Sell your soul for career advancement?

[DocEspana]

This might be a long post and I apologize if so - but id love to hear what people think they'd do in my situation. The TLDR is I have an amazing and high paying job except for a director who it has been made clear is completely untouchable. The pay is great and I love the location, but he makes everything miserable. There is another job at a nominally s***** hospital that is paying the same, but it's a team health location and they offered me a direct pipeline to future team health leadership if I give them a year or two. Do I jump ship on a place I love for a new place and a non-enforceable promise of leadership consideration.

Also this thread could possibly be fun just in general discussing other people considering the (very realistic) pathway for career advancement within the CMG world.

So I've put 4 years in at my current job. Director who was there when I got hired loved me and told me he would put me through leadership pipeline once covid died down. He ended up getting fired for defending the ER too effectively and got replaced by (just being honest) a yes man who would happily sell us out to hospital admin anytime they need a fall person and supports any cockamamie scheme they may have. Yet this guy still loved me and I was going to court his good graces and try to still get into that leadership pipeline with him.

Fast forward 2 years later, this director is a truly malignant person. Makes personal vendettas with people, cuts people's hours based on how he likes them, screams at us for any little thing, and plays power games constantly. Most importantly he has told me he doesn't feel comfortable elevating me to leadership training because I was too supportive of my coworkers while he was hanging them out to dry. But thanks to a workflow plan he created (with my help because I was a team player and designed the plan for him) the C suite adores him for "fixing" throughput over a year ago and he is untouchable. To the point where he has had two investigations by our CMG for abusive practices, targeting , and harassment and survived them both with the hospital REFUSING to fire him on two occasions despite the company flying in to town to ask the hospital to fire him and let them replace him.

So fast forward to today. The job is great and I love the people and the pay is great..... But he makes it miserable. We have another meeting with the senior CMG leadership and it's already been leaked that it was supposed to be about them demanding his resignation but rumor says that the CEO has refused his resignation and the CMG caved once again ; so the meeting will instead be about "how to fix this". I need to stress I *love* this job and it's at a major name reputable center, it's just him that makes it miserable.

Seeing writing on the wall, I already interviewed at some surrounding hospitals, but they all pay notably worse than us. Except one. TeamHealth at a hospital I would have never considered working at, one that is famous for basically being dysfunctional. But word around the street is that after a round of firings in hospital administration, lab, and ED director .... That the place is on an upswing. It still has a terrible reputation in the community, but apparently it's a pleasant place to work now.

I want to stress, I thought the only CMG I would be willing to work with is the one I'm currently working with because They have really treated us very well and not done most of the standard things associated with CMGs.... Except they are unwilling to change the director. So interviewing with team health was a bit strange, but at that interview I found out that everyone I met at this hospital was incredibly chill. The pay is basically the same (more variable, but with a higher ceiling) as what I'm getting now, and my best friend who left my old job a little earlier was just promoted to associate director there. But most importantly, based on the recommendation of my friend and this director looking at my CV, he told me that if I agree to go full-time there, he's going to immediately fast track me into the team health leadership school because I should be an associate director or a director somewhere with my credentials. Said he couldn't believe that I had just been relegated to a line worker for the last 4 years.

I guess my question is, would you leave a job that is great and pays well except for the fact that your leadership is fully making your life miserable with antagonism if the only other reasonable option was going to a place with a bad reputation (though honestly it would probably be a lot of fun) in order to finally get your foot into the leadership pipeline? Going someplace that pays less is 100% not an option for me, so there really are only two options (stay or this one place) I could honestly go with without needing to move my family or start doing travel locums.

And yes, I fully realize this is a conversation that is primarily going to be decided based on my gut instinct and conversations with my family. I get that. But also there is some collective wisdom, as well as a whole lot of cynicism, in this community and I want to at least hear the thoughts of anyone who might have some insight on how they would handle it.

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[JacobMcCandles]

It depends on the person. Could you become the person that we all rail against here? I couldn’t. You can’t fight the good fight and be involved with CMG leadership. If you do fight the good fight then you won’t be in leadership with a CMG long. Calling pit docs ‘line workers’ is pretty insulting considering they’re the ones that bring the revenue in. I would stay at my current job and ignore the director.

