Hospitalist Medical Director and Assistant Medical Director Questions

[questionquestion100]

I'm seeing some MD and AMD positions pop up now and then. What is the extra liability for Medical Directors and Assistant Medical Directors? And how are the positions structured in terms of FTE? Do they usually buy down some FTE time? And are what are the usual extra compensation for these positions? Thank you

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[DoReMiFaSo]

They are both positions of leadership that involve from very little to very much of admin duties. Could be director of a medical floor/wing, a particular service (such as peri-op medicine, obs unit, oncology co-management etc). Yes, they usually come in the form of FTE reduction. Despite what the name might sound like, they often can be as little as 0.1 FTE. Compensation comes in the form of clinical time reduction only (dropping FTEs while keeping the overall salary the same) or additional monetary payment as an addendum to contract, or both. Impossible to say exactly how much as it varies wildly depending on the position, job duties, and seniority, faculty rank, etc. It can be as little as several K (like 3K) to 10s of Ks. Hope that helps.

 

[questionquestion100]

Thank you for the reply. I've seen a few posts regarding the increased liability with Medical Director and Assistant Medical Director roles. Is it true that Medical Directors are sued more often?

 

[jm192]

I work for Team Health, so I can give you a rough idea on that.

The Medical Director is SUPPOSED to work 10 shifts/month. And then Admin time. You're paid a Director stipend to off-set the loss of shifts. Basically, you make the same as a FTE while working 10 shifts+admin time.

There's a lot of downside to it. You're responsible for making sure the schedule is full. Hospital medicine keeps getting harder and harder. People dont' want to work extra. Our Medical Director wound up having to take on a lot of extra shifts.

In addition to that, the Hospital world doesn't respect your "off" time. If an issue arises, you'll be called. Our director was getting calls from the ER to complain about a Locums provider at 10 o clock at night. He was getting calls while out of town on vacation.

If it works out the way it's supposed to, it can be a pretty solid gig. If it doesn't, it can be miserable.

 

[gutonc]

I'm not a hospitalist, but I have been, and am currently, a medical director.

In short, the role of a medical director is to keep the poo flung by the monkeys below you from hitting the a ruling admin class above you. Your other job is to take the poo admin gives you, make nice s*** sandwiches out of it and feed it to your docs as "free lunch, from administration".

That, right there, is the entirety of the job. There are details to be quibbled about, but that's the meat and potatoes of it.

 

[sloh]

I'm not a hospitalist, but I have been, and am currently, a medical director.

In short, the role of a medical director is to keep the poo flung by the monkeys below you from hitting the a ruling admin class above you. Your other job is to take the poo admin gives you, make nice s*** sandwiches out of it and feed it to your docs as "free lunch, from administration".

That, right there, is the entirety of the job. There are details to be quibbled about, but that's the meat and potatoes of it.

Why do you continue doing it?

 

[gutonc]

Why do you continue doing it?

Because now I'm a medical director for a group of 2, one of whom is me, in a rural CAH setting with low expectations from admin and minimal bulls*** from the mothership. My medical director stipend now is exactly the same as it was when I managed a group of 15 docs with 5 offices and PSAs with 2 other groups for a total of 20 docs and 7 clinics. My meeting burden went from 4-5 meetings a day 3 days a week to 2 meetings a quarter.

So I'm really the only one who's flinging poo right now and there's not much to fling, and I bring my own lunch, so I don't bother with the s*** sandwiches.

 

[gutonc]

I'm seeing some MD and AMD positions pop up now and then. What is the extra liability for Medical Directors and Assistant Medical Directors? And how are the positions structured in terms of FTE? Do they usually buy down some FTE time? And are what are the usual extra compensation for these positions? Thank you

to go back and answer the specific questions you asked:

There's not much extra liability. And none really on the med mal side of things. You might get named in a a med mal suit involving one of your docs but your name will be taken off the case if it ever goes to trial unless you were materially involved the management, or you directed the physician to manage the case in a way the resulted in the lawsuit. You're far more likely (but still, highly unlikely overall) to get sued by the docs in your group if you let one of them go for whatever reason. This happened to the director before me in my last position with a locums doc that he let go (who was practicing terrible medicine). That locums doc filed a lawsuit alleging restraint of trade and libel. The suit was dismissed with prejudice, but it was still a massive pain the a** for him to deal with.

Pay structures are variable. Some are just FTE buydowns, some are just extra cash (my current one) and some are a mix of both (my prior one).

Although my last medical director position caused me true physical and emotional harm, I learned a ton about the business of medicine from it.

 

[Splenda88]

Our medical director got the same salary as us but they also have a quarterly stipend. They do the same 7on/off just like us but their census is about 7-8 patients while we see about ~17 patients on average. They have that low census so they can have time to do administrative duties.

 

[sloh]

Our medical director got the same salary as us but they also have a quarterly stipend. They do the same 7on/off just like us but their census is about 7-8 patients while we see about ~17 patients on average. They have that low census so they can have time to do administrative duties.

What’s the stipend?

 

[Splenda88]

What’s the stipend?

I don't know for sure but I was told it's 15k quarterly.


Question for you as a PM&R doc::

How do these hospital rehab wing make money? Our 250+ hospital has 11-12 beds rehab floor and it usually has between 7-10 patients when I cover this floor as a IM hospitalist.

How do they make money with only these few patients when they have a full staff (RNs, PT, OT, SW, techs etc...)?