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.”

Team Hospitalist members debate the pros and cons of HM directors seeing patients.

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.”

There’s a point at which you realize that part-time [administrative work] just doesn’t work. You realize that your expertise and guidance are needed.

—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.

Clinical-Hour Cutbacks

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.

Clever Tips for Meeting Leaders

Well-planned and well-executed meetings keep staff engaged and operating efficiently. Here are some tips from “How to Make Your Meetings More Productive,” by Roger Shenkel, MD, published in the Aug. 25, 2003, issue of Family Practice Management:

Gather the necessary participants;

Make the meeting effective and efficient; and

Follow through on the decisions made and communicate them to the appropriate people.

“Don't wait until the end of the meeting to establish a plan for executing your decisions, because many of the doctors will have already left the room,” Dr. Shenkel says. “As you address each item on your agenda, determine who is responsible for implementing the decisions and set an appropriate deadline for completion. This information should also be highlighted in the meeting minutes.”

—JJ

Even upper-level physician-administrators should maintain a clinical practice simply to monitor the work their department is doing. “It’s not about [clinical] skills as much as it is about whether you can relate to physicians’ day-to-day work, to their frustrations,” Dr. Gorman says. “That’s a management challenge no matter who you are. For example, if hospitalists are complaining about a new EMR [electronic medical record] system, are you going to say, ‘Oh, just put up with it; it’s not that bad. It will be fine’? Or are you out there trying it and saying, ‘Holy cow, this is really inefficient. We have to change this’?”

On the flip side, how much time should be devoted to administrative tasks? The answer depends on the size of your program and the amount of work you have to do, Dr. Faro says. Group directors and department heads normally make themselves available during regular weekday hours. That usually means you’ll have to fit in your clinical work around meetings, budgets, and presentations.

Can You Give Up Clinical Duties?

It’s natural for physicians to be reluctant to relinquish patient care; some reach a point where they have to make the tough decision to stop clinical work altogether.

“You may figure out that you want to pursue an administrative role, but you don’t want to give up clinical work,” says Dr. Gorman, who spent 15 years juggling a full clinical schedule with administrative duties before she became a full-time administrator. “You get plenty of opportunities to make that decision as you’re crossing back and forth.”

You might want to evaluate your options and make the choice sooner rather than later. Once you’re in administration, the decision might be forced upon you. “Eventually, you’ll find that critical things are happening all hours of the day, any given day of the week, in administration as well as clinical practice,” Dr. Faro says. “There’s a point at which you realize that part-time [administrative work] just doesn’t work. You realize that your expertise and guidance are needed.”

Dr. Gorman warns that there are risks and changes involved with becoming a full-time administrator. Once you decide to give up your clinical practice and go the leadership route, your career is “in the hands of someone else,” she points out. “Your position could be eliminated. You could be fired or replaced. … That is a concern. A lot of people keep their hand in on clinical skills for that reason.” You also might find that advancing a management career requires moving to a new organization or a different part of the country.

On the other hand, the rewards of a career in administration can’t be overlooked. “It’s very satisfying personally,” Dr. Faro says. “It’s inventive; you’re constantly solving problems that didn’t exist yesterday.

“It’s a different kind of job satisfaction. It’s a very personal decision. There are people who realize that this just isn’t for them.” TH

Jane Jerrard is a freelance writer based in Chicago.

Clin-Admin Balance