ED Medical Director/Chair Scheduling Flexibility

[Got Em]

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I am interested in becoming a Medical Director/Chair (full time) and working 1-2 days weekly as a pain physician on the side. I just mainly want to know if it's possible to work way less clinical shifts as an EM chair in exchange for a lower salary and more flexibility. Since pain medicine requires someone to work 8-5pm during M-F, it would be extremely difficult to work EM overnight shifts. However, I'll willing to work evenings and weekends for EM shifts.

I have seen places that require for you to work 80 hours clinically and have 80-100 hours of administrative time. Is it possible to work say 40-60 hours a month clinically and take less pay? Here is my breakdown:

EM Chair/Director (full time) with pain medicine (part time) monthly schedule
- 40-60 hours clinical time; 80-100 hours admin time
- Guaranteed off 1-2 weekdays for pain medicine
- Willing to work weekends and evenings (no overnights due to pain schedule)
- Willing to take less pay ($150-200k yearly is fine for EM job)

Thoughts?

 

[BAM!]

I am interested in becoming a Medical Director/Chair (full time) and working 1-2 days weekly as a pain physician on the side. I just mainly want to know if it's possible to work way less clinical shifts as an EM chair in exchange for a lower salary and more flexibility. Since pain medicine requires someone to work 8-5pm during M-F, it would be extremely difficult to work EM overnight shifts. However, I'll willing to work evenings and weekends for EM shifts.

I have seen places that require for you to work 80 hours clinically and have 80-100 hours of administrative time. Is it possible to work say 40-60 hours a month clinically and take less pay? Here is my breakdown:

EM Chair/Director (full time) with pain medicine (part time) monthly schedule
- 40-60 hours clinical time; 80-100 hours admin time
- Guaranteed off 1-2 weekdays for pain medicine
- Willing to work weekends and evenings (no overnights due to pain schedule)
- Willing to take less pay ($150-200k yearly is fine for EM job)

Thoughts?

anything's possible. you need to negotiate it with the group.

Dose of reality: Keep in mind, you may be paid less than $150k/yr if you only work 4-5 shifts per month. Depends on your hourly rate / where you work (5 shifts x 10hrs x 12 months x $250/hr = $150,000)

 

[shoal007]

I am a director. I don't get to pick which shifts that I work. Often I end up turning over in less than 24hrs. After just one year I'm thinking of just going back full clinical. The pushes and pulls, always on and having to answer to both higher admin and my reports gets very tiring.

I personally don't think it can be done unless you are working just a couple shifts a week.

Sent from my Pixel 2 using Tapatalk

 

[Vandalia]

I am a director. I don't get to pick which shifts that I work.

Exactly. In a well run group, the Director is going to be the one "falling on his sword" and picking up the shift when someone's kid is admitted to the hospital or the like. At least where I am now, the rest of us would take a dim view of someone who was not fully committed to the field.

However, as you should know from reading a few posts, there is a wide range of situations, and anything is possible.

 

[Arcan57]

There are definitely reasons to be a director. Unless you’re able to run the place on autopilot (small stable staffed shop without competition), lifestyle is a pretty poor one. The directors/chairs that never work night shifts/off every weekend largely got there by having a worse work life balance then everyone else in the group/department for years if not decades. That old guy that flies out from his lake house in Tahoe to consultant a couple of days a month while spending plenty of time with his wife and young family? He bought that position on the sweat of his brow and the absolute wreckage of his first marriage and non existent relationships with his grown children.

Shout out to shoal007 for revealing an essential truth about being a director. You are firmly middle management. Unless you own the contract you have influence but no actual control over the majority of the resources needed for a successful department. It’s a testament to the skill and resourcefulness of both directors and pit docs that things work as well as they do.

 

[Got Em]

I am a director. I don't get to pick which shifts that I work. Often I end up turning over in less than 24hrs. After just one year I'm thinking of just going back full clinical. The pushes and pulls, always on and having to answer to both higher admin and my reports gets very tiring.

I personally don't think it can be done unless you are working just a couple shifts a week.

Sent from my Pixel 2 using Tapatalk

Shoal thanks for your response.

How many clinical hours are you working monthly? I'm hoping to work 40-60 hours clinically in EM (1-2 shifts per week) and 60 hours in pain, while doing 80-100 admin hours in EM.

 

[Got Em]

Exactly. In a well run group, the Director is going to be the one "falling on his sword" and picking up the shift when someone's kid is admitted to the hospital or the like. At least where I am now, the rest of us would take a dim view of someone who was not fully committed to the field.