In closing, **** the CMGs and their leadership.

 

[GonnaBeADoc2222]

I don't have a lot of insight, except to say that "Leadership," or lack thereof, is the source of the majority of my burnout post covid.

It's really exhausting to have every nursing issue automatically be your fault, and major quality of life issues within the department go unfixed for years, all the while more and more is asked of you.

If you can escape a malignant "leader" that's great.

 

[bravotwozero]

My concern would be TH going the way of APP, as they are in the same financial situation.

 

[GonnaBeADoc2222]

To be fair, you cant fight the good fight in any level of admin.

Even up to the level of department chair, you are firmly lower middle management within the organization. This applies to CMG or hospital employed, it's all the same.

You are a lackey for nursing management, whip the doctors, and roll out whatever asinine flavor of the month idea the slurpers have.

 

[Groove]

I don't need to like the FMD, I simply need to trust them. These are the people usually on peer review committee or throughput committee that are defending you from nursing complaints, peer review cases, etc.. Personally, I absolutely require trust in the FMD. I don't have to like them...but I refuse to work for ones that I don't trust. Period. That being said, it sounds like your current FMD has been skating on thin ice for quite some time and you have a lot of positives at your current job so I might suggest sticking it out for another few months to see if they get canned. CMG admin roles rotate very frequently not unlike hospital c-suite.

Malpractice risk goes up if you start working for a hospital that has a bad reputation in a community so I didn't like that particular description about this TH job. The only positive is that it seems like a more direct admin pathway.

Why the obsession with admin? CMG admin is for suckers. Nothing sounds more miserable to me.

Edit: Oh, I just noticed you work in Florida so any malpractice risk at the new hospital probably pales in comparison to the malpractice risk you accepted by choosing to work in the state of Florida. CMG admin in FL sounds doubly horrifying now.

 

[Mount Asclepius]

Directors come and go. A few years to date may seem like a long time, but it isn't. Give it a few more years and push may eventually come to shove.

Medical director positions aren't as glamorous as you think. I wouldn't jump ship from a "good" job (SDG better) to another solely based upon possible CMG leadership advancement.

 

[DocEspana]

Well I find out soon. *Another* meeting with leadership coming soon. For me I really do feel it's a good fit for me - I do all that state and national organizational stuff and was out into a pseudo fellowship in my last year of residency specifically to learn how to deal with NYC H+H (hhc at that time) and I just enjoy taking stupid ideas by others and making them into tolerable (or even good!) ideas to be put into action.

But yeah. If this guy is fully untouchable it's possibly difficult to tolerate because he does stuff like cut shifts on people he doesn't like. So when we work together to trade shifts back to said people, he will cut mid-level staffing on said day* that they picked up and then send angry emails about why that person shouldn't be allowed to have extra shifts and we should not trade with them since they "can't keep up" even though he's highlighting only shifts he understaffed last minute. That person isn't me, but it could be. This is a guy who used to brag to me about how excited he was to drive out certain coworkers he didn't like and replace them with new graduates "who won't ask any questions." I'm on the naughty list - along with basically the whole team now - because I told them that they needed to lay low because he was targeting them for real (and that they weren't just paranoid). He was given money by the hospital to get extra staffing for a weekend where we knew we would be overwhelmed by a local event and always got extra staffing and he chose to pocket the money (which his boss says is his right to do if he thinks staffing is appropriate), brought in no one, and then yelled at us that we didn't keep up with 22-30 extra visits each night shift above our normal for three days. It's hard to work for someone you can't trust when he can tweak your schedule or make your shifts bad. He's driven out about half the staff he had when he started but the new guys he hired don't like him any more than we do. But leadership has told us the hospital would rather vacate the contract than fire him and has embedded him into all levels of hospital leadership.

And mind you: you don't see or think of him 85-90% of shifts. But then when you do have to deal with him? Nightmare. And if the stuff he does isn't enough to make them move, then nothing will be.

* mid-levels are employees and get paid whether they show up or not if he's the one cutting the shift. So the only reason to cut them is spite.

