ER Directorship Interview

[Pudortu]

Hello All,
I was offered a associate directorship of our ER level 2 trauma center & directorship of our sister freestanding facility.
The CMG has already requested I be part of this position.
Now the hospital is requesting I formally interview with the CMO / CNO / COO / and some higherups with the nursing department.
We've all been through interviews for medschool/residency and job finding but does anyone have any recommendations to prepare for this interview?
Any questions you think they would ask? Any advice would be much appreciated. I understand admin positions bring with it an enormous amount of headaches but I need to get away from some of the clinical burden due to personal health issues and this seems like the best situation for myself. If you all could please help, I would greatly appreciate it.
Thanks so much ahead of time.

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[Rekt]

"We should start an EM residency here!"

Boom, automatic hire.

 

[southerndoc]

First off, you may be trading one headache for another. I really enjoy administrative work, but realize that you're going to be fielding complaints left and right from your docs and consultants, you'll be attending meetings about meetings, and will be spending a lot of your "off" time doing administrative work.

What the C-suite people ask is dependent on your institution. What problems do you have? If it's throughput, then be prepared for questions regarding that. What plans do you have that can help? If it's physicians being mean to the nurses, what can you do about it?

They will ask specific questions and expect specific answers regarding the problems you have at your institution. Without knowing what issues you have, it's hard to suggest things to help you prepare.

I recently interviewed and was offered a directorship (which I turned down despite being an amazing offer; daughter didn't want to change schools). Some of the questions asked during all my directorship interviews have been harder than my medical school and residency interviews. It helps to be well prepared. I've been an associate medical director for a while, and I think that has helped tremendously because I've been involved in flow processes, quality, etc.

 

[Arcan57]

Hello All,
I was offered a associate directorship of our ER level 2 trauma center & directorship of our sister freestanding facility.
The CMG has already requested I be part of this position.
Now the hospital is requesting I formally interview with the CMO / CNO / COO / and some higherups with the nursing department.
We've all been through interviews for medschool/residency and job finding but does anyone have any recommendations to prepare for this interview?
Any questions you think they would ask? Any advice would be much appreciated. I understand admin positions bring with it an enormous amount of headaches but I need to get away from some of the clinical burden due to personal health issues and this seems like the best situation for myself. If you all could please help, I would greatly appreciate it.
Thanks so much ahead of time.

The C-suite has a much less romantic worldview than what you're used to from interviewing exclusively in the ED world. Think about what the c-suite cares about: metrics, quality, med staff satisfaction. Have answers for how you're going to help them achieve these goals. The C-suite is going to want reassurance that you're on their team, expect questions about how you've held (or would hold) other EM docs accountable when their behavior or performance wasn't acceptable. Expect questions about interpersonal conflict between yourself and med staff members and how you've handled it. In terms of quality, C-suite is aware that the ED is under-resourced from a personnel standpoint and (usually) doesn't have an active interest in investing in more staff positions. So when you talk about improving quality, stick to capitol investments (think on order of new U/S machine, not another CT scanner). Even better, offer them quality fixes that are resource neutral for them. Process improvement is very much within an AD's wheelhouse. From a tactical standpoint, being engaged and being able to talk about challenges in neutral language with an emphasis on solutions will help move the conversation along. One of the first rules of leadership is that you get absolutely no points for pointing out the problem. Try not to bring up problems that you don't have ideas on how to solve. When presented with a problem you don't know how to solve, talk about engaging stakeholders and developing personal relationships to improve buy-in is usually a good move.

 

[southerndoc]

To add to excellent recommendations made by @Arcan57 , one of the things I've learned is not to say "no" to any idea brought by the C-suite. Tell them you'll look into it, it's a great idea (even if you think otherwise), etc. and give it time. If possible, allow them to realize it's a bad idea (over time make them realize how much resource intensive it will be, etc.).

Directors that are asked something by a C-suite person and automatically give a "no, that's not going to work" are usually short-lived in their positions.

 

[RustedFox]

To add to excellent recommendations made by @Arcan57 , one of the things I've learned is not to say "no" to any idea brought by the C-suite. Tell them you'll look into it, it's a great idea (even if you think otherwise), etc. and give it time. If possible, allow them to realize it's a bad idea (over time make them realize how much resource intensive it will be, etc.).

Directors that are asked something by a C-suite person and automatically give a "no, that's not going to work" are usually short-lived in their positions.

Not a criticism pointed at you, Southerndoc, in any fashion:

I said this recently on here, seems to fit this situation.

"Any second-grader can tell you that this is called lying."

 

[GeneralVeers]

Not a criticism pointed at you, Southerndoc, in any fashion:

I said this recently on here, seems to fit this situation.

"Any second-grader can tell you that this is called lying."

