Medical Directorship

[Psych19]

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I'm currently doing inpatient work at a small-ish community hospital. Also do a bit of ECT, IOP/PHP and C&L coverage. (I know, that's a lot...)

I'm going through a contract renegotiation discussion with hospital admin now. My contract would otherwise expire this coming summer.

In the contract renewal, they want to add a role as an "associate medical director" for the psych department. We're a small group and a lean operation (2 FT docs, 5 PT docs, and one FT midlevel). We already have a medical director who is one of the PT docs.

I want to learn about different models of compensation for this type of role. I'm still trying to elicit information about what my responsibilities would be, and what my hourly commitment would be. The hospital professes to want to develop some increased academic involvement with the new medical school nearby that is starting up in a couple years, and I'm being told that some involvement with that process might be part of the role.

Aside from an administrative stipend ($/contract year, which is what we are currently discussing), what other models have you all seen?

 

[splik]

It's either a stipend, unpaid, $x/hr up to a certain number of hours per month, % of FTE (as an overage), % of FTE (with reduced patient load), or non-financial compensation.

 

[Monocles]

I'm curious to know - for those of you working in an administrative role, how does the pay per hour compare to clinical work? Is it usually less, the same, more, or way more?

 

[nexus73]

I'm curious to know - for those of you working in an administrative role, how does the pay per hour compare to clinical work? Is it usually less, the same, more, or way more?

Varies, to some extent on how desperate the facility is and how you negotiate. Some places many people want the directorship so they don't need to pay as much, and it's viewed more as a career stepping stone.

Theoretically, I was told by an administrator, that being in admin should not be to enrich you. Rather, if admin time takes you from patient care, the compensation should "make you whole". So the admin pay just offsets the reduced income from not seeing as many patients. I don't agree with this personally because administrative work kind of stinks.

 

[comp1]

This is going to completely vary from job to job. Like an above poster said, some places it will be unpaid, some places it will be a percentage and some a flat stipend. I've seen $10k stipend here in our private psych facilities, but who knows if the job is remotely similar. I can tell you that handling the admin side of medical education can be...a lot. It could also be a little if you had excellent administrative support staff. In terms of whether it pays more than clinical, generally no, it does not. This is why you see so many nurse, psychologist and social work administrators. They are paid a good deal more than their 100% clinical counterparts, but the same is definitely not true for physicians. I say do the job because you find it interesting or think you will enjoy it, definitely not for the money.

 

[splik]

I'm curious to know - for those of you working in an administrative role, how does the pay per hour compare to clinical work? Is it usually less, the same, more, or way more?

for a medical director role it will be less (possibly nothing) or the same as clinical, never more. For executive level positions (e.g. CMO, CEO etc) it can be substantial, particularly for large organizations though of course not an hourly rate (salaried). I know of several who earn or earned over a million in such positions.

 

[Sushirolls]

An already small department has a medical director.
Now they want an associate medical director?
I can't help but wonder if this is because the real medical director is already half foot out the door, and they want some one to actually do the real work in responsive way, so rather than lose/tick off their existing Med Dir, they want to make up an associate direcotor to do his/her work - here's the key - for less than what they are paying he current med director.

I suspect this won't be of any benefit to you and only serve to take advantage of young naive fresh meat.
Let them know you aren't interested in the associate title, but if they wish to replace the med director you'll be open to reviewing the details of that.

 

[comp1]

I've got to say, I'm not as concerned about the associate title. I can see the above reasoning, but even small groups need backups for admin stuff. That might be all they are looking for.

 

[dl2dp2]

I'm curious to know - for those of you working in an administrative role, how does the pay per hour compare to clinical work? Is it usually less, the same, more, or way more?

Generally, the only way to get paid "way more" as an admin is to have equity ownership/profit sharing in the contract. Alternatively, if you have a proven track record and move laterally or up from a smaller organization to a larger organizations, if stars align, sometimes you can negotiate a larger than usual salary.

Internal hires, generally, no.

 

[Merovinge]

I'm curious to know - for those of you working in an administrative role, how does the pay per hour compare to clinical work? Is it usually less, the same, more, or way more?

Agree with above, needs to be C-suite of large organization or ownership to have significantly higher pay. I have had medical director roles at all three jobs I have had and in all cases they essentially replace a small chunk of time from direct care to admin. I find the variety nice and it's pleasant to be involved in moving patient care in the right direction, but it's never yielded significantly better pay. 80% clinical/20% admin is a nice setup for those that like it though if you are paid the same or slightly more than 100% clinical.

