Admin Fellowship Questions

[unoso]

Hi, I'm an M3 currently considering EM but having a bit of an existential crisis. My plan for a career in EM doesn't necessarily involve working in the ED long-term. My goal is to do residency then an admin fellowship (+/- MBA) then work clinically until I'm about 40-45 before switching over to a role more congruent with the business side of things (hospital admin, consulting, private equity, policy, etc.).

I've been having a lot of concerns about this lately though especially regarding whether or not I would be able to secure one of those positions, if I did, how it would pay, what the lifestyle would be like, etc. My biggest concern is that wanting to do this path is possibly choosing EM for the wrong reasons and will thus lead to a lifetime of unhappiness if I am unable to make it work.

Can anyone who has done an admin fellowship or another similar path answer any of these questions/comment on where they would like to end up/ended up?

P.S. For what it's worth, I have a reasonably strong application (Step 1 >250, all H/HP, lots of research)

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[RustedFox]

See my prior post about those who state that they are "interested in administration".

 

[unoso]

See my prior post about those who state that they are "interested in administration".

This one? "Getting into this field with the intention of going 'admin' right out of the gate makes me cast a suspicious glance at you. You know how much we "pit docs" generally dislike admin types, right?"

As the person who responded in that thread said, this isn't something I would necessarily plan to advertise in an interview. And I understand the suspicion. However, I think it's a little harsh to hold someone's genuine interests against them. I have long been interested in healthcare policy/economics and would like to find a career path that can accommodate that interest. What I'm asking is, is that a realistic expectation for EM? And, if so, how would I make it work and what would my life look like?

 

[RustedFox]

This one? "Getting into this field with the intention of going 'admin' right out of the gate makes me cast a suspicious glance at you. You know how much we "pit docs" generally dislike admin types, right?"

As the person who responded in that thread said, this isn't something I would necessarily plan to advertise in an interview. And I understand the suspicion. However, I think it's a little harsh to hold someone's genuine interests against them. I have long been interested in healthcare policy/economics and would like to find a career path that can accommodate that interest. What I'm asking is, is that a realistic expectation for EM? And, if so, how would I make it work and what would my life look like?

There's a more recent post on the topic that I'm particularly proud of.

There are a lot of harsh things in life.
One of these harsh things is that healthcare administrators are what is ruining healthcare for America; primarily because of their sheer number.

That's a lot of fat to cut, right there.
We need less healthcare administrators, not more.
We need more physicians, not less.
By stating that you have some interest in joining the throbbing hordes of useless MBA middlemen, you're stating that you have an interest in becoming a part of the problem that is robbing the system blind and resulting in healthcare premiums of (for my wife and I) close to 2000 dollars a month.

 

[unoso]

There's a more recent post on the topic that I'm particularly proud of.

There are a lot of harsh things in life.
One of these harsh things is that healthcare administrators are what is ruining healthcare for America; primarily because of their sheer number.

That's a lot of fat to cut, right there.
We need less healthcare administrators, not more.
We need more physicians, not less.
By stating that you have some interest in joining the throbbing hordes of useless MBA middlemen, you're stating that you have an interest in becoming a part of the problem that is robbing the system blind and resulting in healthcare premiums of (for my wife and I) close to 2000 dollars a month.

Personally, I believe that statement and graph are a rather simplistic way of explaining a much more nuanced and multi-faceted issue. That being said, I respect your opinion and thank you for responding to my post. However, given that the point of my post was to elicit guidance I'd rather get back on track towards that, and not head into the abyss that is a political debate via anonymous internet forum.

 

[Frazier]

Rustedfox is on one far end of the spectrum (ie a hyperbolic degree of "admins (what a generic term) = satan"... and then there are people on the other end.

A reasonable person somewhere in the middle recognizes that these positions exist and they aren't going anywhere for better or worse. That middle ground clinician also recognizes that these positions are better held by a physician (or "prior" physician)... than "just" a b-school grad that never has done anything clinical in the hospital or ever worked with patients.

Feel free to PM me OP if you want to chat more.

 

[GonnaBeADoc2222]

Yah you should totz ignore people who have been in the trenches for years.

 

[RustedFox]

Rustedfox is on one far end of the spectrum (ie a hyperbolic degree of "admins (what a generic term) = satan"... and then there are people on the other end.

A reasonable person somewhere in the middle recognizes that these positions exist and they aren't going anywhere for better or worse. That middle ground clinician also recognizes that these positions are better held by a physician (or "prior" physician)... than "just" a b-school grad that never has done anything clinical in the hospital or ever worked with patients.