 

[Janders]

(1) sounds like current director on very thin ice and if you love all other aspects of the job I would bunker down and wait it out.
(2) you seem absolutely focused on climbing a leadership ladder. Why? It’s not glorious. It has its perks. It’s not how you get rich. It is rough trying to balance constant competing needs and being on call 24/7/365. But if it’s your PRIMARY passion then I guess you should go somewhere you have the best chance of climbing the ladder.

 

[oldtown]

Leadership track in a CMG sucks, and you put too much stock in it (former FMD here. I lasted 21 months in the position before I had to step down. Now I’m a owner of my own facility and wouldn’t trade that for anything a CMG had to offer. But, I digress).

Your director may seem untouchable now, but if he’s as bad as you make him seem, eventually the rank and file docs (or more damning, nursing) will turn on him and then the hospital / CMG will have no choice but to get rid of him. Or he may fall upwards in the CMG hierarchy. Either way, if the hospital has good bones, I would suggest sticking with your current job, because that is analogous to location with real estate- it can’t be changed (or at least is difficult to change).

I’ve been in the exact same situation 10 years ago- great hospital, great docs, nurses, etc, good patient population and payor mix, every subspecialty under the sun available, triple coverage days, double covered overnights, no floor codes, etc. but with a slimeball medical director. I was looking at jumping ship too. But guess what? The chickens came home to roost for this guy, the CMG lost the contract, and he was the only doc who was not invited to stay on. New benevolent CMG got the contract and the place became one of the more coveted jobs around when just 2 years prior, it was toxic.

 

[DocEspana]

One thing I want to ask you guys, because my past directors (all five of them) I've been very clear that it's been extremely lucrative for them. Now one of them it was extremely lucrative because the RVU system had a flaw in it and he made the schedule and took full advantage of it. But the other four are up front that basically their stipend is meant to cover an amount of shifts "missed" because of administrative duties and that amount is WAY more than how many they actually miss. 4 out of 5 directors I worked for worked full-time or more than full-time clinical (sometimes they would have to tweak schedules mildly to do this). One worked a little more than 50% full-time, but said that his stipend was half of a full-time So he was doing a little more than breaking even, but always said that he would happily trade in six full-time shifts for a handful of hours a week sitting at meetings.

If there is one thing that I am, it's good at making friends. I'd become good friends with all my directors (until I "crossed" this one) and they've been very upfront about the fact that it is remarkably lucrative for them. And universally they were all told that it wouldn't be, and they were all worried that it would be a mistake for a money perspective - and they all told me that it absolutely was not a mistake for a money perspective, it was a windfall.

It might help to understand that the sample size is small and 4 out of 5 of them are in Florida. One of them, as mentioned, was doing it by being shady with the schedule. But it doesn't change the trend. So are these people outliers?

 

[DocEspana]

Btw the real estate thing hits home. So that's compelling.

 

[JacobMcCandles]

If you calculated how much time they actually spend on admin stuff vs. how much you’d make working clinically those extra hours I’d bet you’d be better off working clinically than all the admin issues you’ll deal with.

 

[oldtown]

Re: Admin stipend- Depends on how they are structured. I can only attest to the group I was involved with when I was a FMD (it’s been about 5 years).

With this group, the admin stipend was based on a percentage of collections (including hospital stipends). The smallest director stipend I was aware of was about $8k / month, the largest I was aware of was about $32K a month.

So, if you were FMD at a high volume, good payor mix site, it could be very lucrative.

At the low end of that scale, just working 3 extra shifts a month and remaining a pit doc was easier money for all the headaches you’d have to deal with. No surprise those positions had high turnover.

At the high end, well, when you make as much or more than any of your docs before you even work a shift… let’s just say that position hasn’t turned over in 10 years.

 

[emergentmd]

He ended up getting fired for defending the ER too effectively and got replaced by (just being honest) a yes man

Ahhhhhhh...... Good memories.

I was director at one of the flagship sites in a sought after city. I defended the ER docs and was not a Yes man when TH took over. I got quickly "canned" and my replacement was not a yes man either also canned. They found a yes man who is currently quite hated by the line docs.

