Department Manager

[msuxrt]

I was hoping to crowdsource some information on what people expect/observe/want their department manager to achieve in the department. Working on restructuring tto better delineate roles for chief of physics, department managers, and head of dosimetry.

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[FrostyHammer]

I was hoping to crowdsource some information on what people expect/observe/want their department manager to achieve in the department. Working on restructuring tto better delineate roles for chief of physics, department managers, and head of dosimetry.

How about be a bureaucrat, be in the hands of the higher up administration, care for others like a politician, dump sh1t on the physician, and get nothing meaningful done. Oh and get paid six figures for doing all that.

Haven't met a dept manager that I even remotely like... In my entire life.

 

[deleted969641]

The position of "department manager" should not exist. These were people that barely graduated high school and somehow avoided getting hit in traffic or choking on a KFC chicken leg and barely met the minimum GPA to get an online masters degree. Their job seems to consist mainly of actively obstructing as much as possible the doctor's attempts to practice good medicine while taking home a 6 figure paycheck. They think they not only are your peer but are actually above you as your boss. They will go to all lengths to hide their incompetence and protect their grossly unnecessary pay. As a result, they view virtually all good doctors (you know, smart people who aren't checked out and actually care about their practice) as a threat to their livelihood and will go to all lengths to rein them in or if they can't be controlled, try to get them fired or make them so miserable that they quit.

I'm wondering what really spurred this post. Do you have a problem with your "department manager?" I will never work in a non-physician owned practice again after my experience with these awful creatures. I have heard this story from so, so many other people. I have witnessed a department manager conspire with therapists to make up lies about a doctor they didn't like and ruin his career.

 

[deleted969641]

Here, let me explain this better.

One of these individuals is most likely a radiation oncology department manager:

Try being my size Amy🌛🤣 - YouTube

 

[RickyScott]

After being fired from the DMV..

 

[Ray D. Ayshun]

Lol

 

[deleted969641]

After being fired from the DMV..

Radiation oncology department manager: When you get fired from the DMV for being too much of a jerk but fail the TSA screening exam.

 

[RadRadRad]

I’ve worked with 2 very good department managers. Both were former therapists. Like everyone in admin they have a boss above them that cares about the bottom line. But a good manager requires the following
1. Concern for patient care
2. Respect for physicians
3. Physicians, nurses, therapists respect them
4. Understanding of technical charges/billing and active involvement in charge capture.
5. Ability to manage schedule for docs
6. Ability to step into multiple roles in the department in event of being short staffed (the ultimate might be a therapist turned dosimetrist turned manager)

ive also had one manager that was much more akin to what has been described above. Initially didn’t like them but eventually just felt sorry for them. In way over their head with admin that took couple years to figure out needed replacing . Advocated hard for specific person to be replacement and that would be my suggestion to others in this scenario

 

[FrostyHammer]

I’ve worked with 2 very good department managers. Both were former therapists. Like everyone in admin they have a boss above them that cares about the bottom line. But a good manager requires the following
1. Concern for patient care
2. Respect for physicians
3. Physicians, nurses, therapists respect them
4. Understanding of technical charges/billing and active involvement in charge capture.
5. Ability to manage schedule for docs
6. Ability to step into multiple roles in the department in event of being short staffed (the ultimate might be a therapist turned dosimetrist turned manager)

ive also had one manager that was much more akin to what has been described above. Initially didn’t like them but eventually just felt sorry for them. In way over their head with admin that took couple years to figure out needed replacing . Advocated hard for specific person to be replacement and that would be my suggestion to others in this scenario

Haven't met a rad onc dept manager for which more than 1 of the above applies. They are all just sad sorry sacks of sh1t.

 

[deleted969641]

I’ve worked with 2 very good department managers. Both were former therapists. Like everyone in admin they have a boss above them that cares about the bottom line. But a good manager requires the following
1. Concern for patient care
2. Respect for physicians
3. Physicians, nurses, therapists respect them
4. Understanding of technical charges/billing and active involvement in charge capture.
5. Ability to manage schedule for docs
6. Ability to step into multiple roles in the department in event of being short staffed (the ultimate might be a therapist turned dosimetrist turned manager)

ive also had one manager that was much more akin to what has been described above. Initially didn’t like them but eventually just felt sorry for them. In way over their head with admin that took couple years to figure out needed replacing . Advocated hard for specific person to be replacement and that would be my suggestion to others in this scenario

Ouch. You've hit a nerve. Lets go through these with my current "department manager" (I am looking for a new job because of this terrible person the administration refuses to get rid of despite saying that they are planning to for 2 years now):

1. Concern for patient care.

The DM refuses to let patients be scheduled until their ability to pay is guaranteed and has actively obstructed my attempts to improve patient care by placing spaceOAR in clinic (he had a closed doors meeting with administration where he told them that he would not allow procedures to be done in "his" clinic and that spaceOAR and fiducials were "outdated medicine." He also told the urologists that I thought they were incompetent to place fiducials in an attempt to stop me from having this done and created a giant ****storm between them and me).

