Value of leadership roles early in career?

[Preston Ganey Jr]

Hi Y'all,

A question for the current and former medical directors out there:

I'm early in my attending career and considering a couple different options - an academic job with built-in leadership opportunities for about 60-65% of the pay of an alternative "community" gig within a large health system at a site that already has its site medical director and assistant medical director roles already filled. They're both part of a larger system in which I ought to be able to join committees and take on some of the organizational problem-solving opportunities that I'm interested in; however the community gig would not be nearly so targeted toward operational/organizational management.

For someone interested in taking on medical direction, how much does taking the former position matter vs the latter? Worth the pay cut? I'd by happy to work more shifts to make up some of the difference, but the academic gig doesn't allow for working elsewhere.

I'm trying to find ways to maximize my longevity in EM, and I'm hoping that developing an operational niche to buy down a couple shifts would help in that regard.

Thanks!

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[Groove]

Not worth it unless you want academics. Wait for a med director role with a CMG in a semi decent area. They pop up all the time but you may have to wait until the COVID pandemic is over to negotiate the best contract. Plus you’d make a lot more. “Leadership opportunities” is incredibly vague.

 

[Preston Ganey Jr]

Hah, sorry, it's an assistant medical director (...assistant to the medical director?) title. Roles include helping to shepherd the implementation of a new EMR, integrating with the trauma surgery team at that site, building partnerships with local community EDs to build out other EDs that the academic program could staff. I'm sure there will be plenty of work looking at metrics, quality measures, along with the other work. It's a relatively new residency, but I don't want to say more to give away the program.

 

[Angry Birds]

60 percent???

 

[Groove]

Hah, sorry, it's an assistant medical director (...assistant to the medical director?) title. Roles include helping to shepherd the implementation of a new EMR, integrating with the trauma surgery team at that site, building partnerships with local community EDs to build out other EDs that the academic program could staff. I'm sure there will be plenty of work looking at metrics, quality measures, along with the other work. It's a relatively new residency, but I don't want to say more to give away the program.

While I applaud your interest in carving out a "longevity niche", I'm going to have to say that giving up 40% of your salary as a new attending for an academic "AFMD" position is crazy. AFMD is a glorified scheduler for most community jobs with the option to get involved in lots of committees without being paid to attend them on your days off. Also, academics works completely different than community sites. The politics are different, the departmental interests are different, the power players are different, etc.. You don't need an AFMD position as a stepping stone for directorship if that's what you're worried about. Just be willing to snap up a director position at a small to medium ER somewhere that you don't mind living. You don't need any experience and can pick it all up fairly quickly. Just be sure that administration is what you really want for the rest of your career. Lots of butt smooching, lots of people pleasing, and lots of malpractice exposure because you'll get named on any suit that gets filed against your MLPs and possibly even some of your docs. Putting out fires constantly, responding to complaints, responding to peer reviews on your docs, responding to nursing concerns, responding to c-suite 24 hours of the day, even on vacation. Can you make a difference in carving out departmental policy and see the fruits of your labor? Sure, but I'm not sure it's really worth it in the end.

Now, if you want to stay in academics, I can't speak much for administration in the academic world. I'm sure it works much differently and perhaps there is more psychological income but then you have to ask yourself...do you really want to give up 1/3 of your salary for the rest of your life? I don't.

As long as you were willing to move, all you really need to do at this point is call up the major CMG recruiters and tell them you are looking for a directorship position. I bet they would find one for you in a heart beat. They are always available, at least in my experience. I've got recruiters calling me all the time asking me if I want to be director at such and such ER.

 

[coachB]

Hah, sorry, it's an assistant medical director (...assistant to the medical director?) title. Roles include helping to shepherd the implementation of a new EMR, integrating with the trauma surgery team at that site, building partnerships with local community EDs to build out other EDs that the academic program could staff. I'm sure there will be plenty of work looking at metrics, quality measures, along with the other work. It's a relatively new residency, but I don't want to say more to give away the program.

Sounds like this isn't really academic in the traditional sense of the word. Huge difference between true academics and some hospital system/CMG starting a residency program...

 

[Preston Ganey Jr]

While I applaud your interest in carving out a "longevity niche", I'm going to have to say that giving up 40% of your salary as a new attending for an academic "AFMD" position is crazy. AFMD is a glorified scheduler for most community jobs with the option to get involved in lots of committees without being paid to attend them on your days off. Also, academics works completely different than community sites. The politics are different, the departmental interests are different, the power players are different, etc.. You don't need an AFMD position as a stepping stone for directorship if that's what you're worried about. Just be willing to snap up a director position at a small to medium ER somewhere that you don't mind living. You don't need any experience and can pick it all up fairly quickly. Just be sure that administration is what you really want for the rest of your career. Lots of butt smooching, lots of people pleasing, and lots of malpractice exposure because you'll get named on any suit that gets filed against your MLPs and possibly even some of your docs. Putting out fires constantly, responding to complaints, responding to peer reviews on your docs, responding to nursing concerns, responding to c-suite 24 hours of the day, even on vacation. Can you make a difference in carving out departmental policy and see the fruits of your labor? Sure, but I'm not sure it's really worth it in the end.

Now, if you want to stay in academics, I can't speak much for administration in the academic world. I'm sure it works much differently and perhaps there is more psychological income but then you have to ask yourself...do you really want to give up 1/3 of your salary for the rest of your life? I don't.

As long as you were willing to move, all you really need to do at this point is call up the major CMG recruiters and tell them you are looking for a directorship position. I bet they would find one for you in a heart beat. They are always available, at least in my experience. I've got recruiters calling me all the time asking me if I want to be director at such and such ER.

Appreciate the advice there! This is what I suspected. I'd eventually like to transition to a more competitive locale, and I'm hoping to build out some sort of niche that could make more competitive to either the CMG/community or academic departments in that city. My wife is moving her private practice, so my geographic flexibility is limited to places I can stack shifts and commute.

Sounds like this isn't really academic in the traditional sense of the word. Huge difference between true academics and some hospital system/CMG starting a residency program...

Actually a legit academic residency hah. I've seen quite a few postings from HCA looking for folks to lead some of their new EM residencies going up, however. Mostly wish the coming glut of new EM grads would be displacing midlevel providers, but I think that's just a pipe dream. Doubly makes me want to find a niche that'll make me a value-add to a community or academic department.