 

[SmallBird]

It can really depend, but it’s critical to negotiate this very assertively as the time involved often exceeds the pay - even if there is a pay differential for the medical director, it could probably be more easily achieved through additional clinical work. I have continued to stay in a role like this despite the stress because there are advantages to being able to make the schedule and I have been able to negotiate a 60/40 split which is more favorable than many places.

 

[mojetter]

An already small department has a medical director.
Now they want an associate medical director?
I can't help but wonder if this is because the real medical director is already half foot out the door, and they want some one to actually do the real work in responsive way, so rather than lose/tick off their existing Med Dir, they want to make up an associate direcotor to do his/her work - here's the key - for less than what they are paying he current med director.

I suspect this won't be of any benefit to you and only serve to take advantage of young naive fresh meat.
Let them know you aren't interested in the associate title, but if they wish to replace the med director you'll be open to reviewing the details of that.

This is the best advice imo...ask yourself "why" and what responsibilities are they giving you

My 1st med director job I essentially got to do all the things the Director didnt/couldnt do anymore... with none of the authority to do it

It wasnt a big deal but it sure felt like middle management AND I still had a similar caseload but now I had to deal with all the non-physician complaints and admin troubles

That being said I got $10k bump...not worth it imo. Ive seen as high as $30k stipend but thats HCA sooooo...lol

Any updates?

 

[Psych19]

This is the best advice imo...ask yourself "why" and what responsibilities are they giving you

My 1st med director job I essentially got to do all the things the Director didnt/couldnt do anymore... with none of the authority to do it

It wasnt a big deal but it sure felt like middle management AND I still had a similar caseload but now I had to deal with all the non-physician complaints and admin troubles

That being said I got $10k bump...not worth it imo. Ive seen as high as $30k stipend but thats HCA sooooo...lol

Any updates?

Excellent advice/insight from everyone who contributed to this thread. It's been particularly helpful to hear the $ amounts quoted by multiple posters, which aren't too far off from what me and admin are currently discussing. Clearly you don't take on medical directorship for the money.

The "why" and "what" of this new role are very important questions.

The negotiations are inching along at a glacial pace, which I expected. I've asked to sit down with our CMO and the current medical director to try to get more clarity on specific time- and role-expectations, ideally in writing for the latter.

 

[Sushirolls]

Medical Directors can be lucrative.
One for profit psych hospital near me, was paying 100K+ for the title of medical director, but it was also a farce of a position. The CEO still retained all control and ability to dictate medical things to the med dir in the contract, and the place runs very low on staffing which would induce a lot of extra "emergent" coverage work. Plus the facility ran things in a way that I could only imagine it was a matter of time before it is a "fall guy" position.

Another Big Box shop I used to work for, the med dir got paid for .1 or .2 FTE, and the their caculation of lump sum rate was on par or better than a clinical rate. This person, did a mediocre job, and still scheduled themselves to work full time, but the way the wRVU was set up with an expected 0.8FTE, but earning 1.0 FTE, triggering the slightly higher rates for wRVU this person was quite content - and very apparent in their lack of desire to induce any positive departmental changes.

 

[nexus73]

Medical Directors can be lucrative.
One for profit psych hospital near me, was paying 100K+ for the title of medical director, but it was also a farce of a position. The CEO still retained all control and ability to dictate medical things to the med dir in the contract, and the place runs very low on staffing which would induce a lot of extra "emergent" coverage work. Plus the facility ran things in a way that I could only imagine it was a matter of time before it is a "fall guy" position.

Another Big Box shop I used to work for, the med dir got paid for .1 or .2 FTE, and the their caculation of lump sum rate was on par or better than a clinical rate. This person, did a mediocre job, and still scheduled themselves to work full time, but the way the wRVU was set up with an expected 0.8FTE, but earning 1.0 FTE, triggering the slightly higher rates for wRVU this person was quite content - and very apparent in their lack of desire to induce any positive departmental changes.

How long did the latter medical director last with no desire to make changes? It's interesting to me that administrators are all about making changes. It's practically a necessity to get the next promotion. Like if you say you basically made no changes but just kept a decent program running and all the docs were happy... that's not going to bode well to get the next echelon up the administrative ladder.

 

[Sushirolls]

This doc is still there and been there for years. This Big Box shop has hit the national news multiple times in different facets, and could be one of the worst Big Box shops - or just really good about getting into the news. Yet, they have some how continued to get a top 100 of whatever list. The leadership doesn't want changes. So this doc is adept at doing what the leadership wants. Give them engagement in meetings, but change nothing. Recipe for success!

 

[Psych19]

Plus the facility ran things in a way that I could only imagine it was a matter of time before it is a "fall guy" position.

Liability issues are certainly on the list of my concerns.