2. Respect for physicians.

He has literally screamed at me, told me I was "the worst doctor we've ever had" and "full of ****" He uses the title "doctor" ironically and rolls his eyes when he says it.

3. Physicians, nurses, therapists respect them.

LOL

4. Understanding of technical charges/billing and active involvement in charge capture.

I had to explain to him that 5 fraction intracranial radiosurgery should be billed as SBRT (77373), not IMRT. He argued with me and to this day still thinks he is right. So our stereotactic plans are getting billed as 77386 because he is smarter than everybody else. Good for him justifying his 6 figure salary by losing the hospital (and me) a lot of money.

5. Ability to manage schedule for docs

If by ability to manage, you mean desire to control the entire schedule and accuse the doctor of being lazy for not wanting to mix follow-ups, consults, and sims all on the same afternoon, but at the same time accuse the doctor of overworking the staff if you try to do three simulations in a row on the same day.

6. Ability to step into multiple roles in the department in event of being short staffed (the ultimate might be a therapist turned dosimetrist turned manager)

The current department manager is a CMD but has not done a plan since I've been here and has no idea how to do an IMRT plan or even a complex 3D plan. Yet, he gets paid as a dosimetrist with the addition of his department manager role, pushes his income absurdly high.


Granted this person is by far the worst of the worst of the managers I've worked with, but from others I have talked to, my experience is typical.

 

[FrostyHammer]

I know a dept manager who makes $250k per annum. No wonder why that person cares so much about money...because that manager is fleecing the department with that salary...which btw is a higher salary than some rad onc docs in desirable areas of the country! SMH.

 

[RadOncDoc21]

Dept manager at my last gig wanted to control my schedule and couldn’t understand how I couldn’t do a brachy procedure and see two follow ups and a consult all at the exact same time.

 

[deleted969641]

I am curious if anyone has any ideas how to completely eliminate this position. What of the department managers few actually important roles can be divided up amongst RTT, CMD, and the MD? How to suggest allocating them? Anybody actually seen a functioning department without this "manager" role?

 

[RadRadRad]

Ouch. You've hit a nerve. Lets go through these with my current "department manager" (I am looking for a new job because of this terrible person the administration refuses to get rid of despite saying that they are planning to for 2 years now):

1. Concern for patient care.

The DM refuses to let patients be scheduled until their ability to pay is guaranteed and has actively obstructed my attempts to improve patient care by placing spaceOAR in clinic (he had a closed doors meeting with administration where he told them that he would not allow procedures to be done in "his" clinic and that spaceOAR and fiducials were "outdated medicine." He also told the urologists that I thought they were incompetent to place fiducials in an attempt to stop me from having this done and created a giant ****storm between them and me).

2. Respect for physicians.

He has literally screamed at me, told me I was "the worst doctor we've ever had" and "full of ****" He uses the title "doctor" ironically and rolls his eyes when he says it.

3. Physicians, nurses, therapists respect them.

LOL

4. Understanding of technical charges/billing and active involvement in charge capture.

I had to explain to him that 5 fraction intracranial radiosurgery should be billed as SBRT (77373), not IMRT. He argued with me and to this day still thinks he is right. So our stereotactic plans are getting billed as 77386 because he is smarter than everybody else. Good for him justifying his 6 figure salary by losing the hospital (and me) a lot of money.

5. Ability to manage schedule for docs

If by ability to manage, you mean desire to control the entire schedule and accuse the doctor of being lazy for not wanting to mix follow-ups, consults, and sims all on the same afternoon, but at the same time accuse the doctor of overworking the staff if you try to do three simulations in a row on the same day.

6. Ability to step into multiple roles in the department in event of being short staffed (the ultimate might be a therapist turned dosimetrist turned manager)

The current department manager is a CMD but has not done a plan since I've been here and has no idea how to do an IMRT plan or even a complex 3D plan. Yet, he gets paid as a dosimetrist with the addition of his department manager role, pushes his income absurdly high.


