EM "Quality Director"

[Daiphon]

Hey all -

So, a buddy of mine in an academic shop across the street from mine has been given the proverbial "offer he can't refuse" and asked my input.

His chair has asked him to take on the mantle of "Director of Quality Improvement/Insurance" which will be generated by splitting the job description of the Clinical Operations Director.

Problem is, I'm not sure what to make of it, as my shop doesn't have one of these. My inclination is that this would be a "foot soldier" job tasked to implement departmental initiatives, while freeing the Ops Director to wrangle more with what the initiatives ought be.

In other words, he'd be the tactician under the strategist.

Anyone else have thoughts on this? Anyone in a shop (academic or community) with both positions & if so, how's it work?

Cheers!
-d

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[Greenbbs]

One of our longtime mid levels does our quality- he runs sepsis numbers, deals with complaints, etc. helps a lot because it's a huge job

 

[sum dude]

Metrics metrics and more Metrics!! Welcome to the world of Operations Management running doctors. Just don't seek any statistical correlations or relevance, enjoy good numbers, and tell everyone to try harder with bad numbers (even if statistically insignificant or undecipherable, and especially if the months follow each other). On the plus side, you can make terrible corporate initiated protocols less-terrible, so there's always that.

 

[Hair Police]

Our asst ED director does a lot of what you describe. Likely different names for the same job.

 

[WilcoWorld]

I sat on our hospital's search committee to hire our Quality Director - SumDude nailed it.

 

[Apollyon]

On my phone, I read it as "Powerball" (not 'proverbial'), and came wondering what the jackpot was. Again, though, what is the carrot - the "offer you can't refuse"? Interminably boring repetition? Interminably boring meetings? For $500K/year, I MIGHT do it. For the same $$, though, - no way.

 

[Janders]

There are a few parts of this:
(1) quality metrics, i.e. Door-to-Balloon times, sepsis metrics
(2) Case reviews, provider QI, interdepartmental QI, etc
(3) Complaints from patients, families, PCPs, other services.

I've done it, and still do a lot of of it. #1 and #2 are necessary and can be rewarding. #3 less so

 

[emergentmd]

Hey all -

So, a buddy of mine in an academic shop across the street from mine has been given the proverbial "offer he can't refuse" and asked my input.

His chair has asked him to take on the mantle of "Director of Quality Improvement/Insurance" which will be generated by splitting the job description of the Clinical Operations Director.

Problem is, I'm not sure what to make of it, as my shop doesn't have one of these. My inclination is that this would be a "foot soldier" job tasked to implement departmental initiatives, while freeing the Ops Director to wrangle more with what the initiatives ought be.

In other words, he'd be the tactician under the strategist.

Anyone else have thoughts on this? Anyone in a shop (academic or community) with both positions & if so, how's it work?

Cheers!
-d

Offer he can't refuse?

I hope he is getting double pay b/c this sounds like a terrible job. I have been there, done that. Trying to be the middle man between admin and line docs is an exercise in futility

 

[Daiphon]

Offer he can't refuse?

I hope he is getting double pay b/c this sounds like a terrible job. I have been there, done that. Trying to be the middle man between admin and line docs is an exercise in futility

Yeah... effectively has to take the position, or will get dismissed (he's nontenured in an academic shop).

He's leaning towards it, a lot of the above commentary are things we've already discussed & brainstormed... really just wanted to check if there were any landmines that he or I hadnt considered.

Thanks all!
-f

 

[Psai]

Has to take it or be dismissed? That's not a huge red flag already?

 

[GeneralVeers]

Terrible job and not worth the pay unless you love numbers. Most places will give you a subsidy of $1000 or so a month to do it. Not worth it IMO to go to boring meetings and harass providers on metrics.

 

[TooMuchResearch]

There are a few parts of this:
(1) quality metrics, i.e. Door-to-Balloon times, sepsis metrics
(2) Case reviews, provider QI, interdepartmental QI, etc
(3) Complaints from patients, families, PCPs, other services.

I've done it, and still do a lot of of it. #1 and #2 are necessary and can be rewarding. #3 less so

Our quality person does #1. #2 and #3 are handled by 2 other people.

 

[Apollyon]

Yeah... effectively has to take the position, or will get dismissed (he's nontenured in an academic shop).

