Director’s Corner: Running the chair is a Marathon

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Follow these steps to prevent against early burnout.

Dear Director,


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I’ve been a chair for several years, but I feel like I’m burning out on the job.  I like the work, but I can’t get control over my schedule and I feel like I’m always at the hospital and on-call.  What secrets do long-term chairs have to maintain their sanity?

No one should take on a chair job thinking their life will be easier. It’s a rewarding job, but it’s 24/7 with a steep learning curve. While conventional wisdom says the life expectancy of a chair is 5-7 years, I know numerous chairs that are in their second decade at their site. Clearly, they’re doing something right in their job and they’ve also achieved a workable work-life balance to avoid potential burnout. Although the jobs may be different, whether you’re the chair at a site with 15K annual visits or one with 95K annual visits, both chairs can still experience burnout.

Year one


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Whether you’re promoted from within or coming from outside the hospital, taking over as a new chair requires a tremendous amount of time.  There are people to meet, committees to serve on and some early victories that are necessary.  As a new chair, the best way to learn the lay of the land and identify key stakeholders is to attend every, or at least, almost every committee meeting, work clinically frequently with a very diverse shift schedule, and have regular meetings with all of your key stakeholders, including your physician team and other chairs throughout the hospital.  Everyone will find some low hanging fruit to generate some small wins, but there will inevitably be some bigger obstacles to overcome (perhaps starting with why the previous chair left).  I’ve lived this twice and talked to numerous chairs, and consistently, the first 12-24 months seems like a non-stop sprint with round the clock work.  While I believe this pace is necessary to get started, it’s not sustainable.  So, you may start your job as a sprint, but every chair ultimately realizes the job is really a marathon.

Get a Good Second

No matter how many years you’ve been a director, if you want some piece of mind when you’re on vacation, you have to have a good associate director or vice chair.  You may have someone with this title already or you may be hiring or developing a doc to take this job.  This person can not only take some of the committee burden off of you, but should be able to trouble shoot problems when you’re on vacation. Preventing burnout requires the occasional escape and you and the C-suite team need to be comfortable that the second in command can handle the administrative issues that seem to appear as soon as the “out of office” gets activated.  When you have the right person, they’ll also serve as a confidante, so you have someone to discuss issues with or get feedback on the state of the ED.

Work Smarter


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By year two or three, you should be settling into the job and looking to achieve a better work-life balance than what typically exists in year one.  Your institutional history, knowledge and insight can now be put to use.  Since you’ve been sitting on most, if not all, committees, you know that not every committee requires a chair at the table, and you can begin to assign these committees to docs on your team.  You also should have a good sense of your docs about who can represent you and the ED appropriately at these meetings.  Although you might have met with key stake holders frequently initially, you now have a better sense of who the real stakeholders or power brokers are in the hospital and can adjust these meetings accordingly.  Hopefully, you’ve been able to build relationships with these people so perhaps you can eliminate the monthly meetings and touch base ad hoc (before or after the Medical Executive Committee has worked well for me) or just when you cross paths in the doctor’s lounge.  With experience comes knowledge about the potential land mines your team may step in, creating headaches for you.  Use your department meetings to teach your team to troubleshoot the hot spots—such as with psych dispositions or difficulty with consultants or hospitalists, and how to prevent the types of patient complaints that are due to poor communication.

Department Maintenance

As the years go by, it’s important to not get complacent in the job.  It’s easy to get comfortable with the meetings you’re attending and the work you’re doing, while losing sight of the details that made you successful in the first place.  You still have to look for new low hanging fruit and meet with your key stakeholders.  If you’ve stopped attending certain committee meetings, hold your replacement accountable to provide you with regular updates.  You don’t have to do it all yourself, but you do have to take responsibility for the department.  It’s also important to not lose touch with your front-line workers.  As years go by, your clinical hours or your night or weekend burden may decrease, so you need to make sure that all of your docs still have a voice and to show them that you appreciate them.

Micromanage Your Schedule

Early in my administrative career, I remember finishing an evening shift, checking my calendar before I left and seeing a 7 a.m. meeting in my office a few hours later.  I didn’t recognize the name, but I was taking all meetings throughout the hospital, so I returned for the meeting.  By 7:05 a.m., I realized the mistake I made.  Our department coordinator had scheduled a meeting with a drug rep since she knew I didn’t have a shift that day.  I was a drug rep after college for a couple of years so at the time, I was happy to meet with most of the reps.  The mistake was letting our ED assistant control my schedule.  What she hadn’t looked at was the end time from my evening before.  We live in a 24/7 clinical world, yet our administrative job is generally between 7a.m. to 6 p.m. and not everyone understands how shift work and sleep go together.  Managing my own calendar has been critical to achieving some balance.  While I can’t control all of my meetings, it does allow me to stack meetings on my administrative days and fill in empty slots when I have mandatory meetings separated by hours and sometimes prevents me from having a 9 a.m. meeting on the same day I have a 4 p.m. to midnight shift.