Feel free to PM me OP if you want to chat more.

Its not an opinion; its demonstrable fact.
We don't need MOAR admins.
Those positions may exist now.
Doesn't mean that they should.

 

[unoso]

Yah you should totz ignore people who have been in the trenches for years.

I don't believe anyone said anything about ignoring. In fact, I said the exact opposite in that I respect RustedFox's opinion and thank him for responding.

Just trying to encourage fruitful discussion that goes beyond "x group of people are all bad", and hopefully elicit some guidance as per my original posting.

 

[deuist]

If your goal is to go into administration later, I'm not sure why you need to do the fellowship now. You can always pursue an MBA later in life. Or, don't pursue any formal business training. I know lots of physician administrators who are self-taught and never bothered to go through the expense and hassle of school again.

 

[unoso]

If your goal is to go into administration later, I'm not sure why you need to do the fellowship now. You can always pursue an MBA later in life. Or, don't pursue any formal business training. I know lots of physician administrators who are self-taught and never bothered to go through the expense and hassle of school again.

I was under the impression that it was more difficult to pursue a fellowship years down the line. Is that incorrect?

 

[InternistDO]

Most EM fellowships, especially ones like Admin, aren't very competitive (since they don't really change your practice options or increase your pay). The reason people don't do fellowships later is because no one wants to take a massive pay cut after they've been making Big Money for several years.

If you think you won't like clinical EM though, why would you specialize in it as your path to administration?

 

[bengaltiger211]

There is nothing wrong with choosing that path. In fact, you will find that EM physicians are well represented in administrative positions. It's a specialty that touches many parts of the hospital, and the practical aspects of the job (i.e. shift work), allow you to slowly ramp up more leadership/administrative responsibilities if you so choose.

If you do choose to do an admin fellowship my recs are:
1) Go to a place that will pay you a decent amount. Maybe not attending salary, but most will pay you a junior attending salary.
2) Make sure you get a free degree out of it. Above poster is right, maybe you don't NEED a degree to do those jobs, but if you can get a free degree that gives you formal education in the field you're interested in... why not?

Admin fellowships aren't hard to come by - many go unfilled every year and meet these criteria I just mentioned.

Oh, and you're gonna get haters at every corner when you choose this path. Don't let it bother you. We need smart physicians who are well trained to be leaders in our organizations. Shocker, but clinical training alone does not prepare you for that.

 

[enalli]

My biggest concern is that wanting to do this path is possibly choosing EM for the wrong reasons and will thus lead to a lifetime of unhappiness if I am unable to make it work.

Take the MBA/administration thing out of the equation. You can go down this route from any field. If someone hypothetically banned you from ever leaving clinical medicine, which specialty would you go into?

Are you choosing EM mainly because of the "lifestyle"? If so, then you are picking it for the wrong reasons and I would strongly advise you to reconsider your plans because you will be miserable. If you genuinely love the practice of emergency medicine, then you should be fine.

 

[It's lupus!]

I get being suspicious of administration aspirations but isn't a large chunk of the problem that a lot of these positions are getting filled by individuals who are not physicians? In my area that seems to be a large portion of it.

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[RustedFox]

I get being suspicious of administration aspirations but isn't a large chunk of the problem that a lot of these positions are getting filled by individuals who are not physicians? In my area that seems to be a large portion of it.

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One of the more senior docs at my very first job "went admin" after he was too old to work clinically. I remember the emails that he used to send when he was a line doc; full of fire and brimstone about how poor of a job admin was doing and whatnot.

Then he went admin. I was so hopeful that real change was going to happen. Things only got worse. He became yet another yes-man with little to do every day besides take another lunch break and offer flimsy excuses about why the things he used to complain about were "good things". Keeps on getting paid a bunch, though. Oh, and he gets paid health insurance and plenty of benefits - which are things we still don't get as clinicians.

 

[VA Hopeful Dr]

One of the more senior docs at my very first job "went admin" after he was too old to work clinically. I remember the emails that he used to send when he was a line doc; full of fire and brimstone about how poor of a job admin was doing and whatnot.

Then he went admin. I was so hopeful that real change was going to happen. Things only got worse. He became yet another yes-man with little to do every day besides take another lunch break and offer flimsy excuses about why the things he used to complain about were "good things". Keeps on getting paid a bunch, though. Oh, and he gets paid health insurance and plenty of benefits.

My experience has been that the doctors that want to do Administration are usually bad at it. But my current job the president of the medical staff is a family doctor who was quite happy still working full-time clinically and the hospital essentially begged him to take that job.