Granted this person is by far the worst of the worst of the managers I've worked with, but from others I have talked to, my experience is typical.

Didn’t mean to touch a nerve. I’m not arguing that you have a good manager only that good managers exist. If you are willing to walk away and have another job lined up doesn’t hurt to Lay down an ultimatum of me or them

 

[Ray D. Ayshun]

Lucky me, I have a manager that's all 6

 

[randomname2018]

I have worked with 3 department managers. Two of the three were excellent. Strong work ethic and constantly working on improving the department for patients and staff. However, one of the three was hands down the most incompetent person I've ever met. Multiple people have left after having worked for her and have cited her as the reason for the departure. I have no idea how she continues to be employed to this day.

 

[RadOncDoc21]

I am curious if anyone has any ideas how to completely eliminate this position. What of the department managers few actually important roles can be divided up amongst RTT, CMD, and the MD? How to suggest allocating them? Anybody actually seen a functioning department without this "manager" role?

You can, just need to make sure there is someone there who can handle the admin workload. We have a system where there are different levels of admin so that role is divided up and honestly works better than what I’ve seen in the past. I think like any role , if you get a good one, definitely can be crucial for the team.

The best I’ve experienced had a MBA or MHA and focused more on the business and less on the clinical setup.

 

[Palex80]

I'd like her/him to stay out of my way...

 

[Palex80]

I have worked with 3 department managers. Two of the three were excellent. Strong work ethic and constantly working on improving the department for patients and staff. However, one of the three was hands down the most incompetent person I've ever met. Multiple people have left after having worked for her and have cited her as the reason for the departure. I have no idea how she continues to be employed to this day.

Perhaps that's what she's good at, making people quit.

You will be amazed to find out that some bosses out there actually WANT to hire such people. The ones that make the motivated, self-thinking, engaged co-workers quit.

 

[Mandelin Rain]

Yeah. I've worked with some really good ones I guess.

Invariably, the common thread between good and bad managers is RTT vs RN. RTTs typically aren't chasing some higher ambition in hospital administration or involving themselves in some drama nonsense. They just want to do their work and go home.

Anyway, you want them to 1.) understand the value that radiation brings to a healthcare system (i.e. massive profits, which I think most RTTs do), 2.) support the doc and staff in maintaining/growing those profits by interfacing with higher administration, 3) deal with staff/patient conflict/complaint issues in a straightforward, fair manner, 4.) lead by example (i.e. jump on the linac if needed). That's about it.

They need to see themselves as a fixer for the department,

 

[ramsesthenice]

The quality of all admins comes down to one simple thing: being a decent human being. If they put people before ambition they can be great. If they will do anything to climb the ladder and please the higher ups...these are the people we are tempted to run down crossing the street if given the chance.

 

[RadOncDoc21]

Yeah. I've worked with some really good ones I guess.

Invariably, the common thread between good and bad managers is RTT vs RN. RTTs typically aren't chasing some higher ambition in hospital administration or involving themselves in some drama nonsense. They just want to do their work and go home.

Anyway, you want them to 1.) understand the value that radiation brings to a healthcare system (i.e. massive profits, which I think most RTTs do), 2.) support the doc and staff in maintaining/growing those profits by interfacing with higher administration, 3) deal with staff/patient conflict/complaint issues in a straightforward, fair manner, 4.) lead by example (i.e. jump on the linac if needed). That's about it.

They need to see themselves as a fixer for the department,

Agree, the best ones were focused on the dept needs and the worst ones definitely had their own agenda.

 

[OTN]

Ouch. You've hit a nerve. Lets go through these with my current "department manager" (I am looking for a new job because of this terrible person the administration refuses to get rid of despite saying that they are planning to for 2 years now):

1. Concern for patient care.

The DM refuses to let patients be scheduled until their ability to pay is guaranteed and has actively obstructed my attempts to improve patient care by placing spaceOAR in clinic (he had a closed doors meeting with administration where he told them that he would not allow procedures to be done in "his" clinic and that spaceOAR and fiducials were "outdated medicine." He also told the urologists that I thought they were incompetent to place fiducials in an attempt to stop me from having this done and created a giant ****storm between them and me).

2. Respect for physicians.

He has literally screamed at me, told me I was "the worst doctor we've ever had" and "full of ****" He uses the title "doctor" ironically and rolls his eyes when he says it.