I could never sell my soul for a title/money. I am sure I could have been some regional director but ever time I walked into the halls of medicine, I would feel like I failed our profession.

Fast forward 6 years and I have a better title/work less/make more $$ than I could imagine. Plus I did not have to sell my soul.

When you do what is right, things always work out.

I am not telling OP what to do, just to do what is right in his heart.

 

[emergentmd]

TBH, CMG admin sucked. Useless meetings, getting on docs to hit metrics, wearing a suit, doing shifts with people complaining to you.

better to be a line doc IMO

I was offered 2 FMD jobs after being canned and also a National VP/head of EM for a smaller CMG after. They would have to pay me 750K minimum to even consider doing it.

 

[GonnaBeADoc2222]

The AMD at a CMG shop has 2 jobs: making the schedule and filling shift vacancies.

The FMD has two jobs: whip the doctors and fellate the admin

I was offered the AMD spot at a CMG shop 1 year out of residency with plans on making me FMD. I knew what thr above jobs were. Hard pass.

The FMD there is now the medical director for the entire corner of the country. They are mega stressed out.

 

[Pudortu]

The AMD at a CMG shop has 2 jobs: making the schedule and filling shift vacancies.

The FMD has two jobs: whip the doctors and fellate the admin

I was offered the AMD spot at a CMG shop 1 year out of residency with plans on making me FMD. I knew what thr above jobs were. Hard pass.

The FMD there is now the medical director for the entire corner of the country. They are mega stressed out.

This is shop dependent.

I am associate director at one site and don’t do either. I attend a bunch of meetings the director doesn’t want and do menial tasks. I don’t pick up extra shifts because I already work a full clinical load.

I am also medical director at a few other sites and do have to whip the docs and please the admin. Every place is different.

 

[xaelia]

Die a hero or live long enough to see yourself become the villain.

 

[DocEspana]

So the meeting happened. Higher CMG administration let us know in not so vague terms that they are incredibly angry that they had to ask for his resignation. They also stated that he's not going to be going anywhere for the next few months, the resignation does not kick in until they find a replacement. They basically implied that if it wasn't for the fact that we went through formal patient safety protocols and filed this whole thing as a whistleblower issue that they would have found some way to keep him and/or fire some of us. And he was very open about the fact that it had nothing to do with us - that's how the hospital wanted to solve this issue to avoid losing him.

Well now I know the hospital views all of us as not just expendable but undesirable. Then again, this crew has lasted multiple directors so far. Gonna take this info to heart and consider how much leadership means to me because it won't happen here.

 

[Pudortu]

So the meeting happened. Higher CMG administration let us know in not so vague terms that they are incredibly angry that they had to ask for his resignation. They also stated that he's not going to be going anywhere for the next few months, the resignation does not kick in until they find a replacement. They basically implied that if it wasn't for the fact that we went through formal patient safety protocols and filed this whole thing as a whistleblower issue that they would have found some way to keep him and/or fire some of us. And he was very open about the fact that it had nothing to do with us - that's how the hospital wanted to solve this issue to avoid losing him.

Well now I know the hospital views all of us as not just expendable but undesirable. Then again, this crew has lasted multiple directors so far. Gonna take this info to heart and consider how much leadership means to me because it won't happen here.

Why not secretly reach out to CMG admin and ask for his job? Lay yourself out as having been here, having experience with the group and admin, understanding what admin wants. Make it seem like a smooth transition. They can even give you an interim director title if it pleases them to get him out.

 

[EctopicFetus]

Sounds like a horrific place to be a leader. It’s not unlikely they asked him / forced him to do stuff that sucks. Won’t be different for the next one.

 

[DocEspana]

Why not secretly reach out to CMG admin and ask for his job? Lay yourself out as having been here, having experience with the group and admin, understanding what admin wants. Make it seem like a smooth transition. They can even give you an interim director title if it pleases them to get him out.

I've been told that he made sure to blame everything on me and two other people. In the words of someone from CMG leadership who was sympathetic to us "your director poisoned the well over the last few weeks to make sure the hospital administration can't consider you viable." It's why it was made clear that the search would be external.

