hospitalist practice. It doesn’t just happen by magic. I think it helps to have that perspective.

Q: What other advice would you offer to new physicians?

A: Don’t be afraid to get involved, whether it’s in hospital committee work or in the business of medicine. We are always looking for new leaders, and if that’s something that interests you, there will definitely be a role for you. It’s intimidating to come out of residency and think “Gosh, I didn’t get that much business education.” You can definitely learn it. If you have the interest, it’s worth asking the questions and getting involved.

Q: You say you better understand the value a hospitalist brings to the table. How does that translate into quality of care?

A: By expanding physicians’ view away from just direct clinical care to the quality metrics that need to be followed. What is the documentation appropriate for a patient? What are the hospital’s goals, from time of discharge to patient satisfaction scores, and how can we help meet them? While we all still very much prize our independence, we are part of a larger field of healthcare in general. We can’t make all of our decisions in a vacuum.

Q: What’s the biggest challenge you face?

A: The continual pursuit of the right mix of the right staffing and workload for our program. Having done this for 10 years now, I don’t have any doubt that you can do it, but it’s a continual adjustment to find the right balance.

Q: You gave a talk at an SHM annual meeting about hospitalist burnout. What’s the secret to recognizing it and preventing it?

A: One of the first things—before the hire ever happens—is to make sure the group’s philosophy and the individual’s philosophy about time and money and workload are in agreement. You need to continue to evaluate those principles on an ongoing basis to make sure they continue to agree, because they can diverge over time. It’s a constant focus on the group’s end.

Q: What’s your biggest reward?

A: Taking care of patients. There’s no greater satisfaction than making a complex and frightening hospital stay a little more simple to understand, and a little less frightening, by having an open discussion with the patient and their family to help them get through it. That’s still what gives me the greatest joy.

Q: You were inducted into SHM’s inaugural class of physicians who received Fellow in Hospital Medicine (FHM) distinction. What does that recognition mean to you?

A: I was very honored to be in the inaugural class, and I’m excited to see them offer that distinction. I think that’s very important. It allows SHM to recognize a greater variety of leaders beyond those who make it their focus to write and speak.

Q: What’s next for you professionally?

A: I’m enjoying the respite, as much as it is one. I’m sure I’ll get involved again with a physician leadership role. When I started, there was some concern no one would be a hospitalist forever. The thinking was you’d do it for a year or two, burn out, and do something else. The biggest question I had in 1999 was, Can HM be a career? Ten years later, it’s nice to see that question answered. TH

Mark Leiser is a freelance writer based in New Jersey.

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