However, as you should know from reading a few posts, there is a wide range of situations, and anything is possible.

Vandalia, thanks for your response.

I know of a few EM chairs/directors that are fellowship trained (tox, US, etc). Are you saying that if they take 1-2 shifts per week doing EM sub-specialty shifts, other EM docs in the group would look down upon them?

Also, pain is an official EM subspecialty as of 2014 and more EM trained folks will be doing this. I just don't want to be caught in a situation where doing pain on the side limits my ability to get an ED director/chair position.

 

[shoal007]

I'm not fellowship trained. My colleagues would be upset if I had shift preference and would have more trouble with leadership duties. I work 115 hrs/ mo clinically.

Sent from my Pixel 2 using Tapatalk

 

[Got Em]

There are definitely reasons to be a director. Unless you’re able to run the place on autopilot (small stable staffed shop without competition), lifestyle is a pretty poor one. The directors/chairs that never work night shifts/off every weekend largely got there by having a worse work life balance then everyone else in the group/department for years if not decades. That old guy that flies out from his lake house in Tahoe to consultant a couple of days a month while spending plenty of time with his wife and young family? He bought that position on the sweat of his brow and the absolute wreckage of his first marriage and non existent relationships with his grown children.

Arcan thanks for the response.

I am not looking to "never work night shifts/off every weekend". As previously stated, I am willing to work all evening/weekend shifts. For my 40-60 hour scenario at a 10 hour shop, if I work 4-6 shifts a month, 2-3 can be evening shifts and 2-3 can be weekend shifts. I think that's pretty fair if half of your shifts are on the weekend right?

As far as on the administrative side, I'm not going to skimp out on any hours. I plan to fully commit 80-120 hours per month on the admin side. In exchange for more flexibility and less clinical shifts, I just wanted to do 1-2 days of interventional pain.

 

[Got Em]

I'm not fellowship trained. My colleagues would be upset if I had shift preference and would have more trouble with leadership duties. I work 115 hrs/ mo clinically.

Sent from my Pixel 2 using Tapatalk

Wow 115 hours clinically sounds like a lot for a medical director. How many hours per month are you spending on administrative duties?

If you wanted to, are you able to reduce your clinical load for much less pay?

 

[deleted480308]

I'm not fellowship trained. My colleagues would be upset if I had shift preference and would have more trouble with leadership duties. I work 115 hrs/ mo clinically.

Sent from my Pixel 2 using Tapatalk

The leader has to take the hits now and then.... some of my favorite gen mattis stories are of him pulling gate duty as a 1 star on Christmas

 

[Janders]

I don't get the concept of a "part-time" ED director / chief / chair. Does not compute.

Standard break down for a random director (hypothetically), is 2/3 clinical work, 2/3 admin work. Yes it adds up to >1. Ask around, the other directors know what I mean.

If you tried to pull off 1/3 clinical work, 1/3 clinical work during prime daytime hours in an "unrelated" specialty clinic, and 1/2 admin work I think it would be VERY tough to keep your finger on the pulse of your department. Add to this to vitriol you will get by being unwilling to work overnights, and I can't see it being easy for you to lead change. Doing "100 hours of admin work" does not mean sitting in your office and reviewing charts leisurely at times of day you would like to be doing that. It means constant 24/7 emails, pages, crises, STAT schedule issues, along with a bevy of standing committees, medico-social obligations AND stacks of QI, chart review, provider review and other paperwork you can do at your leisure.

I think perhaps you could pull this off in a very small shop where there are only 6 full time docs and the director is really a part time job you can ad-hoc onto your clinical duties...

But in any moderate or larger ED, IMO they will desire a chief fully committed to that job.

Now if you start as an ED doc, with a 1d a week interventional pain side gig, and slowly grown into and admin role in said ED (QI director, then associate director), could you with sweat equity and hard work perhaps eventually arrive at a state where you are the director, you work 4 clinical shifts a month AND you still have your pain side hustle? Sure.

Now for some of your specific questions--

I work about 115hr/mo clinically.
I could work less shifts for less money, yes.
I think there is a certain number of shifts a new grad needs to work x 2-3 years to get the proper knowledge base...
I think there is also a certain number of shifts a month a community ED director needs to work to truly know what is happening in his/her department...
I think a director needs to work SOME overnights because the hospital is a very different place during overnights and you need to see it, feel it, know the overnight staff, and be a part of that "burden" in your group.
I do get to largely cherry pick my schedule around the very numerous committees and meetings I have to be at.
HOWEVER, I still work the same breakdown of nights, weekends, OVERNIGHTS and holidays as the rest of the staff.