Isn't effective lying the whole point of being in an administrative position? The most effective leaders make the people below them feel good about the lies.

 

[dadaddadaBATMAN]

Not a criticism pointed at you, Southerndoc, in any fashion:

I said this recently on here, seems to fit this situation.

"Any second-grader can tell you that this is called lying."

That only matters if you consider lying to be an evil thing. Lies are a tool like any other.

I tell lies all the time, like “I’m glad you came in today” or “I could never have guessed you were pregnant!”

And if lies protect me from the c suites mor onic ideas then lie away.

Edit:spaced out *****ic since that apparently triggers the filter

 

[Apollyon]

Not a criticism pointed at you, Southerndoc, in any fashion:

I said this recently on here, seems to fit this situation.

"Any second-grader can tell you that this is called lying."

That's kind of concrete thinking, brother.

 

[gutonc]

That's kind of concrete thinking, brother.

Which, 2nd graders are really good at.

 

[LibBum]

There are no problems, they are called opportunities by admin. It's a world of dumb language on the dark side.

Gl with the interview.

 

[RustedFox]

There are no problems, they are called opportunities by admin. It's a world of dumb language on the dark side.

Gl with the interview.

Oh my good Loooord.

"Corporate Doublespeak". I hate it SO much.

"Challenges" - "Opportunities" - "Mutual Benefit"

its all untruths.

 

[Arcan57]

Not a criticism pointed at you, Southerndoc, in any fashion:

I said this recently on here, seems to fit this situation.

"Any second-grader can tell you that this is called lying."

Most corporate cultures prioritize compliance.

There are no problems, they are called opportunities by admin. It's a world of dumb language on the dark side.

Gl with the interview.

“We’ve significantly increased our opportunities for improvement.”

 

[RustedFox]

THINGS MED STUDENTS NEED TO QUIT SAYING:

"I really want to get into admin; what residencies will prepare me for an admin fellowship?"

Every time I hear that... the venom breaks from my fangs and drips out the front of my mouth.

 

[Arcan57]

THINGS MED STUDENTS NEED TO QUIT SAYING:

"I really want to get into admin; what residencies will prepare me for an admin fellowship?"

Every time I hear that... the venom breaks from my fangs and drips out the front of my mouth.

Admin fellowships are possibly the biggest scam in post-residency training in EM. The idea that spending a year doing some administrative project is necessary or even helpful to the s$&@ shoveling middle management that is most FMD spots is dubious.

 

[KnuxNole]

Hey, someone's gotta be an administrator. I don't think everyone is a spawn of Satan in the C-suite world.

 

[Arcan57]

Hey, someone's gotta be an administrator. I don't think everyone is a spawn of Satan in the C-suite world.

No, they’re not all spawns of Satan. But in most cases, EM docs are going to be viewed as vendors by the C-suite and the interests of a vendor rarely align with the interests of the buyer.

 

[emergentmd]

In order to get the director ship gig and be a good director. In your interview you must say,

"Yes, there are challenges and I see many problems that needs to be fixed to increase efficiency, metrics, PG scores, and improve physician moral. I will fix XXXXX issues by making the physicians step up and buy into this process"

You now got the job. To be an effective and long lasting director, you will be disliked by most of your EM docs because you will be spewing the C suite Mantra even though you know it is FOS.

I never even realized docs interviewed to be directors. This must be the new level of Admin owning your soul. I guess they need to know that you are willing to sell your soul before investing energy on the back end.

I was Department director/Chair 10 yrs ago and essentially when the old director quit, a few of us was willing to do the job then there was a vote by some of the partners. No interviews, no personal statement, no C suite interviews. I mean, I have been working in the dept for 10 yrs, what is a personal statement/interview going to change.

I eventually stopped being director once the C suite wanted me to push policies that I knew I could not in good faith champion. I could not find the morality in pushing bad policies in the name of good medical care when all the docs knew that it was bad medical care. If you are able to believe in one thing but say something else, then being a director may be good for you.

Fast forward 3 yrs after quitting, I was offered another director job at 2x the pay. They would have to offer me 5x that much to sell my soul.

 

[GeneralVeers]

I went through the directorship course at what is now USACS. It was a year of courses and lectures. It was definitely valuable, but really showed the inner workings of how the CMG tricked new grads to get them to work as slave labor so the leadership could have fancy dinners and work non-clinical jobs.

 

[emergentmd]

I went through the directorship course at what is now USACS. It was a year of courses and lectures. It was definitely valuable, but really showed the inner workings of how the CMG tricked new grads to get them to work as slave labor so the leadership could have fancy dinners and work non-clinical jobs.

Hopefully this was a mandatory course. Someone would have to do some real coercion to get me into one of these classes. I have seen the games played and something I will not be part of. Once our group sold out and taken over by a CMG, the writing was on the wall.