 

[Pudortu]

I've been told that he made sure to blame everything on me and two other people. In the words of someone from CMG leadership who was sympathetic to us "your director poisoned the well over the last few weeks to make sure the hospital administration can't consider you viable." It's why it was made clear that the search would be external.

That sounds terrible dude. I’m really sorry you have to deal with that kind of leader and hurt to your reputation.

 

[bravotwozero]

That sounds terrible dude. I’m really sorry you have to deal with that kind of leader and hurt to your reputation.

might be a blessing in disguise. Clearly, this isn't a good place to work as FMD anyway, although day to day ED ops sounds fine.

 

[DocEspana]

Sounds like a horrific place to be a leader. It’s not unlikely they asked him / forced him to do stuff that sucks. Won’t be different for the next one.

Used to be amazing. Going back like 10-12 years. We had a string of very doctor friendly directors, some of whom are able to stay on staff and remind us regularly that they know all the people in the c suite and it doesn't have to be this way. They would all last three or four years and then get replaced with another one who was also doctor friendly. Sure you still had to do all the normal stuff forced on you last minute as an initiative, but they would be very clear that they were defending you from the worst of the bad ideas of administration.

The c suite friendly one is the one that lasted the least amount of time. A lot of this is not policy problems, if it was policy issues the choice to leave would be easy because policy is not going to change with a new director. This is a lot of personality issue. The same policies in the hands of someone who was not actively antagonistic would probably be fine.

 

[JacobMcCandles]

So the meeting happened. Higher CMG administration let us know in not so vague terms that they are incredibly angry that they had to ask for his resignation. They also stated that he's not going to be going anywhere for the next few months, the resignation does not kick in until they find a replacement. They basically implied that if it wasn't for the fact that we went through formal patient safety protocols and filed this whole thing as a whistleblower issue that they would have found some way to keep him and/or fire some of us. And he was very open about the fact that it had nothing to do with us - that's how the hospital wanted to solve this issue to avoid losing him.

Well now I know the hospital views all of us as not just expendable but undesirable. Then again, this crew has lasted multiple directors so far. Gonna take this info to heart and consider how much leadership means to me because it won't happen here.

I’d bet the truth is somewhere in the middle of this.

 

[emergentmd]

So tell me why you were even contemplating this job again? Sounds like you have crappy CMG leadership on one side, Crappy hospital C suite on the other side, crappy current FMD on the 3rd side. You have one side left to escape and you considered actually standing in the middle of said box and get pounded on atleast 3 sides while having the docs hate you on the 4th side?

 

[RuralEDDoc]

So tell me why you were even contemplating this job again? Sounds like you have crappy CMG leadership on one side, Crappy hospital C suite on the other side, crappy current FMD on the 3rd side. You have one side left to escape and you considered actually standing in the middle of said box and get pounded on atleast 3 sides while having the docs hate you on the 4th side?

+1
I’ve seen more than my fair share of good docs take undesirable leadership jobs because of a title or a “bump in pay” which isn’t actually a bump because the time commitment is massive. It can be a net loss and accelerate burnout in the wrong situation and this situation doesn’t sound good.

 

[GonnaBeADoc2222]

+1
I’ve seen more than my fair share of good docs take undesirable leadership jobs because of a title or a “bump in pay” which isn’t actually a bump because the time commitment is massive. It can be a net loss and accelerate burnout in the wrong situation and this situation doesn’t sound good.

But is it a powerhouse cmg?

 

[DocEspana]

So tell me why you were even contemplating this job again? Sounds like you have crappy CMG leadership on one side, Crappy hospital C suite on the other side, crappy current FMD on the 3rd side. You have one side left to escape and you considered actually standing in the middle of said box and get pounded on atleast 3 sides while having the docs hate you on the 4th side?

Loyalty. I put in a lot of time here and it was (and when people leave the ER alone, still is) a real great place. The pay amazing and let you work basically as much as you can tolerate. Respected hospital name in the community and good nursing and resources.