I’ve spoken with many chairs who were overwhelmed with the work and hours, and one of the common themes that emerge is that they continue to submit schedule requests rather than controlling their own clinical schedule.  Your total clinical hours are typically pre-determined, and your night commitment will depend on your administrative responsibilities, tenure at the site, and the night burden that your docs face each month. So you still may not have your ideal clinical schedule if your goal was to work only weekday day shifts, but the best way to make each work day as productive as possible, is to schedule your clinical time around your meetings and admin days.

If you don’t micromanage your clinical schedule, you’re going to have more 12-16 hour days in the hospital and more nights with less than ideal sleep, and that’s going to make you less effective as a chair and increase your burnout. For me, Mondays are pretty heavy meeting days, so I can do an evening shift if I don’t have to be back super early on a Tuesday.  I also have a mandatory meeting at noon on the second Wednesday each month, so working our 2:30 p.m. shift that day is great as it allows me time between the meeting and the shift to get some office work done, but keeps my day in the hospital to about 12 hours.  The last full week of the month is typically light on meetings, which is good for getting in clinical time.  If we have shifts that are tough to fill, our scheduler will let me know and I’ll see if I can plug the hole.  But at the end of the day, the value I bring to the department is when I wear my chair’s hat.  However, I do clinical shifts to stay clinically competent, to have clinical credibility both inside and outside the ED, to see first-hand how things work, because I like seeing patients, and because it pays the bills.

Mentoring

There are a lot of challenges in being a chair.  It’s not unusual to get grief from bosses daily on metric performance or budget and worry about getting fired.  Therefore, it’s important to find the areas of your job that you enjoy, and make sure you’re committing time to them.  For me, it’s about the relationships with docs throughout the hospital and mentoring the emergency physicians.  Therefore, one of my strategies to prevent burnout is to build this into my schedule.  Maintaining contact with peers is also important to prevent burnout.  If your group is large enough to allow you to have site director peers, then take advantage of these colleagues to get advice, support or just to vent.  Or build your own network of chair peers.

Getting the Work Done

At least one weekend a month I’ll get an email from a ticked off consultant about an issue they had in the ED.  I left the hospital at 1 a.m. recently, only to get a text from someone at 7:30 a.m. asking me to call them.  Smart phones and EMRs give us 24-hour availability and access that just wasn’t available 10 years ago. As a chair, you don’t always get to pick your office hours or to set your boundaries, but there are some opportunities.  A request to call my CMO will be honored regardless of how much sleep I’ve had.  Email etiquette allows for 24 hours and I think an email received over the weekend can wait until Monday.  It’s important to develop your own habits to get the work done, which may require blocking time in your calendar each week to complete the routine office work.  You may elect to not return non-critical emails every evening for a few hours while you have dinner and spend time with your family.  But you need to review them before you go to bed.  I’m usually up hours before my kids on Sundays and will drink coffee, get caught up on the past week and plan for the next week.

Find time for you

As a disclaimer, I don’t live this as well as I should.  When I started my current job, I was running marathons and doing triathlons.  I loved running.  It gave me time to put my phone away and just enjoy being outside with my thoughts.  But I can’t remember the last time I ran and I’m not quite sure where I put my bike.  But I’ve backfilled this time with watching my kids play sports (and commuting).  The hospital has the potential to consume all of your time, so it’s up to you to maintain, or get back, the things that make you, you.

Conclusion

I’ve enjoyed being a chair.  It’s rewarding and seems to fit my skill set.  Some weeks are pretty demanding while others are more reasonable.  If you’re going to have long-term success, you’ll need to find ways to keep the job from swallowing you.  Controlling your schedule is key as is developing your team so they are self-sufficient troubleshooters in the ED and that you have a trusted and effective associate director.

ABOUT THE AUTHOR

EXECUTIVE EDITOR Dr. Silverman is Chairman of Emergency Medicine at the Virginia Hospital Center. He also serves as the Chief Performance Officer with Emergency Medicine Associates, a founding partner of Alteon Health. Dr. Silverman’s practical wisdom is available in an easy-to-use reference guide, available on Amazon. Follow on Twitter @drmikesilverman

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