Any benefit in being a medical director?

[cyanide12345678]

Would any of you guys consider being a medical director of an ED if the opportunity dropped in your lap?

Pros vs Cons?

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[deleted497653]

It seems to attract people who want power and money(stipend)

 

[Dr Mantis Toboggan]

Never again for me.

Cons:

Frequent calls about problems: from your docs, consultants, hospital admin. The same stuff will come up over and over (these admissions are lame, so and so was rude to me when I called to admit, the wait times last night were really long etc) but you have little power to actually make changes. I would get these calls at the worst times.

Ultimately you are the last line of defense if someone calls out and a replacement can’t be found

Patient complaints. Brutal. Hated dealing with these.

Meetings


Pros:

Typically less night/weekend time and a more predictable schedule.

Money

 

[Groove]

If the financial incentives were right...sure. I don't know what our current director makes as stipend but I think it's on the order of 16K based on some discussions with my previous director. He worked fewer shifts when he first started but now he's got things smoothed out and is working....let me look at the schedule....14 shifts next month. 13 this month. That's 127 hours next month @ $275/hr at least, probably more as he's one of the fastest in the group. Let's be conservative though and 127x$275=34,925+16K=$50,925 That's $611,100 per year. Not bad if you ask me. I certainly couldn't make that on my own just by working shifts. Now, I'll admit that it's probably a pain in the ass to be director. So, is it worth all the extra headache? I think that's a personal decision. I've been assistant director for the past 5 years and for me...that's a better sweet spot. Enough of a stipend so that I could work 2-3 fewer shifts if I wanted and none of the responsibility that director entails. My primary responsibilities are the schedule and filling in for emergency shifts but that only happens a few times a year.

If the best I could hope for was to break even...I doubt I would do it unless I really had a strong desire to get out of the ED and work fewer shifts. Think about it..you're on call 24/7. That psychiatrist I went off on on other week who reported me to the CMO for unprofessional behavior? My director got called about that while on the beach in Florida. So, better make sure that iPhone is always charged. God help you if you decide to take an ambien at night and try answering a phone call from c-suite at 2a.m.

Don't forget about all the extra liability. You'll probably get named on suits simply for being the director. Especially with the MLPs since you will be filling out all their credentialing forms as their supervising physician unless you can get the assistant director to sign them all!

 

[cyanide12345678]

16k per month is quite a bit of a stipend actually. That's a pretty impressive pay for the number of hours.

Any idea how much time an average medical director spends on administrative things?

Out of curiosity, is there significantly difference if the ED is staffed by a CMG? Smaller stipend maybe?

 

[Groove]

16k per month is quite a bit of a stipend actually. That's a pretty impressive pay for the number of hours.

Any idea how much time an average medical director spends on administrative things?

Out of curiosity, is there significantly difference if the ED is staffed by a CMG? Smaller stipend maybe?

I seem to remember a formula somewhere but can't seem to find it. Hell, he may very well be making more than that. Here's the average medical dir salaries nationwide:

Emergency medicine

Average compensation per year: $131,490
Average hours worked per year: 801
Average hourly rate: $147.95
Compensation per year (50th percentile): $77,000
Average hours worked per year (50th percentile): 576
Average hourly rate (50th percentile): $145
Compensation per year (75th percentile): $171,900
Average hours worked per year (75th percentile): 1,040
Average hourly rate (75th percentile): $155.39
Compensation per year (90th percentile): $300,474
Average hours worked per year (90th percentile): 2,080
Average hourly rate (90th percentile): $196.43

It seems to fluctuate pretty wildly with 50% at 77K and 90% at 300K

I think many of the CMGs lowball an incoming dir. TH does this for certain. Emcare also. My colleague was a director for a smaller ED and they only paid him 6K/mo I believe.

There's no way I would consider a director gig with all the headaches, meetings, liability exposure, job risk, etc.. without the opportunity to maximize my compensation. It would be way easier just to grind out shifts and turn off your phone after work if you can't make much more than your pit docs.