Just from the perspective of not wanting to take a major pay cut (of which every single hospital in the county and the next county over would represent) I was basically left with just one choice. And the appeal there is that the leadership there and the whole vibe is super chill (for an ER) and they want to fast track me for leadership... Something I wanted and was always shot down by at my current place. But the new place is going to have its own share of dysfunction, every place has dysfunction. And I know I can tolerate the dysfunction here - except the director. But I'm realizing that he is more a product of a system that wants to find someone like him and protect someone like him.

 

[slchino]

If the fastrack to medical directorship isn’t in writing then hard pass. Cmg will say sorry, we went in another direction

 

[DocEspana]

If the fastrack to medical directorship isn’t in writing then hard pass. Cmg will say sorry, we went in another direction

I mean they're both CMGs. 😂 none of these are me leaving a benign model. Those don't exist in my area.

 

[GonnaBeADoc2222]

Loyalty. I put in a lot of time here and it was (and when people leave the ER alone, still is) a real great place. The pay amazing and let you work basically as much as you can tolerate. Respected hospital name in the community and good nursing and resources.

Just from the perspective of not wanting to take a major pay cut (of which every single hospital in the county and the next county over would represent) I was basically left with just one choice. And the appeal there is that the leadership there and the whole vibe is super chill (for an ER) and they want to fast track me for leadership... Something I wanted and was always shot down by at my current place. But the new place is going to have its own share of dysfunction, every place has dysfunction. And I know I can tolerate the dysfunction here - except the director. But I'm realizing that he is more a product of a system that wants to find someone like him and protect someone like him.

What is "amazing pay"?

 

[DocEspana]

What is "amazing pay"?

Average pay down here for CMGs is 225-250/hr with two major groups paying 180 and 190 an hour (admittedly with lots of benefits as those are employees and a private group that functions as pseudo employees). Also those are mostly all saturated leading to only the standard 120ish hours available.

This is 275-320 /hr per being a worker at one of them and talking to guys at the other one. And they both have openings in their schedule to work above the contracted minimum currently.

 

[GonnaBeADoc2222]

Average pay down here for CMGs is 225-250/hr with two major groups paying 180 and 190 an hour (admittedly with lots of benefits as those are employees and a private group that functions as pseudo employees)

This is 275-320 /hr per being a worker at one of them and talking to guys at the other one

1099 or w2? How many pph

 

[dchristismi]

Geez man, I don't have a lot to add except that I saw what TH's "leadership track" did to my friend and colleague (who I hired) when I refused the AMD position when they ate my old group. I WAS the AMD when they swept in, and they wanted a meeting to hear all about why I loved admin and how I saw myself fitting into their cogs.

I told them I hated it, I wouldn't do it and if they made me, I'd quit on the spot.
(Granted, I was a little stressed because this was Thursday, we'd found out it would be TeamHealth on Wednesday and I was getting married on Saturday.) But also, I'd noticed that I was having palpitations any time the nursing manager walked over, so I figured I really wasn't meant to be in admin anyway. And I really, really didn't enjoy any part of it.

They were a little surprised.

 

[DocEspana]

1099 or w2? How many pph

1099. Literally only 1 w2 job in the whole county.

The one I'm at now is 2.5pph. The new one is just under 2.0. But they both pay essentially the same due to a huge difference in the $/RVU and only a small difference in the hourly flat pay

 

[RustedFox]

Yeah. Theres ONE site that is W2 in four counties up and down my half of the coast. I was obligated to take that job when I moved here in 2012 or else there was no way for us to get health insurance.

No, people. No third party insurer would just up and insure me and the wife with our pre-existing conditions.

 

[Janders]

If you calculated how much time they actually spend on admin stuff vs. how much you’d make working clinically those extra hours I’d bet you’d be better off working clinically than all the admin issues you’ll deal with.

This is my experience. I initially was director for a roughly 25-30k/yr ED for what amounted to… 0.20-0.25FTE, with no AMD. Trust me, I spent more than 0.25FTE on the tasks. Now I still worked about 0.9-1.0 FTE, so yes I made “more money” but I also could have just picked up shifts for less total involvement for the same $$. But I was young, it was a neat oppurtunity, and it wasn’t a CMG cog position so I learned a lot and was involved in a rather stable group so the effort to improve things (say, start an OBSV program or bill for US or make ketamine legal in the ER or hell make propofol legal in the ER or bill for our EKG interpretations) was doubly worthwhile.