That's what I want to see, not people who know from early on that they want to go into administration because I don't think they'll ever truly be clinical doctors in the same way the rest of us are.

 

[It's lupus!]

I mean like it or not administration is a necessary evil. We can argue about it's level of involvement and number of necessary employees in that arena BUT we can't escape it's necessity. Arguably we should have physicians in admin but right now much of who ends up there is in for the wrong reasons or isn't really ideal for meaningful change and management. The people who should be in these positions are also the same people who avoid it at all costs, and not to stir up trouble but these are also often the voices that complain the loudest. It's kind of the conundrum at the heart of the issue isn't it? Those most interested in meaningful change never seem to have an interest in being the person that is in the position to initiate that change. Obviously, this is an overgeneralization as it's not always the case but the point still stands.

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[Got Em]

I think your plan works.

1) As someone pointed out before, admin fellowships through EM are not competitive, unless if you're shooting for Harvard/Stanford, etc.
2) I have spoken to numerous fellowship directors - fellowship grads can usually obtain administrative positions within a few years of finishing (some can get one right after)
3) You can practice as an administrator while doing clinical shifts. In fact, most admin jobs require 60-100 hours of clinical duty, unless if you're in the c-suite, or if you want to take a massive pay cut.
4) If you do decide to do admin when you're 40-45, you can do one without an MBA or fellowship.
5) No matter what people say, you are in a better position to do these things with an MBA and/or admin fellowship (although you just lost a lot of income).
6) I'm a lowly resident (but I do have an MBA and spoke to many admin people), so take my advice with a grain of salt.

 

[EctopicFetus]

Someone who does an admin fellow and gets an mba has shown their complete lack of understanding of opportunity cost and business.

 

[deuist]

I think your plan works.

1) As someone pointed out before, admin fellowships through EM are not competitive, unless if you're shooting for Harvard/Stanford, etc.
2) I have spoken to numerous fellowship directors - fellowship grads can usually obtain administrative positions within a few years of finishing (some can get one right after)
3) You can practice as an administrator while doing clinical shifts. In fact, most admin jobs require 60-100 hours of clinical duty, unless if you're in the c-suite, or if you want to take a massive pay cut.
4) If you do decide to do admin when you're 40-45, you can do one without an MBA or fellowship.
5) No matter what people say, you are in a better position to do these things with an MBA and/or admin fellowship (although you just lost a lot of income).
6) I'm a lowly resident (but I do have an MBA and spoke to many admin people), so take my advice with a grain of salt.

5. "No matter what people say..." including all of those physician-administrators without MBA's or fellowships such as the chief of the emergency department at Massachusetts General Hospital.

 

[deuist]

Someone who does an admin fellow and gets an mba has shown their complete lack of understanding of opportunity cost and business.

That should be the essay question to get into business school: what is the net present value of pursuing this MBA?

 

[Got Em]

5. "No matter what people say..." including all of those physician-administrators without MBA's or fellowships such as the chief of the emergency department at Massachusetts General Hospital.

Did you not read the post right above? I clearly stated that you can get where you want WITHOUT an MBA or an admin fellowship. However, doing an MBA (in healthcare/ED) or an administration fellowship gives you early, relevant experience you may not have had until later on in your career. Just because Bill Gates/Mark Zuckerberg can drop out of Harvard and build billion dollar companies does not mean everyone can do it too.

 

[Got Em]

Someone who does an admin fellow and gets an mba has shown their complete lack of understanding of opportunity cost and business.

Why does it always have to be so black and white? Maybe it's someones dream to get an MBA? Maybe they have other reasons to get an MBA/admin fellowship and don't view money as such an important factor in making this decision. You know, some people may want to do a one year fellowship at Harvard/Stanford, or live on the coast for a year, and are very willing to take a hit on their salary early on in their careers.

 

[EctopicFetus]

Did you not read the post right above? I clearly stated that you can get where you want WITHOUT an MBA or an admin fellowship. However, doing an MBA (in healthcare/ED) or an administration fellowship gives you early, relevant experience you may not have had until later on in your career. Just because Bill Gates/Mark Zuckerberg can drop out of Harvard and build billion dollar companies does not mean everyone can do it too.

Poor choice of example. Those guys started their own business. You dont need any degree to do it. Many of the biggest and best companies especially tech struggled with management (see google). They had to bring in an outside person because there is often little to no overlap.

 

[Got Em]

Poor choice of example. Those guys started their own business. You dont need any degree to do it. Many of the biggest and best companies especially tech struggled with management (see google). They had to bring in an outside person because there is often little to no overlap.