There seems to be a certain lifespan for medical directors, at least in my current hospital. Our current director is our third in 6 years. One of them only lasted a few weeks before our CMO axed him. The first director had been there for 1-2 years and we got a new CMO who essentially forced the CMG to fire him (great doc and fantastic director...really disappointing when the CMG threw him on a sacrificial altar). When our second director got axed, they offered the job to me and I declined. Then our current director came onboard and they kept me as assistant director.

 

[GonnaBeADoc2222]

I think it's maybe a valuable opportunity for professional development in a stable group / hospital (non CMG). I was offered an assistant directorship at one CMG site and promptly turned it down after it become apparent that it was really just a whipping boy post for filling shift vacancies that the director didn't feel like dealing with.

 

[bravotwozero]

You may be able to work less night shifts...that may be the only benefit.

 

[thegenius]

Never again for me.

Cons:

Frequent calls about problems: from your docs, consultants, hospital admin. The same stuff will come up over and over (these admissions are lame, so and so was rude to me when I called to admit, the wait times last night were really long etc) but you have little power to actually make changes. I would get these calls at the worst times.

Ultimately you are the last line of defense if someone calls out and a replacement can’t be found

Patient complaints. Brutal. Hated dealing with these.

Meetings


Pros:

Typically less night/weekend time and a more predictable schedule.

Money

It's seems like you would be constantly dealing with people who complain and have problems. Good point on not actually making much difference though. Sounds like a miserable job. Fielding calls all day, and all night, and trying to fix stuff that can't get fixed?

What do they typically make? An extra 100K/year?

 

[TooMuchResearch]

I think ours typically reduce their shifts rather than make more. They do get more daytime hours for the director stuff although ours are still required to work the proportion of days/evenings/nights as the rest of us. I don't think they're taking many after hours calls. They are definitely **** buffers for us though.

It's seems like you would be constantly dealing with people who complain and have problems. Good point on not actually making much difference though. Sounds like a miserable job. Fielding calls all day, and all night, and trying to fix stuff that can't get fixed?

What do they typically make? An extra 100K/year?

 

[deleted245139]

I feel conflicted about it sometimes.
I'm the director of an academic trauma center. Factors more into contracted hourly buy down rather than salary per say.
I like that my efforts make the daily lives of my docs better.... But it takes an ungodly amount of time and effort personally to make a dent.
I feel like I have reasonable institutional support, but that's not saying a ton - it's market forces and hospital admin etc etc. Conflicting interests.
I'm early in my career, so we will see how things go. I enjoy it, but it comes with a cost, for sure

 

[southerndoc]

Most CMG's and small groups pay 10-15k/month. Associate/assistant medical directors make about a third to half that. Usually you'll spend about 40-60 hours/month with work. It's all dependent on how well your shop runs. A smooth shop needs less oil and maintenance, a rough shop can take a lot of work.

I spend about 20 hours/month as associate medical director with all the work I do. Most of it are meetings, but some are teleconferences, work from home, etc. Luckily, I don't have to deal with patient complaints.

 

[Vandalia]

The advantage for me was that when it came to stupid decisions made by the medical director, they were my stupid decisions.

 

[Porfirio]

You make more working locums in place of the time spent doing medical director stuff, and locums are optional (chose to not work overnight shifts). Plus, you get your foot in the door to many hospitals and eventually cut back on your main shop to take the big boy $$ from starving CMG/SDG opportunities. Just be willing to travel.

 

[deleted109597]

I left my last director job.
For the next one to be worth it, I would need a very, very stable group of doctors, and the stipend would need to cover 50% of my normal income.
And even then, I might say now.

This BS of basically one extra shift's pay per month? Yeah no. F that noise.

