Viewpoints from the Executive Suite and the Bedside

The Hospitalist. 2009 May;2009(05):

May 6, 2009|The Hospitalist

Like many family medicine practices, Chris Heck, MD’s, group in Waynesboro, Va., made the tough decision two years ago to limit their practice to outpatient services. According to Dr. Heck, one partner, Tom McNamara, DO, MMM, CPE, was reluctant to give up hospital work.

So, maybe it’s not surprising Dr. McNamara now fills a unique dual role, as president and chief executive officer and a working hospitalist at Carilion Stonewall Jackson Hospital in Lexington, Va. Dr. McNamara is the first physician CEO at Stonewall Jackson, and the first doctor of osteopathic medicine CEO at one of the hospitals in the Carilion Clinic, a Virginia-based multispecialty organization with more than 400 doctors and eight hospitals.

Serving double duty as CEO and a hospitalist at a critical-access, 25-bed hospital seems to suit Dr. McNamara. “It has allowed me to quickly and thoroughly learn about our staff and our patients,” he says. “And it has given me insight into quality, cost, and feedback programs from both sides, so that I can make informed decisions.”

Both Perspectives

When Dr. McNamara first agreed to be CEO and work shifts, he feared he might have difficulty considering doctors’ requests impartially, or that physicians might feel uneasy working with their boss during patient encounters.

Neither fear has panned out. He says the physicians and recruits he works with generally feel they have an advocate in the executive suite. In addition, when they come to him with suggestions and requests, “they bring very thorough arguments because they know I know exactly where they’re coming from,” he adds.

Dr. McNamara already has put this unique perspective to use several times since taking the jobs in April. For example, when he started the staff was experiencing glitches when filing lab reports in patients’ electronic health records. “They were changing the process when I came in, but since I had broad experiences,” he says, “I was able to help make the changes smoother.”

Dr. McNamara also improved the hospital’s hand-washing practices by having dispensers placed in hallways, where their use could be more readily observed. The idea was to increase documentation of hand washing. “I had this thought because I had used the dispensers [at another hospital] myself,” he says.

Dr. McNamara’s hands-on experience also has made the hospitalist recruiting process easier, according to Howard Graman, MD, medical director of Carilion. “[Dr. McNamara] knows the profile of the job and the kind of person who would like it,” Dr. Graman says. “He’s a savvy judge of character.”

What Hospitalists Should Ask Executives

With his viewpoints from the executive suite and the patient floor, Dr. McNamara believes hospitalists should ask the following questions of their hospital’s executives:

1) How do hospitalists communicate with referring, office-based physicians? What technology do you use to enhance their communication?

2) Does the hospital value its relationship with the community it is located in? What activities and staff facilitate the relationship?

3) Describe what programs the hospital uses to ensure maximum reimbursement, cost-efficiency and safety. Are any of the programs tied to compensation?

4) What are the tactics for recruiting subspecialists and is there a process through which hospitalists can suggest specialists?

Double-Duty Accolades

Dr. McNamara’s bosses are happy with how he has handled the juggling act, so far. Dr. Graman says Dr. McNamara has helped him to better understand the institution, how to make improvements, and how to respond to staff. “It’s great for employees to see the head of the hospital working,” he says.

The man Dr. McNamara replaced, Steve Arner, now vice president of cardiac and vascular services for a larger Carilion hospital, agrees there are advantages to having the hospital’s CEO also be a working physician. “On the floor or in the emergency department, [Tom] can test the processes, especially new ones,” Arner says, “and see first hand the impact on practitioners and patients.”