Yikes - that is the flip side of "offer you can't refuse". Damn, man!

 

[emergentmd]

Yeah... effectively has to take the position, or will get dismissed (he's nontenured in an academic shop).

He's leaning towards it, a lot of the above commentary are things we've already discussed & brainstormed... really just wanted to check if there were any landmines that he or I hadnt considered.

Thanks all!
-f

Yikes. Unless this is his dream job or have no other option to get another job then he should give an emphatic NO. Why any hospital would tell a doctor to take an admin job or get fired is unethical. The hospital obviously think very little of your friend to give him this ultimatum.

I would never take this job. Whats next? This sounds like the first step to be completely owned by the hospital. Whats next? Clean the CEO's car and wipe his backside?

 

[Daiphon]

Yikes. Unless this is his dream job or have no other option to get another job then he should give an emphatic NO. Why any hospital would tell a doctor to take an admin job or get fired is unethical. The hospital obviously think very little of your friend to give him this ultimatum.

I would never take this job. Whats next? This sounds like the first step to be completely owned by the hospital. Whats next? Clean the CEO's car and wipe his backside?

Fully agree. He's painting a slightly less egregious picture, though. Currently holds a half-time position, and the hospital is looking to dump those... and has a hiring freeze.

So he's framing it as a way for his chair to increase his time (e.g. not get fired by the hospital, as he tells me the Chair is piiiiiiiiissssssssed about this dictum) while not running afoul of the hiring freeze.

Either way, agree it's shady, but seems to be in terms of what's been discussed here in keeping with the original thoughts we had.

Oi. Glad it ain't me.

 

[gro2001]

Fully agree. He's painting a slightly less egregious picture, though. Currently holds a half-time position, and the hospital is looking to dump those... and has a hiring freeze.

So he's framing it as a way for his chair to increase his time (e.g. not get fired by the hospital, as he tells me the Chair is piiiiiiiiissssssssed about this dictum) while not running afoul of the hiring freeze.

Either way, agree it's shady, but seems to be in terms of what's been discussed here in keeping with the original thoughts we had.

Oi. Glad it ain't me.

Well, in that case it sounds more like "doing it to get a (full time) position he does not have" rather than "doing it to avoid being fired".

 

[WilcoWorld]

Fully agree. He's painting a slightly less egregious picture, though. Currently holds a half-time position, and the hospital is looking to dump those... and has a hiring freeze.

So he's framing it as a way for his chair to increase his time (e.g. not get fired by the hospital, as he tells me the Chair is piiiiiiiiissssssssed about this dictum) while not running afoul of the hiring freeze.

Either way, agree it's shady, but seems to be in terms of what's been discussed here in keeping with the original thoughts we had.

Oi. Glad it ain't me.

Sounds like a good chair trying to do the best with a bad hospital situation. All things considered, it's a reasonably decent option. With the chair's support, the Quality Improvement Officer could work to make sure that the metrics are well thought out and transparent. Heck, that may even help patients (but I wouldn't hold my breath - the hospital's actual intent is to squeeze another 0.5-1.5% out of medicare).

Whether the hospital will accept well-conceived metrics, or just and 'em back saying "Nah, we'd prefer that you get patient satisfaction >90%ile for all docs and obtain blood cultures on 100% pneumonia patients," well, that's another chapter.

 

[Daiphon]

Well, in that case it sounds more like "doing it to get a (full time) position he does not have" rather than "doing it to avoid being fired".

Yeah. But he took the half-time position for a reason & is gonna have to back out of the community shop he likes.

Again. Glad it ain't me.

Edit: and if he doesn't take it, he's out of the academic shop.

 

[emergentmd]

Good luck to your friend and hope everything works out. I have no clue where your friend works or how tight the market is. If its really tight and he is stuck in said city, I would probably take it while looking for other options. I am well capable of going to unproductive meetings, smiling, and going back to line docs with ways to meet the metrics.

But I would definitely be looking for another job b/c its just more restrictions in the future to keep the job.

Whats great about most Er markets is that there are big shortages. You have to literally pee on the CEOs legs, call his wife names, key his car to even lose your job.