 

[GeneralVeers]

Hopefully this was a mandatory course. Someone would have to do some real coercion to get me into one of these classes. I have seen the games played and something I will not be part of. Once our group sold out and taken over by a CMG, the writing was on the wall.

Voluntary. When I was younger and relatively less burnt out.

 

[heyjack70]

I think the good directors get in and try to maintain balance with admin and docs, and advocate for the docs. These are the directors everyone respects and are usually strongest clinically, but annoys administration because they don't support just any idea admin is pushing especially if it's going to make life worse for the docs. But over time this gets too difficult and they end up burning out and quitting.

I think some people that actually want to be directors are looking to reduce clinical work. So they end up with some fraction of the job that is patient care, and more and more admin work. And they usually get paid more. It's an alluring trap, and you end up selling your soul and selling out the doctors you work with.

 

[KnuxNole]

Admin should be the ones to bend to the doctor's will. Not the other way around.

 

[Arcan57]

Admin should be the ones to bend to the doctor's will. Not the other way around.

Why?

 

[RustedFox]

Why?

Because they say so .
My CEO used to come walk around the ER once a week and recite empty statements like:

"What can we do to help you?"

But when we actually asked for anything, even something simple like "new chairs; all ours are falling apart"... We got answers like; "you can buy your own chairs."

Meanwhile, the boardroom has lots of empty, expensive, chairs.

Edit: I don't intend a curt tone with you, amigo. Admins need to realize that they're not seeing patients. They only have a job because we're doing ours.

 

[KnuxNole]

Doctors are necessary for a hospital. They can all just quit and admin is SOL.

 

[Birdstrike]

I went through the directorship course at what is now USACS. It was a year of courses and lectures. It was definitely valuable, but really showed the inner workings of how the CMG tricked new grads to get them to work as slave labor so the leadership could have fancy dinners and work non-clinical jobs.

How do they trick them?

 

[nexus73]

Because they say so .
My CEO used to come walk around the ER once a week and recite empty statements like:

"What can we do to help you?"

But when we actually asked for anything, even something simple like "new chairs; all ours are falling apart"... We got answers like; "you can buy your own chairs."

Meanwhile, the boardroom has lots of empty, expensive, chairs.

Edit: I don't intend a curt tone with you, amigo. Admins need to realize that they're not seeing patients. They only have a job because we're doing ours.

Your problem is you need to talk to the dept CHAIRman, the CEO has no control over that

 

[bravotwozero]

Department chairs are mostly at academic facilities, not at most community shops. The CEO/C suite has a LOT of control over where hospital resources are diverted.

Your problem is you need to talk to the dept chairman, the CEO has no control over that

 

[Arcan57]

Department chairs are mostly at academic facilities, not at most community shops. The CEO/C suite has a LOT of control over where hospital resources are diverted.

It’s relatively rare for the medical director to have capitol control over the department. Capitol approval is going to flow through the nursing director who’s responsible for maintaining the budget for the department. But the CEO doesn’t actually want to help you out. They’re in the ED because their boss told them that they have to round on the various departments they control at certain intervals. You’re a line worker to them, so they really only want to hear about safety concerns and money saving ideas. Asking for a better chair from the CEO is functionally equivalent to a poultry processor asking for a more comfortable knife handle. Based on your report of the CEO’s follow up, they viewed your request with a mix of “why is this person talking to me?” and “what a pampered wimp”.

Protip- if you want better chairs, suck up to the nursing director just before the budget’s due. They have a vested interest in keeping their budget fat and are usually more favorable towards about one off expenses than reoccurring.

 

[GeneralVeers]

How do they trick them?

A certain rotund CEO would pay $20K for parties at ACEP in order to wine and dine new grads. They'd be impressed by the spread, being relatively poor residents. Lobster and open bar goes a long way. They were told that they'd be "physician owners" and could "actively participate" in the company. No mention was made of the revolving door of new grads at problem sites, or the huge skim of profit off of their sweat equity. They were told the low hourly was because they'd get "productivity bonuses" and "equity".

 

[RustedFox]

It’s relatively rare for the medical director to have capitol control over the department. Capitol approval is going to flow through the nursing director who’s responsible for maintaining the budget for the department. But the CEO doesn’t actually want to help you out. They’re in the ED because their boss told them that they have to round on the various departments they control at certain intervals. You’re a line worker to them, so they really only want to hear about safety concerns and money saving ideas. Asking for a better chair from the CEO is functionally equivalent to a poultry processor asking for a more comfortable knife handle. Based on your report of the CEO’s follow up, they viewed your request with a mix of “why is this person talking to me?” and “what a pampered wimp”.