 

[Arcan57]

Arcan thanks for the response.

I am not looking to "never work night shifts/off every weekend". As previously stated, I am willing to work all evening/weekend shifts. For my 40-60 hour scenario at a 10 hour shop, if I work 4-6 shifts a month, 2-3 can be evening shifts and 2-3 can be weekend shifts. I think that's pretty fair if half of your shifts are on the weekend right?

As far as on the administrative side, I'm not going to skimp out on any hours. I plan to fully commit 80-120 hours per month on the admin side. In exchange for more flexibility and less clinical shifts, I just wanted to do 1-2 days of interventional pain.

I’m not impugning your work ethic. Just stating that for most places the road to becoming a director is going to be MUCH heavier clinically then what you are describing as your ideal. As assistant I was averaging 140 hrs clinically with probably 30 admin. I probably averaged 120 hrs clinically during my years as director and probably could not have cut down below 110 due to staffing with any consistency. As director when there are holes on the schedule (which there usually are) you have to fill them. Begging other docs works for a couple of months but eventually docs get sick of picking up overtime and you have to step up. I could conceive of doing 2 half days a week of pain clinic but not two full days. Also, why do you want to be director? It would be easier to carve out two days a week for pain as a pit doc.

 

[EM Junkie]

Agree with all of the above responses. I spent 5 1/2 years as director. There are always meetings, “emergency meetings”, wild CEO hairs, you get the picture. Even in our small, well-run shop the medical director job took up most of the weekdays that I wasnt working clinically. I also worked nights, weekends, and holidays. Many times after night shifts I’d sleep on the couch in my office before a full day of meetings.

The situation you describe would only be acceptable if you’d earned the director spot, and after a few years of doing an excellent job and optimizing your time you were able to convince your group that you were up to the task of balancing both.

In my SDG, my bosses were the Group President and all of the docs that worked there. They were the ones paying my salary.


Sent from my iPhone using SDN mobile

 

[oldtown]

Agree with all the directors / former directors above. I'm currently a medical director of a 40k volume ED. I work about 80-90 hrs / month clinical. If I quit the director role and became a pit doc working 130-140 hrs / month, I would probably triple my free time.

Side gig is not really possible as a director. Too many admin responsibilities, and too many things pop up with short notice. Better to be a pit doc, know when you're on and when you're off, craft your side gig around your ED schedule, then dial back on the ED shifts as the side gig grows.

 

[Got Em]

Thanks for the replies everyone. This was very help for me and possibly others thinking about going this route. It really seems like ED director/chair is a 1.5-2x full time position and a side gig is better suited for regular ED docs.

 

[The White Coat Investor]

I am interested in becoming a Medical Director/Chair (full time) and working 1-2 days weekly as a pain physician on the side. I just mainly want to know if it's possible to work way less clinical shifts as an EM chair in exchange for a lower salary and more flexibility. Since pain medicine requires someone to work 8-5pm during M-F, it would be extremely difficult to work EM overnight shifts. However, I'll willing to work evenings and weekends for EM shifts.

I have seen places that require for you to work 80 hours clinically and have 80-100 hours of administrative time. Is it possible to work say 40-60 hours a month clinically and take less pay? Here is my breakdown:

EM Chair/Director (full time) with pain medicine (part time) monthly schedule
- 40-60 hours clinical time; 80-100 hours admin time
- Guaranteed off 1-2 weekdays for pain medicine
- Willing to work weekends and evenings (no overnights due to pain schedule)
- Willing to take less pay ($150-200k yearly is fine for EM job)

Thoughts?

I don't think this is a good combination. The reason why is that you have to be at the hospital often during banker's hours as a medical director or a chair for administrative meetings. Those also happen to be the hours for most pain clinics. Working your shifts in the evenings and on weekends and running a pain clinic would work well, but I don't think it would mix well with administrative duties. Pick one or the other as your side thing.

 

[deleted109597]

The leader has to take the hits now and then.... some of my favorite gen mattis stories are of him pulling gate duty as a 1 star on Christmas

Now and then?
The leader is in front, period. If they're not getting shot at they aren't leading soldiers into battle often enough. It's a testament to leading that often the family life is left on the wayside, and job comes first.

 

[deleted245139]

As associate medical director I'm working more now even with my hour reduction for my contract than I did when I was just a clinical instructor. All for those reasons above.