As volume grew significantly we upped the stipend so its more in the range of 0.35 (we are eat what you kill, so precisely what 1FTE makes is a bit vague?) and I have an awesome AMD. This let me work about 0.85FTE, pick up a moonlighting shift or two a month even, and have some semblance of balance and make a little more than a pure 1FTE foot soldier, but I was basically working 6 days a week and permanently on-call. Still seemed reasonable / fair… we have open books so if everything thought I was overpaid they’d just pitchfork me (or so I hope).

Then COVID hit, and admin chores / meetings / time commitment… doubled? Maybe tripled? So the pendulum has swung a bit towards the “hey I get a nice chunk of cash but boy howdy do I need to do a LOT of work and be on call forever to get it”. We’re still working on how to right-size that with the hospital, our group, and the large group we are part of.

So, in my lived experience, being an admin for cash in our set up… well I guess it works, but I also could have done 2-3/shifts a month the past decade moonlighting and probably come out to the same financial status. Most months the moonlighting would have been EASIER, though in a few doldrums the admin work was easier for a month or two at a time.

HOWEVER, if you can find an ED where the director is getting >>0.5FTE, even 0.75FTE… then yes perhaps it could be truly lucrative. In my experience those expect you to wear a suit and be present on campus / in meetings 4 days a week, but you could cobble shifts on top of that.

 

[nVictus]

Usually not worth the headache to be director. Don't be sold a false bag of goods you'll never get.

The same CMG selling you this leadership track is part of the same CMGs that sold you the profession of EM while pillaging it.

 

[Saddleshoes]

I learned this lesson in the military...


...You want to rise into management --BUT-- not too fast.

The "rapid risers" burn out faster.
If you elevate to the top slowly you become more strategic, mellow and wiser.

 

[Arcan57]

Did the TH director thing for roughly 3 years, was an AFMD for another 6. AFMD was by far a better gig, some ability to make things better with a lot less busy-work, complaint management. Being an FMD (as mentioned above) is middle management except you're relying on two corporate structures above you not to suck instead of just one. The game is making the hospital happy using a constantly changing level of resources depending on how your CMG is faring at the regional and national level. The first time you have cut pay or (more likely) hours at your shop because some division 1000 miles is underperforming is definitely a gut check. Especially if your volume is still trending up.

On the hospital side, the game is to get in tight with admin and be seen as a source of solutions, not problems. Most c-suites don't want to have to think too hard about the ED, they just want it to be a frictionless and moneymaking gateway between the outside world and their particular profit centers. Rookie FMDs either fight like rabid dogs for their docs and get replaced immediately or they sell out their docs at the first hint of hospital displeasure. A wise few whisper words like "root cause analysis" and "systems improvements" and buy themselves and their docs some time and distance from the temper of the CEO. Eventually most FMDs are going have to choose between being a total pawn for admin, doing nothing and hope nobody notices, or being an advocate and a leader. The last choice starts a timer since it's extraordinarily difficult to continuously generate political capital and at some point you're not going to have the influence to protect your people. I read the writing on the wall and bounced when both the CMG and TH still thought well-ish of me. Another 6-12 months and I probably would have been fired or forced to resign.

 

[RustedFox]

A strange game.
The only winning move is not to play.
How about a nice game of chess?

 

[emergentmd]

Loyalty

This is fools gold. Business is business. Docs think medicine is different but its all a way of making $$$$. You are only good to anyone when what you produce is more than your costs. If they can a more efficient way to use their money, you will be gone. It all comes down to efficiency of money.

 

[Apollyon]

First season of Elementary. In a board room, Sherlock says, "You, sir, are a sociopath." "Mr Holmes, in this room, we are ALL sociopaths!"

Business is sociopathic. Business doesn't care if you've been there for 30 years, if you have a sick kid at home, or anything else, except if you can do the job. EmergMD is right. Business, period.