3. Physicians, nurses, therapists respect them.

LOL

4. Understanding of technical charges/billing and active involvement in charge capture.

I had to explain to him that 5 fraction intracranial radiosurgery should be billed as SBRT (77373), not IMRT. He argued with me and to this day still thinks he is right. So our stereotactic plans are getting billed as 77386 because he is smarter than everybody else. Good for him justifying his 6 figure salary by losing the hospital (and me) a lot of money.

5. Ability to manage schedule for docs

If by ability to manage, you mean desire to control the entire schedule and accuse the doctor of being lazy for not wanting to mix follow-ups, consults, and sims all on the same afternoon, but at the same time accuse the doctor of overworking the staff if you try to do three simulations in a row on the same day.

6. Ability to step into multiple roles in the department in event of being short staffed (the ultimate might be a therapist turned dosimetrist turned manager)

The current department manager is a CMD but has not done a plan since I've been here and has no idea how to do an IMRT plan or even a complex 3D plan. Yet, he gets paid as a dosimetrist with the addition of his department manager role, pushes his income absurdly high.


Granted this person is by far the worst of the worst of the managers I've worked with, but from others I have talked to, my experience is typical.

Yikes. Maybe it's just because I am a spiteful, hateful man, but I would go as far as getting an MBA in the evening so I could push back against this guy with administration, with the end goal of getting him out of that job. It would take some time, for sure, but just imagine the satisfaction when it happened.

I've had wonderful experiences with our last two department managers, but that's because we're a private practice. The one before that sucked, so she got fired. My partner took care of that. Since then, we've had two RTTs, and they have been fantastic. We're a large pp and affiliated with an even larger organization, and my goal for both of them was to get them experience as our department manager, then move them up the leadership chain. It worked with the first one, as she's now in charge of ~7 RT centers. They do exactly what we want them to do in the department, and you had better believe they have all 6 of those qualities listed above and then some. I explained to both of them when they took the job the opportunities that would be available to them, should they succeed. It makes me incredibly proud and happy to see an employee go from RT student ----> RTT ----> department manager ---> regional leadership, etc.

Creating and utilizing a good department manager is yet another example of how physician-led radonc teams excel compared to business-admin-led hospital programs. In the above example the DM was acting as an antagonist to the MD and his/her goals and surely substantially negatively impacting the revenue of the program. The precise opposite should instead be the case.

 

[RickyScott]

Didn’t mean to touch a nerve. I’m not arguing that you have a good manager only that good managers exist. If you are willing to walk away and have another job lined up doesn’t hurt to Lay down an ultimatum of me or them

Have experienced similar situation in the past where managers clearly have personality disorder/pathology. Hard to deal with since radiation a black box to administration. Seen docs loose jobs in these type of situations. Nails why job market is such a big concern to those of us established in practice.

 

[seper]

Best admins are ones with "discretionary funds"... can be used for regular happy hour events. Presuming, life goes back to normal eventually.

 

[Neuronix]

This is one of many reasons why the ARRO survey "Are you satisfied with your job offer?" is nonsense.

You have no idea what your job is like until you actually work there. Good luck finding a new position if your first position doesn't work out, especially a quality position. An evil practice manager is one of these things that you don't appreciate until you've been under one, and Palex is exactly right that the practice manager can be the chair's way of deflecting all negativity onto someone else so the chair's reputation isn't hurt.

More senior docs are much better at knowing what they want and trying to negotiate for it. The more malignant places prefer new grads for this reason--they don't negotiate and they don't know what to ask about, though even better is a desperate experienced doc who also can't negotiate but is also experienced.

OTN's nice little fantasy of running a practice manager out is not realistic in most health systems. The rad onc is the one who is more likely to be let go or quit in disgust in that kind of battle. I've seen it happen several times.

 

[OTN]

This is one of many reasons why the ARRO survey "Are you satisfied with your job offer?" is nonsense.

You have no idea what your job is like until you actually work there. Good luck finding a new position if your first position doesn't work out, especially a quality position. An evil practice manager is one of these things that you don't appreciate until you've been under one, and Palex is exactly right that the practice manager can be the chair's way of deflecting all negativity onto someone else so the chair's reputation isn't hurt.

More senior docs are much better at knowing what they want and trying to negotiate for it. The more malignant places prefer new grads for this reason--they don't negotiate and they don't know what to ask about, though even better is a desperate experienced doc who also can't negotiate but is also experienced.