Protip- if you want better chairs, suck up to the nursing director just before the budget’s due. They have a vested interest in keeping their budget fat and are usually more favorable towards about one off expenses than reoccurring.

Yeah; that particular RN director is about as useless as a (insert joke here).

 

[RustedFox]

It’s relatively rare for the medical director to have capitol control over the department. Capitol approval is going to flow through the nursing director who’s responsible for maintaining the budget for the department. But the CEO doesn’t actually want to help you out. They’re in the ED because their boss told them that they have to round on the various departments they control at certain intervals. You’re a line worker to them, so they really only want to hear about safety concerns and money saving ideas. Asking for a better chair from the CEO is functionally equivalent to a poultry processor asking for a more comfortable knife handle. Based on your report of the CEO’s follow up, they viewed your request with a mix of “why is this person talking to me?” and “what a pampered wimp”.

Protip- if you want better chairs, suck up to the nursing director just before the budget’s due. They have a vested interest in keeping their budget fat and are usually more favorable towards about one off expenses than reoccurring.

Reason #182 why EM is a dumpster fire.
Also reason #385 why C-suiters are trash.

 

[sluggs]

It may not seem like this at first, but any time you take $ for an administrative title, the admin views you as their tool-- hired gun to support their stupid policy of the day! I so wish this were not true. But it is..

 

[emergentmd]

Man, Another reason why I am so glad to be out of the pit.

Did EM director somewhat early on in my career. Thought my opinion matters, thought my doctor's opinions matter, though I had some control over the department. Looking back, really laughable. All they cared about was to keep the docs happy, don't ask for a stipend, take on crappy contracts, keep consults happy, keep pts happy, and make sure metrics followed.

Admin got a crappy review from the medical staff and suddenly meeting popped up left and right to fix all the wrongs felt by the medical staff. All departments had meetings, admin showed up, feedback given to improve medical staff morale. Fast forward 6 months and I guess Admin just got tired of doing it the hard way. Edict came from the top..... "Just tell your docs to write good Admin evals next time"

That was the beginning of the end. Eventually left as director/chair. Did Locums at another hospital system, and no more than 6 months doing a few shifts a month offered the director position by the regional director. A big NO. Offered another director position at sister site for another hospital system after working 2 shifts for twice as much as my 1st. A BIG NO.

They obviously did not care other than to fill the position with someone with "experience" in taming the line docs, increase PG, and appease admin.

So glad to have control over my work environment. When my nurse manager wants new chair, I just say yes then its bought.

 

[GeneralVeers]

It was great when at one site I worked at, they brought on an "Assistant Medical Director" who was fresh out of Residency in NYC. It was enlightening to have a boss with way less experience than myself, who had no clue how to run a department.

 

[KnuxNole]

Worse is it they acted high and mighty against all the more experienced docs

 

[NYEMMED]

What’s the going average stipend for a assistant director these days?

 

[bravotwozero]

about 5-10k per month.

 

[Groove]

It was great when at one site I worked at, they brought on an "Assistant Medical Director" who was fresh out of Residency in NYC. It was enlightening to have a boss with way less experience than myself, who had no clue how to run a department.

LOL, I hear you. I’m currently at a job with tons of new grads. All of them eager to please and jockeying for any administrative position they can get. Sometimes, it takes experience and wisdom to turn down those roles. I’ve been an assistant director for 7 years and am only in my new job for a few months. Still, the director called me recently and offered me an administrative position because of my “experience“. Assistant director positions are inconsequential roles with no real influence and usually underpaid for the administrative tasks required. I respectfully turned it down. I’ll never do administration again unless the stipend significantly allows me to decrease my clinical time. Otherwise, it’s a meaningless position and usually includes a plethora of administrative tasks that the medical director offloads onto the AFMD. Medical directors have the only administrative roles that pay commensurate stipends but even then...it places your head on a chopping block. I’ve seen too many medical directors piss of someone new (or old) in administration and suddenly be taken off the schedule. I’m wise enough these days to see the value in being a mere “pit doc”.

 

[Groove]

about 5-10k per month.

WTF? I’ve never seen those amounts unless it was a massive department. Apollo offers 4K for a 50K site in my region. I negotiated for 6K because it included additional obligations. TH recently offered 2.5K for an AFMD position at a 35K site. I thought the latter was ridiculous.

 

[emergentmd]

5-10K for AFMD is way too high and never seen anything close.

I was FMD and got a 5k stipend but back then had very very little admin work. Prob about 5-10 hrs/mo

Offered another FMD for a 20K site @ 10K/mo but sounded like way more admin time.

I don't think I would do Admin unless it paid about 300/hr. Much better to work as a pit doc at 200+/hr than deal with admin work plus complaints every day. Makes a shift much more tiring when I have admin wanting me to solve some stupid problem that could wait until my shift ended.