What does this have to do with my post? I gave an example where just because a few people can do something does not mean that everyone can do it as well. If you don't view money as an overriding factor in your decision, then an MBA/fellowship can help. For example, if you get paid the exact same amount doing your admin fellowship/MBA + limited clinical duties vs. all clinical duties without any admin experience, why wouldn't the former be more advantageous? Most of these replies people are giving are centered around your salary. I'm taking salary out of the equation.

 

[EctopicFetus]

Why does it always have to be so black and white? Maybe it's someones dream to get an MBA? Maybe they have other reasons to get an MBA/admin fellowship and don't view money as such an important factor in making this decision. You know, some people may want to do a one year fellowship at Harvard/Stanford, or live on the coast for a year, and are very willing to take a hit on their salary early on in their careers.

To each their own. If you want an MBA go get one. The admin fellowship makes little sense. Want to play with the C suiters. Go get a FACHE.

 

[EctopicFetus]

What does this have to do with my post? I gave an example where just because a few people can do something does not mean that everyone can do it as well. If you don't view money as an overriding factor in your decision, then an MBA/fellowship help. For example, if you get paid the exact same amount doing your admin fellowship/MBA + limited clinical duties vs. all clinical duties without any admin experience, why wouldn't the former be more advantages? Most of these replies people are giving are centered around your salary. I'm taking salary out of the equation.

Well then if money doesn’t matter sure. For most people work = money. If your question is hey money doesn’t matter I think an admin fellowship would be cool what do you think?

My response would be sure. If that interests you why not?

 

[deuist]

if you get paid the exact same amount doing your admin fellowship/MBA + limited clinical duties vs. all clinical duties without any admin experience, why wouldn't the former be more advantageous?

But you don't get paid the same. I once heard an admin fellowship director say, "Fellowships are the best deals for a hospital. We pay fellows half the salary to do two-thirds of the work."

 

[Apollyon]

To each their own. If you want an MBA go get one. The admin fellowship makes little sense. Want to play with the C suiters. Go get a FACHE.

...which you have a master's degree to get. Tautology is sloppy.

 

[enalli]

Want to play with the C suiters. Go get a FACHE.

bruh

This is like saying "Want to start working as an emergency physician? Go get a FACEP."

 

[deleted109597]

Maybe it's someones dream to get an MBA?

I'm not sure that person actually exists.

 

[EctopicFetus]

bruh

This is like saying "Want to start working as an emergency physician? Go get a FACEP."

I get it man. It’s not an accident I don’t have the fache. Get one from a good program and it has value like a Harvard mba.

 

[sum dude]

Hi, I'm an M3 currently considering EM but having a bit of an existential crisis. My plan for a career in EM doesn't necessarily involve working in the ED long-term. My goal is to do residency then an admin fellowship (+/- MBA) then work clinically until I'm about 40-45 before switching over to a role more congruent with the business side of things (hospital admin, consulting, private equity, policy, etc.).

I've been having a lot of concerns about this lately though especially regarding whether or not I would be able to secure one of those positions, if I did, how it would pay, what the lifestyle would be like, etc. My biggest concern is that wanting to do this path is possibly choosing EM for the wrong reasons and will thus lead to a lifetime of unhappiness if I am unable to make it work.

Can anyone who has done an admin fellowship or another similar path answer any of these questions/comment on where they would like to end up/ended up?

P.S. For what it's worth, I have a reasonably strong application (Step 1 >250, all H/HP, lots of research)

As someone who is involved in Admin (w/o MBA or Admin Fellowship), I can tell you you don't need one and Admin Fellowships are virtually worthless. MBA does have value, but honestly, we wouldn't hire anyone for an admin position until they cut their teeth at least a few years in the ED. Same goes for pretty much any group, CMG or independent (can't speak for academic, but have to imagine research trumps fellowship). Being a hard worker, reliable, willing to go to hospital meetings, solving problems, and filling in for shifts >>>>> any fellowship. MBA would come useful, but I'd recommend working a few years before blowing out some money.

The idea that you'll start working admin right out of the gate probably misguided. Maybe you can find a niche in some academic place studying policy/economics (say in DC or NY), but no one is going to hire a new grad for an admin role right out of a fellowship (sans a desperate CMG director position, and you will be in way over your head). Also, reconsider what "admin" means--it's less financial and more sitting through endless meetings on your days off where not much gets accomplished.

