Am I Right for ED Administration?

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Dear Director,
I’ve been thinking that I want to cut back clinically and maybe get started doing administrative work for our department. I’m pretty good at picking out some things that need improving in our department. How do I know if I’m ready to take that next step up?

Dear Director,
I’ve been thinking that I want to cut back clinically and maybe get started doing administrative work for our department. I’m pretty good at picking out some things that need improving in our department. How do I know if I’m ready to take that next step up?


I’m always excited to work with physicians who want to make their department better and get involved in administration.  However, before we talk about the necessary skill set or experience that I look for when choosing who to develop as a physician administrator, here’s a few myths that we should dispel before considering a career in administration.

Myth #1: I’ll get an administrative stipend and make more money
While some chairmen get large administrative stipends, starting out in administration will likely lead to cutting your clinical time and it’s very unlikely that any administrative stipend will make up for the loss of clinical income. For many junior administrative physicians, the hour-to-hour stipend is likely to be 40-60% of your clinical hourly rate.

Myth #2: I’ll get a reduction in my clinical hours and have more free time
As a chairman, I’m in the hospital much more than when I was an associate director and even that was more than when I just worked clinically. I should have realized this 10 years ago when our group of docs would leave our monthly staff meeting and head to the golf course, only to leave our most avid golfer, and our chairman, behind doing meetings and administrative work. Clinically speaking, any shift reduction that comes with administrative time is unlikely to be completely balanced. However, there is the benefit of flexibility that frequently comes with administrative work—some of it can be completed before or after shifts or during a short day at the hospital. Ultimately, however, most people in administration are in the hospital more often and work more hours per week than those who are just clinical.


Myth #3: I’m out of residency two years and I need to keep climbing the ladder
Admittedly, I felt the same way, but the reality is that you have 25-30 years of work left in you. Being a medical director is likely the top administrative position any of us will obtain and that job is not necessarily a lifetime position. It’s more important in your first 7-10 years as a clinician to work on your professional practice, your interaction with your colleagues outside of the hospital, and your own personal life. The opportunity for administrative advancement will still be there down the line, and you’ll be a stronger candidate for the position at that time.

Assuming you’re good with the above, when I talk to chairman and medical leaders about the skill set necessary for their job, there are some common threads about why and when they looked to advance in administration.

You must have a high level of clinical competence, including efficiency and patient satisfaction. After all, you need to be able to “walk the walk.” You will be the example to your department’s providers and staff as well as the face of the ED to your hospital administrators and colleagues outside of the department.

An inability to control anger will usually get you in trouble as an administrator (as well as when working clinically). Managing difficult situations and learning how to read people and react appropriately are essential skills for an administrator. Being able to effectively communicate is another must, whether it’s negotiating an ICU admission policy, recruiting a new physician, or explaining a business plan,


Lots of people can identify problems but the challenge is finding the physician who can bring solutions to the table.

While having an MBA is not necessary, it’s important to have enough business sense to understand how the O-Wing thinks and speaks when it comes to discussing topics like reimbursement, return on investment, and budgets.

The department has to come ahead of you. Selfishness needs to go away. Years back, our group was voting to bring in our second coverage doc an hour earlier in the morning. It was the obvious choice and everyone was in agreement but one physician. As it turns out, he was concerned that the hour earlier would severely limit his ability to get his kids off to school several times a month, and he didn’t want to make that compromise. The schedule changed, patient flow improved and he survived, but it gave us a sense of where that doc’s priorities were.

The hospital has to come ahead of the department. The ED may have conflicting issues with what’s best for the hospital, but your job as an ED administrator is to support the hospital president and their agenda.

The patient must come first. Department and hospital are great, but always remember who you work for and that will guide you to do the right thing.

You have to have a global vision and be able to see a project from all angles, not just from your view. I find the answer to questions from my view always to be obvious and simple, but when I put myself on the other side with competing priorities, it may not be that clear. Projecting a win-win solution and reaching middle ground is a must-have skill.

Besides seeing a problem from all sides, you must have a vision for the department. Whether it’s taking a small quality project forward, working with EMS or directing a department, you need to be able to create the road map to achieve your vision.

Finally, you have to be willing to accept all responsibility and that the buck stops with you. My wife describes her job as being a “Sh*t Umbrella” for her staff. Whether it comes from above, below, or lateral, and whether it’s about inadequate supplies, surge capacity inefficiency, or core measure success, it’s your job to accept it and work to find the solution.

Having a career in ED administration can be very rewarding. While business and leadership skills can be learned, it’s helpful to start with some of the right personality traits and communication skills, ability to problem solve from all angles, and a willingness to be accountable. Oh, and don’t forget your umbrella.

Michael Silverman, MD, is chairman of emergency medicine at Harbor Hospital in Baltimore, MD and is on TEAMHealth’s Medical Advisory Board.

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