Heading up a hospitalist program

Speaking in public, resolving conflicts and mastering spreadsheets are just a few of the things a hospitalist leader must do well.

Leading a hospitalist program requires a latticework of skills—public speaking, conflict resolution and spreadsheet mastery, among others—many of which can be acquired before making the leap into management.

However, some of those skills, particularly in regard to more complex people dynamics, are more difficult to hone until the leader assumes a management role, said Mark Williams, MD, FACP, chief of the division of hospital medicine at Chicago's Northwestern University Feinberg School of Medicine.

Photo by Thinkstock
Photo by Thinkstock.

“I think the biggest [skill] I had to learn was how to seek out others' opinions, and make sure that they were engaged in the conversation,” said Dr. Williams, who previously directed Emory University's hospital medicine unit in Atlanta. “It's easy for the leader to sort of barge ahead and push things along. It's important to make sure that everyone is involved and contributing, so that they feel part of it.”

Hospitalists—and thus hospital medicine directors—tend to be younger than other types of physicians, so they haven't had as much time to develop the kind of leadership skills that often are born of experience, said Mark Hamm, chief executive officer at EmCare Hospital Medicine, which contracts with hospitals to develop or manage physician programs.

Thus, careful selection and training of program leaders is vital, Mr. Hamm said. “A lot of times people these days are thrown into that role without a lot of experience,” he said. “A lot of them are having to learn on the fly.”

Leadership qualities

When Mr. Hamm hires hospitalist medical directors, he looks for flexibility—people who can adapt to a rapidly changing health care system and its myriad challenges, from technology to quality measurements, he said. He also seeks candidates who can work as easily with senior hospital administrators as with front-line hospitalists.

“What I have seen is you need someone who's a good listener, someone who is very calm and cool when everything is getting out of control.” Mr. Hamm said. “Someone who can handle stress and who can handle pressure.”

ACP Fellow David Gates, MD, PhD, agreed that listening is key. “You'd be surprised at what a challenge that is—physicians tend to be problem solvers,” said Dr. Gates, who is a hospitalist and medical director at Eagle Hospital Physicians, serving as medical director at Bon Secours St. Francis Medical Center in Midlothian, Va.

“Most of the time, coming up with the solution is not the solution,” he added. “Most of the time, listening to what people's issues and problems are may go 75% toward actually solving the problem itself.”

If, for example, a nurse is having difficulty getting a doctor to return pages promptly, Dr. Gates might give the nurse time to vent for a stretch, then encourage him or her to suggest a solution. “I can tell you that it is not innate—it's a skill that you have to acquire,” he said.

Dr. Williams described how, early in his medical director role at Emory, he would schedule the shifts himself. That didn't fly very well. “People want control over their schedule,” he said.

So he allowed the hospitalists to self-schedule, albeit with some parameters to guard against working too much. For example, hospitalists couldn't schedule a night shift immediately after a day shift, or vice versa. “You need to protect them from themselves,” he said.

If you don't have an outsized personality, don't worry. Good leaders aren't limited to extroverts, Dr. Gates said. “I've seen good managers and good medical directors from the quiet and reserved type.”

Training opportunities

Hospitalists contemplating a management role should look for opportunities to build related skills, Mr. Hamm said. One potential route is to join a few hospital committees to learn how to navigate group dynamics and to meet players in the C-suite, he said. Some hospitalist groups also are large enough to employ an assistant medical director, which is a good stepping stone, he added.

“There's politics in every meeting in every hospital,” Mr. Hamm said. “You have to learn how to move through those politics. If you have a surgeon who is a power broker, then you have to befriend that surgeon and you have to be his buddy and learn what he needs.”

EmCare provides fledgling medical directors with training opportunities, such as sending them to leadership courses, Mr. Hamm said. The company also gathers its medical directors periodically, including at a national meeting and at smaller, regional meetings.

Educational programs for hospitalist leaders are offered by the American College of Physicians, the American College of Physician Executives and the Society of Hospital Medicine. Some aspiring directors also might want to specialize in a particular area like quality improvement by getting a related master's degree, or by going through Six Sigma training, Dr. Williams said.

Regardless of a leader's particular focus, financial skills are vital, he noted. “You need to understand spreadsheets. You need to understand return on investment. I don't think it's necessary to get an MBA. But it's certainly a good start,” Dr. Williams said.

Abilities like building relationships and delegating responsibilities are frequently sharpened on the job, said Alan Wang, MD, FACP, who directs the division of hospital medicine at Emory University School of Medicine and Emory Healthcare. Leaders also have to learn the communication styles of their hospitalists: Some may prefer a handwritten note or a face-to-face chat, he said. Others are glued to their smartphones and employ text-based communication.

“I had one physician who wouldn't respond to emails and I couldn't get him on the phone,” Dr. Wang said. “But as soon as I would text, an immediate text came back.”

Vetting the job

Dr. Gates, who directed several hospitalist programs before becoming medical director at Bon Secours, recommends that doctors who are offered a hospitalist leadership position carefully vet its responsibilities and reporting relationships before accepting it. Ideally, the responsibilities should be in writing, he said. In some programs, for example, the director can counsel and work with struggling hospitalists, while in others they cannot, he noted.

A physician who is promoted from within will already know the program's dynamics, but more legwork is needed for the hospitalist who is being hired from outside, Dr. Gates said. Among the details to find out, he suggested: “Are we in crisis mode? Do I have personalities I have to deal with when I walk in?”

Doctors who lead large hospitalist groups serve a role closer to physician executive and likely only pull a few shifts a month to maintain their clinical skills, said Tommy Bohannon, vice president of the hospital-based recruiting team at Merritt Hawkins in Irving, Texas. Pay packages typically range from $250,000 to $350,000 at larger groups, which he describes as 20-plus doctors, sometimes spread across several facilities, he said.

At smaller to mid-sized groups, a hospitalist medical director is more likely to pull regular shifts, with some time carved out for administrative duties, he said. He or she is likely to receive additional compensation on top of base pay, Mr. Bohannon said. That extra amount can range from $15,000 to $30,000 in a smaller group of three to six hospitalists or up to $60,000 in groups of 10 to 15 doctors.

As the number of U.S. hospitalist programs multiplies, so do the leadership opportunities. A hospitalist medical director can wield considerable influence, given the specialty's role as patient-care quarterback at many hospitals. A competent medical director can make a big difference—and a struggling medical director can become a big liability, the experts noted.

A program with quality doctors can still suffer under sub-par leadership, said Dr. Gates, who added: “Even with average doctors, if the medical director is good, things will usually work pretty well.”