 

[RuralEDDoc]

As has been said, cost/benefit really depends on your group and hospital admin. Nearly all groups struggle to a certain extent to staff the ED - the national shortage of doctors and midlevels guarantees that. With that said, some places REALLY struggle. Imagine trying to staff a rural ED more than an hour away from a major airport with modest pay - that’s really hard. Try improving throughput and patient satisfaction with an unstable group of docs pulled from the bottom of the barrel. Tough to do.
With that said, there is more to be gained from holding such a position than money. You have to learn or sharpen people skills and business skills that you don’t use as a physician. You have to learn how to collaborate and work with hospital leadership and staff to get things done. Doing so, you may develop skills that will make you more valuable than the average pit doc. Or, it may just raise your blood pressure and lead to burnout and depression. YMMV.

 

[PabsMD]

To those who have been/are in the medical director position, are there any resources that you found invaluable for the position? Aside from improving leadership/people skills and the ability to deal with BS, is there anything to help prepare you for the day-to-day decision making required?

 

[RustedFox]

To those who have been/are in the medical director position, are there any resources that you found invaluable for the position? Aside from improving leadership/people skills and the ability to deal with BS, is there anything to help prepare you for the day-to-day decision making required?

 

[PabsMD]

Touché, RustedFox, touché...

 

[deleted109597]

ACEP does the medical director academy. It's better than their teaching fellowship for sure.

 

[emergentmd]

I was recently offered 12k/mo director's stipend and I thought that was alot.

I was way under paid as director 10 yrs ago.

 

[Hercules]

To those who have been/are in the medical director position, are there any resources that you found invaluable for the position? Aside from improving leadership/people skills and the ability to deal with BS, is there anything to help prepare you for the day-to-day decision making required?

Strauss and Mayer’s ED Management is not a bad resource. It’s broken down into quick easy chapters that are only a couple pages long. Some are better than others. I purchased it and read various parts of it when I took over as president/medical director for my group a few years ago.

 

[RustedFox]

So, here's the point in the thread where some naive pre-med or MS1-4 says something like:

"Well, the problem is that you aren't organized and have a voice and can be heard and robbledy robbledy robble."

The fact that nobody wants to be medical director says a lot about how ugly EM is.

I'm not going to regurgitate all those things here; but I am going to say this:

EM is only so freaking ugly because the powers that be have made it so ugly.

HINT: it doesn't have anything to do with the MEDICINE at all.

Instead, it has everything to do with convenience, satisfaction, the American Public, Adminstrators, and the Almighty Dollar.

Veers, Birdstrike, et.al. can be far more eloquent that I can be right now on this topic - but I guarantee they won't disagree.

Then, there are the jackholes who say things like: "Weeeeellll 75% of ER visits can be taken care of by FM/IM, so why can't we do your job as well as you can?!"

S.O.R.R.Y. - but the FM/IM guys... they defecate in their pants when they're confronted with a crashing patient. Paralysis. Patient dies. Doc dies (sometimes). I have twice wrested the care of an ICU-bound and moribund patient from the FM/IM guy last month (this month is young; I have only worked one shift yet).

Even worse; we have one FM guy that will stick a needle into anything he sees. Yep! His rationale is: Geez, I can bill for this; so why would I not do this?! Four weeks later; we have a line of people outside our ER asking for paracentesis and thoracentesis like its a gas station. So, FM diickhead is sticking needles into things while [meanwhile], the stroke alerts come in for the "other doc" to see. Lol-ol-ol-ol...

Sorry; anecdotes aside - I can't imagine a "modern" ER being taken over by non-EM trained folks. The truly emergent folks would wait while biopsies that don't need to emergently happen.... happen.

 

[RustedFox]

- and if anyone cares [and is studying languages, as I presently am] -


This word "happen" is freaking trouble in so many languages.
What is the parent verb? What is the tense?

This happened.
I'm going to make this happen.

You've made this happen, but I want to make it happen.


[OCCURIR (ESP)?]

Psst: the easy way is to use [pasar]... but naaaaah, that doesn't do it.

 

[lp430]

This thread pretty much sums up my experience and why I'm glad I didn't take any of the admin fellowships I applied for when I was a resident.