 

[Daiphon]

Good luck to your friend and hope everything works out. I have no clue where your friend works or how tight the market is. If its really tight and he is stuck in said city, I would probably take it while looking for other options. I am well capable of going to unproductive meetings, smiling, and going back to line docs with ways to meet the metrics.

But I would definitely be looking for another job b/c its just more restrictions in the future to keep the job.

Whats great about most Er markets is that there are big shortages. You have to literally pee on the CEOs legs, call his wife names, key his car to even lose your job.

This is effectively what I told him earlier today over lunch... sounds like a good opportunity to stay in the department he likes & to try it out for a while. If it sucks, reevaluate & redispo.

Appreciate the advice, oh interwebs! d=)

-d

 

[Danbo1957]

Why do you ED docs allow yourselves to be treated like hired help. Oh wait.

Feel free to hold a meeting between all the ED doctors working at your shop: at the meeting decide that all of you are not going to show up for work next Monday. Inform administration of this plan and see what their response is.

You're welcome.

 

[gro2001]

Why do you ED docs allow yourselves to be treated like hired help. Oh wait.

Feel free to hold a meeting between all the ED doctors working at your shop: at the meeting decide that all of you are not going to show up for work next Monday. Inform administration of this plan and see what their response is.

You're welcome.

I am not sure what your point is. Are you trying to say ER docs should employ collective bargaining more effectively? What you describe isn't so much collective bargaining as patient abandonment. I think options for true collective bargaining are very limited for all professions, not just medicine. Generally speaking, collective bargaining is not going to be effective if the strike option is not on the table, which it isn't for good reasons. Striking is a worthwhile Labor tactic, but we enjoy the privileges of the Profession (which include a higher degree of self regulation than other industries, for example) and therefore have to abide by the responsibilities of the same (not abandoning patients, for one).

If I what you are saying (with a touch too much unnecessary inflammatory language) is that we should be stronger advocates for ourselves, then that's something I imagine everyone here would agree with. And there is room for collective action in advocacy, only it's called lobbying. Technically, that is a large part of what ACEP and AAEM (and technically AMA) are supposed to be doing. Unfortunately, they are not super effective at lobbying our interests. However, I think that has more to do with the average EM docs lack of political involvement than anything specific about those organizations.

 

[Danbo1957]

What I am saying is, do not allow others to determine your personal worth or the value of your MD, training, and experience. You can't solve all relevant issues affecting your present job, of course. But you guys have got to stop being treated as employees, it begins there. Never be afraid or wary of walking away from a job, position, hospital, city.

Some admin tells you to "take it or leave", leave.

 

[emergentmd]

What I am saying is, do not allow others to determine your personal worth or the value of your MD, training, and experience. You can't solve all relevant issues affecting your present job, of course. But you guys have got to stop being treated as employees, it begins there. Never be afraid or wary of walking away from a job, position, hospital, city.

Some admin tells you to "take it or leave", leave.

All hospital based practice Can Not do this. There is a reason radiology, Anes, ER docs are being bought out/kicked out. You can't just give this type of ultimatum. If our ED group did this, Admin would give in and 1 min later call a CMG with a new group in 6 months.

Its life. That is why we need FSEDs. It gives us bargaining power. FSEDS should be opened throughout the US

 

[gro2001]

What I am saying is, do not allow others to determine your personal worth or the value of your MD, training, and experience. You can't solve all relevant issues affecting your present job, of course. But you guys have got to stop being treated as employees, it begins there. Never be afraid or wary of walking away from a job, position, hospital, city.

Some admin tells you to "take it or leave", leave.

Are you an ER doc? It sounds from your phrasing that you are not. Have you ever fearlessly walked a way from a job at a hospital/in a city you liked after giving them an ultimatum? I am genuinely interested.

It can be difficult to walk away from a position, let alone a city, if you've got family obligations keeping you in the area. Also, many people don't yet have an emergency fund to hold over their expenses in the meanwhile, or have recently bought a home, or have other significant anchors that don't allow them to just say F U to the admins.

Also, giving any sort of ultimatums is a great way to get yourself a bad reputation. EM is a small world. I certainly would not want to burn bridges, particularly if I plan to stay in the same geographic area for a while.

 

[Danbo1957]

IM here. I walked away from a great job because my life circumstances changed where the "job" no longer defined me.

So, I infer that ED docs are trapped in an inherent bad job situation and there's nothing to do about it. Ok.

