Tips to being a department asset instead of a liability.
Dear Director,
I recently started as a new assistant medical director and am still figuring out how to be effective. What advice do you have for me to be a successful assistant medical director?
Congratulations on the new job. Starting an administrative career is exciting and will push you to learn new skills.
It is important for any employee to understand the mission and vision of their organization and how their individual role affects outcomes. My overall job is to make my boss look good and ultimately, that holds up in any organization at any level.
As a facility medical director (FMD), I have a lot of bosses including my hospital CEO and my regional medical director. Therefore, I need to know the mission and goals for each of them and work to achieve them. Your efforts as an assistant director (AD) should align with and positively impact those projects that are important to your department chair.
I had a great mentor when I started as an AD. I’ve tried to replicate the experience I was provided with each doc who has taken on administrative roles in my ED. There are key characteristics that the relationship is based on including communication, honesty, trust, availability, and initiative.
What your boss owes you
A medical director should define the workload of a new AD and define ways that the AD can contribute to strategic planning. When I bring on a new AD, it’s my responsibility to define their workload. It’s also my responsibility to communicate how they can help and to include them in strategic planning.
When I first became an AD, I was given some responsibility to lighten my chair’s load, and more importantly to me, over time, I was ultimately brought into the circle of trust and given background into issues and the opportunity to voice an opinion.
Typically, a medical director will handle outward facing roles such as meeting with the c-suite, attending medical executive committee meetings, attending meetings with other department chairs and fundraising with the foundation. The AD often focuses on quality reviews and day-to-day operations/flow.
Another philosophy is to split the work, but each person is informed enough that you and the FMD can be interchangeable when it comes to meeting attendance. For example, the AD may take on the sepsis work while the FMD takes on stroke, but if clinical responsibility or vacation prevents one of you from attending the hospital meeting, the other person has enough knowledge to represent the department.
As the chair, I’ve always owned the human resources pieces—interviewing, hiring, evaluations, feedback, etc…However, there can still be a role for the AD in providing feedback. Sometimes, particularly for younger docs, it can be intimidating to receive feedback about a case from the chair.
While there are QA and complaint issues I need to be involved in, I’ve often used my AD to provide “low key” feedback prior to an M and M presentation or to provide a gentler touch when one is needed. Providing feedback is a critical skill for any FMD and getting the opportunity to learn this is beneficial for the AD.
There is also tremendous value by including an AD in the interviewing/hiring process. First, it’s another voice to represent the department and perhaps someone a little closer in age to the resident being interviewed. Teaching the skill of how to interview and what to look for is useful and is part of the routine development that should occur with an AD. Interviewing skills also come in handy when that star applicant is only coming to town when the chair is on vacation and the AD has to do the interview.
Your responsibilities
The first step of the AD job is to make sure you have a clear understanding of your job and what is not your job. A good first step would be taking something off your medical director’s plate. Find a project and own it. You should allow your FMD to provide oversight and mentorship, but you need to be sure to commit to meeting attendance and getting the work done.
As you get involved in the work, you’ll want to schedule regular check-in meetings with your FMD to review the work you’re doing and to talk about the big picture and career development.
Communication and trust are two-way streets. The FMD owes you project oversight and mentorship. While I’d like to think that I know all the answers, in reality, I rely a lot on my admin team to provide feedback as we adjust the schedule, discuss APP supervision, talk through bad outcomes and discuss strategic initiatives. An AD should be trustworthy and someone the director can confidentially discuss delicate issues. Your FMD wants your opinion, so be able to provide feedback.
It’s important to understand your FMDs communication style during meetings and with emails. I prefer that group communication goes through me and I specifically tell my ADs when it’s okay to send a group email (and yes, over time, they no longer get micromanaged). Meetings we both attend can by tricky.
My AD may not know my entire strategy so we’ll often silently communicate about whether one of us should speak up on a topic or not during in person meetings. Virtual meetings are easy because we can text each other, but the key is we’re in communication about pushing issues or not so we can be on the same page.
Think of new projects you want to take on and discuss these with the medical director. You can’t over-communicate with the medical director. The FMD should never be surprised by hearing about something you’re working on from hospital administration or colleagues. I generally have had one to two ADs and I’m usually in touch with them almost daily. Sometimes it’s touching base during a shift or before/after a meeting, but often it’s on the phone or by text/email.
As an AD, you become a second set of eyes and ears in the department for the administrative team. In most EDs, a new AD is both friends and colleagues with the providers and has a professional obligation and responsibility to the organization to let the FMD know what’s going on. This could be anything from “I never noticed how often Thomas comes late to work,” to “I hear Samantha is looking for a new job.”
It could also mean providing feedback on an obnoxious consultant or on the great job one of the docs did on a difficult airway. Good or bad, not everything discussed will warrant action, but it all helps the physician administrative team better understand and manage the department. Your FMD may make a conscious decision to really watch a doc who shows up late and may recommend to you to encourage “Samantha” to go talk to the FMD about their interest in leaving.
There is also a fine line between being seen as the FMD’s “yes man” to showing public support for changes being introduced to the department. As the AD, you should have been given the opportunity to provide private and honest feedback to the FMD about changes. Ideally, you’re on board with the plan before it’s presented to the group. Once this is happening, you shouldn’t undermine the FMD in front of the group. Either you fully endorse it, or you share that you were involved in the development, had concerns that have been addressed, and believe it’s worth trying.
Although you will likely have far less protected time than the FMD, try to be available when given opportunities to attend meetings, work on projects and even fill in for the director when they’re on vacation. These are opportunities to learn and grow your skill set. I was petrified the first time Joint Commission showed up and my chair was on vacation out of the country.
It made for a very long week, but it was a great experience and I only had to use the excuse that I was “covering for the chair” a couple of times. It certainly helped prepare me for my first Joint Commission inspection when I became a chair. Available also means adapting your routine to be more responsive to emails. A general rule of thumb is that email should be returned within 24 hours. However, urgent matters may require your input long before the 24 hour window closes.
Dress for the job you want, not the job you have. That means showing up professionally dressed for meetings on your non-clinical days rather than dressed for the golf course. We keep strange hours and at times, need to conform to the norms of the hospital. Apply this professionalism to the way you interact with others and manage yourself. These behaviors will demonstrate the maturity needed for further leadership positions and make the transition to leadership less tumultuous.
Finally, don’t neglect your clinical job. You need to walk the walk in the clinical area. We work in a fishbowl, but your actions become much more visible once you become an administrator. Your metrics will be scrutinized by your colleagues and your attitude and actions by everyone in the department. Know the rules for sepsis, STEMI and stroke so you can be a department resource. You wouldn’t get this position without being excellent clinically, but you’ll be pressed to show it now.
Conclusion
As you get started, be sure to have frequent meetings with your FMD. Take ownership of a project or two to get started. Responsibility and mutual trust develop over time, but it starts by showing that you are engaged, understand the issues at play, and can follow through on tasks.
My preference has been to have some clearly defined tasks and responsibilities but communicate enough that we can cover for each other at meetings if necessary. Being an AD is a great opportunity to learn new skills and potentially find a niche outside the clinical area. It takes time and commitment to grow into your role so be patient. The opportunity to impact healthcare and quality more than one patient at a time is worth it.