 

[HooliganSnail]

I am medical director at a small rural shop. I get only 45K a year extra, but it's quite an easy job. A few phone calls a month, department meeting every 3 months with doughnuts and coffee for an hour, occasional chart review. Patient complaints are really not difficult, occasional pain seeker (easy complaint), and a few legit ones.

Although the above is really a function of the fact that in the rural shops everything is easier if you can handle the fact that you have no back up. Less patients, more time to just sit and talk with them, less frustrated people, less complaints.....

I'm 32. I think it is a great career development opportunity, not in the sense that I need it on a resume (where I work, you can work anywhere, there is such a need in rural areas), but more of the fact that it gives you a full perspective on the business end of medicine, and even more understanding of the house of medicine as a whole.

 

[RuralEDDoc]

Although the above is really a function of the fact that in the rural shops everything is easier if you can handle the fact that you have no back up. Less patients, more time to just sit and talk with them, less frustrated people, less complaints.....

Just to clarify for others, rural does not mean easier. Small, low volume rural with an understanding patient population may be easier. But a busy, overwhelmed, high volume rural place where you see over 2 high acuity PPH and half of your admits need transfer because of no local resources - that’s a living hell.
With that said I’m glad you’ve found a good gig (clinically and admin wise).

 

[cyanide12345678]

Just to clarify for others, rural does not mean easier. Small, low volume rural with an understanding patient population may be easier. But a busy, overwhelmed, high volume rural place where you see over 2 high acuity PPH and half of your admits need transfer because of no local resources - that’s a living hell.
With that said I’m glad you’ve found a good gig (clinically and admin wise).

My semi rural sees 20k vol with 12 hour mlp coverage and 24 hrs doc coverage. It truly can become very difficult when sometimes everyone needs to be transferred and the ambulances aren't available for the transfer.

 

[GonnaBeADoc2222]

My semi rural sees 20k vol with 12 hour mlp coverage and 24 hrs doc coverage. It truly can become very difficult when sometimes everyone needs to be transferred and the ambulances aren't available for the transfer.

20k volume can get quite hairy with that level of coverage.

 

[cyanide12345678]

20k volume can get quite hairy with that level of coverage.

In my 3 months there so far, my worst day was when I saw 22 in 5 hours. I'm sure it can get much worse. Flu season is coming, so will see what happens. But an ambulance can take 2.5 hours to take one patient and then come back, and that can sometimes really limit things when extra ambulances aren't available. It's even worse when the bird isn't flying and a critical patient ends up sitting in the department.

 

[GonnaBeADoc2222]

In my 3 months there so far, my worst day was when I saw 22 in 5 hours. I'm sure it can get much worse. Flu season is coming, so will see what happens. But an ambulance can take 2.5 hours to take one patient and then come back, and that can sometimes really limit things when extra ambulances aren't available. It's even worse when the bird isn't flying and a critical patient ends up sitting in the department.

Yeah that coverage is not very good for 20k

 

[TooMuchResearch]

Low volume rural and high acuity urban/suburban has been a good career combo for me so far.

Just to clarify for others, rural does not mean easier. Small, low volume rural with an understanding patient population may be easier. But a busy, overwhelmed, high volume rural place where you see over 2 high acuity PPH and half of your admits need transfer because of no local resources - that’s a living hell.
With that said I’m glad you’ve found a good gig (clinically and admin wise).

 

[cyanide12345678]

Yeah that coverage is not very good for 20k

It's not terrible most days. Most of the time i see 16-20 in 12 hours

 

[Groove]

Low volume rural and high acuity urban/suburban has been a good career combo for me so far.

Care to elaborate? I've always avoided single coverage low volume shops because I always hated working alone and sometimes a busy rural ED can be a real ball buster with no back up.

Transfers were usually easy and no sweat. You can generally sell anything over the phone to a local tertiary care, but I really hated some of the high acuity stuff that would roll in at odd hours when no specialists were around for support.

Am I missing something?

I do miss the slow nights where you could get 2-3 hours sleep though.