 

[RustedFox]

As someone who is involved in Admin (w/o MBA or Admin Fellowship), I can tell you you don't need one and Admin Fellowships are virtually worthless. MBA does have value, but honestly, we wouldn't hire anyone for an admin position until they cut their teeth at least a few years in the ED. Same goes for pretty much any group, CMG or independent (can't speak for academic, but have to imagine research trumps fellowship). Being a hard worker, reliable, willing to go to hospital meetings, solving problems, and filling in for shifts >>>>> any fellowship. MBA would come useful, but I'd recommend working a few years before blowing out some money.

The idea that you'll start working admin right out of the gate probably misguided. Maybe you can find a niche in some academic place studying policy/economics (say in DC or NY), but no one is going to hire a new grad for an admin role right out of a fellowship (sans a desperate CMG director position, and you will be in way over your head). Also, reconsider what "admin" means--it's less financial and more sitting through endless meetings on your days off where not much gets accomplished.

Read this, those who cussed me out on the other thread when I said "these positions do not need to exist", and argued with "this is a necessary evil; we need the admins".

 

[deleted547339]

Read this, those who cussed me out on the other thread when I said "these positions do not need to exist", and argued with "this is a necessary evil; we need the admins".

The funny thing is that I feel like we need the admins only because we have the admins. If we didn’t have hospital committees telling us about sepsis bundles, we wouldn’t need medical directors to explain why a 17 year old with strep didn’t get a lactate checked per the bundle.

 

[NRAI2001]

Could someone theoretically go straight into an admin fellowship if they truly were not interested in clinical medicine?

 

[southerndoc]

Maybe it's because they're new, but I've yet to see an administrator who did an administration fellowship.

 

[KGflyboy]

Could someone theoretically go straight into an admin fellowship if they truly were not interested in clinical medicine?

Theoretically? Maybe. Realistically? No. Why would someone go to medical school just to go straight into admin without clinical work? A more direct route would be business degree with a masters in healthcare admin.

 

[Apollyon]

I get it man. It’s not an accident I don’t have the fache. Get one from a good program and it has value like a Harvard mba.

I just saw this again. Again, tell me where you, today, can get FACHE without a master's degree. You can't. Correct me if I am wrong.

What has value like a Harvard MBA? A Harvard MBA.

 

[gutonc]

I just saw this again. Again, tell me where you, today, can get FACHE without a master's degree. You can't. Correct me if I am wrong.

I read the rules (and I may be wrong) as that you have to have at least a Master's Degree, not just a Bachelor's degree. So, presumably, someone with a doctoral degree, would be allowed in. There are definitely no rules as to what specific kind of Master's you need. Not MBA, not MPH, not MPA, etc. Just a Master's.

 

[RustedFox]

Could someone theoretically go straight into an admin fellowship if they truly were not interested in clinical medicine?

Where's the "hate" button?

 

[Apollyon]

I read the rules (and I may be wrong) as that you have to have at least a Master's Degree, not just a Bachelor's degree. So, presumably, someone with a doctoral degree, would be allowed in. There are definitely no rules as to what specific kind of Master's you need. Not MBA, not MPH, not MPA, etc. Just a Master's.

Our old CEO was a "diploma" FACHE (no master's degree, grandfathered in), and our new CEO has an MPH in statistics. He's FACHE, too.

Although, I wonder if MSN works! Probably.

 

[southerndoc]

Fellow Requirements at a Glance
Become a Fellow of the American College of Healthcare Executives (FACHE) and earn the distinction of board certification in healthcare management!

1. Fellow candidates must meet all of the following requirements prior to applying and sitting for the Board of Governors Exam.
   1. Current Member with three (3) years tenure as an ACHE Member, Faculty Associate, or International Associate. Student membership does not count toward tenure.
   2. Master's degree (or other post-baccalaureate degree). A copy of your diploma or final conferred transcript is required.
   3. Currently hold an executive healthcare management position with a minimum of five (5) years of executive healthcare management experience. A copy of your job description, organizational chart and resume is required.
   4. Demonstrate 36 hours of healthcare-related continuing education within the last three (3) years of submitting an application (12 hours must be ACHE Face-to-Face education).
   5. Two (2) examples of community/civic activities AND two (2) examples of healthcare-related activities within the last three (3) years of submitting an application.
   6. Two (2) references: One (1) Fellow reference (must be a structured interview), the second reference may be from a senior-level executive (VP or higher) in your organization, OR it may be from a second Fellow.
   7. $250 Application Fee (non-refundable)

Your MD/DO will suffice. I know a few ACHE fellows who don't have MBA's, MPH's, and haven't completed administration fellowships. Two are VPMA's and one is a CEO of a fairly large health system. One guy I know just obtained his fellowship status with an MD and an emergency medicine residency.