Next thread.

 

[gro2001]

IM here. I walked away from a great job because my life circumstances changed where the "job" no longer defined me.

So, I infer that ED docs are trapped in an inherent bad job situation and there's nothing to do about it. Ok.

Next thread.

No. But thank you for using a false dichotomy. It is the best logical fallacy after all.

I do think EM physicians need to advocate for their needs and I do agree that we often don't do it as well as we should or could. What I disagree with are your suggestions of giving the administration ultimatums/threats of strike (both counter productive) and your implication that anyone not willing to walk away from a less than ideal situation is consenting to be treated like "hired help" (which is not true). Sometimes the right choice is to leave a bad situation, sounds like it was for you. But it is far from the only option. Not everything has to go nuclear.

 

[GeneralVeers]

I agree to some extent with what the IM guy(or girl) is saying. If we want to take back our profession, then we shouldn't work in terrible places that: 1. Pay us less than we are worth. 2. Tell us how to treat patients. 3. Force us to work more than we want, or in unsafe environments.

If we really treated this like a business, and looked out for the interests of our specialty, then we could make positive change for ourselves and our patients. Unfortunately the altruism that many in our profession have is our own worst enemy. Placing patients needs above our own personal and professional health has steadily eroded any control we once had. The C-suites and government are much better at this game than we are, and have no problem using our altruism against us to further their own goals.

 

[WilcoWorld]

#GeneralVeers - Are you familiar with Paul Bloom's thoughts on the negative impact of empathy? Check this out, I think you'll find it interesting.

 

[southerndoc]

Why do you ED docs allow yourselves to be treated like hired help. Oh wait.

Feel free to hold a meeting between all the ED doctors working at your shop: at the meeting decide that all of you are not going to show up for work next Monday. Inform administration of this plan and see what their response is.

You're welcome.

I remember air traffic controllers doing this one time. It didn't go so well.

Docs that do this may risk sanctions by their state medical board or may even lose their license. The least that would happen is a rapid contract with a large group that would employ a "stat team" to staff the hospital in a hurry.

 

[southerndoc]

All hospital based practice Can Not do this. There is a reason radiology, Anes, ER docs are being bought out/kicked out. You can't just give this type of ultimatum. If our ED group did this, Admin would give in and 1 min later call a CMG with a new group in 6 months.

Its life. That is why we need FSEDs. It gives us bargaining power. FSEDS should be opened throughout the US

It doesn't take 6 months. My group has a stat team that can staff an ER in 24 hours pretty much.

 

[emergentmd]

It doesn't take 6 months. My group has a stat team that can staff an ER in 24 hours pretty much.

I am sure you can in 24 hrs. My group has 100 docs and 10 hospitals. Good luck trying to staff this in 24 hrs. How are they going to get credentialed in 24 hrs? NEVER Happen in 24 hrs.

 

[RustedFox]

I keep hearing of these "STAT TEAMS", yet so many of my regional sites just can't seem to get ANYONE in the box and lean heavy on us full-time guys to "give more".

 

[emergentmd]

Stat team is bunch of CMG docs giving a few shifts a month to help cover. No way its permanent. No such thing as a doc being paid to just sit back waiting for a contract to fall apart.

 

[southerndoc]

I am sure you can in 24 hrs. My group has 100 docs and 10 hospitals. Good luck trying to staff this in 24 hrs. How are they going to get credentialed in 24 hrs? NEVER Happen in 24 hrs.

Most hospitals (including the large one where I work) allow emergent temporary credentialing. One person approves it (the hospital president/CEO) and you have temporary privileges. Takes the time of a phone call. We actually did this once for a plastic surgeon who needed to see his patient in the ER.

 

[emergentmd]

Most hospitals (including the large one where I work) allow emergent temporary credentialing. One person approves it (the hospital president/CEO) and you have temporary privileges. Takes the time of a phone call. We actually did this once for a plastic surgeon who needed to see his patient in the ER.

Sorry but this would not fly at my hospital. Even if the CEO pushes it through, good luck getting 100 doc to come and staff the system. The learning curve would be daunting to begin with.

I do wish this happens to me. I would be happy to go towards the sunset, get a better paying job and watch the Chaos ensue. I would love to see a CMG come crashing in