OTN's nice little fantasy of running a practice manager out is not realistic in most health systems. The rad onc is the one who is more likely to be let go or quit in disgust in that kind of battle. I've seen it happen several times.

Unfortunately, I agree. I feel very, very fortunate to be in the situation I'm in. I just wish more of us had an opportunity to find one for themselves.

 

[RickyScott]

Wq

OTN's nice little fantasy of running a practice manager out is not realistic in most health systems. The rad onc is the one who is more likely to be let go or quit in disgust in that kind of battle. I've seen it happen several times.

agree, this is not rare, and inconceivable to most graduating residents.

 

[ramsesthenice]

An evil practice manager is one of these things that you don't appreciate until you've been under one

And psychopaths are very charming people so you have to work to figure it out ahead of time. Never never never get laser focused on the chair. You need to get a sense of how physicians in the group interact with administration. The bigger the group is, the > the ratio of time you will spend dealing with administration vs department chair. I liken it to federal vs local governments. We all fixate on the top but its the folks most of us can't even name that actually dictate a lot of our day to day comings and goings.

 

[thecarbonionangle]

The quality of all admins comes down to one simple thing: being a decent human being. If they put people before ambition they can be great. If they will do anything to climb the ladder and please the higher ups...these are the people we are tempted to run down crossing the street if given the chance.

100 agree. One of the most important quality for a DM or any coworker to make a broader point is are they a decent human being? there are way too many POS in medicine and “leadership” managerial roles, empty suits with MBAs from univ of phoenix. These people can make your life absolute hell pit.

 

[thecarbonionangle]

This is one of many reasons why the ARRO survey "Are you satisfied with your job offer?" is nonsense.

You have no idea what your job is like until you actually work there. Good luck finding a new position if your first position doesn't work out, especially a quality position. An evil practice manager is one of these things that you don't appreciate until you've been under one, and Palex is exactly right that the practice manager can be the chair's way of deflecting all negativity onto someone else so the chair's reputation isn't hurt.

More senior docs are much better at knowing what they want and trying to negotiate for it. The more malignant places prefer new grads for this reason--they don't negotiate and they don't know what to ask about, though even better is a desperate experienced doc who also can't negotiate but is also experienced.

OTN's nice little fantasy of running a practice manager out is not realistic in most health systems. The rad onc is the one who is more likely to be let go or quit in disgust in that kind of battle. I've seen it happen several times.

Also a very important point. It is all fun and games at recruiting dinners and first/second looks, jeez everyone seemed very nice!. Then reality hits for some. That question probably should not be asked until maybe 6 months to a year into your new job because quite frankly there is a lot of information asymmetry. A lot can happen in just a few months as people drop the facade. I can tell you I did not know what to ask completely when i got my first job. I asked what I could but now i know even more things to ask.

for example, i heard of someone who had a “great” job and then they started and a few months in they realized they had been lied to on multiple issues, especially discovering “senior” physicians had other income streams that they were not offered. Is this still a “great” job months later? Surely this person answered very positively in survey. Perhaps there should be a checking in survey sent out at 6 mo and 1 yr to make better sense of the data, if i may make a humble suggestion.

 

[seper]

And yes, job security of a usual department admin is superior to that of a RadOnc attending. Good to know for new grads

 

[metallica81788]

Perhaps there should be a checking in survey sent out at 6 mo and 1 yr to make better sense of the data, if i may make a humble suggestion.

Definitely

 

[Mandelin Rain]

And yes, job security of a usual department admin is superior to that of a RadOnc attending. Good to know for new grads

I guess I disagree.

In my experience (not the longest, mind you), the shelf life of a psychotic middle manager type person in health care is about 2 years.

You can usually wait them out, especially if when their supervisor is around you start making comments like:

"Yeah, clinic is doing well. We're busy. Could maybe use an extra dosimetrist because sometimes plans are taking too long. I wonder if Jim could still run a plan if we needed him to? He hasn't in years and a lot has changed. Dosimetrists are really expensive. Like 125k per year. We could really save some money if we didn't need an extra one. Say, you guys aren't still paying Jim as a dosimetrist, are you...?"

 

[RickyScott]

Early on in my career, I treated whole brain on the weekend clinically and psycho manager made a big stink about not documenting in the record whether pt had a pacemaker (he did not) and tried to escalate with risk management. Would take potshots like this all the time.