Dr. John Jurica’s Blueprint for Leading a Top 100 Hospital – 369
In this podcast episode, Dr. John Jurica delves into what it takes to become an exceptional Chief Medical Officer (CMO) at a Top 100 hospital.
He shares his journey from a family physician to a CMO, emphasizing the importance of aligning your skills with the hospital’s goals. This episode is a must-listen for any physician considering a move into hospital leadership.
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The Journey to Becoming a Top CMO
To become an outstanding hospital Chief Medical Officer (CMO), you must start with the end in mind. John shares his own experience, highlighting the importance of aligning your skills to help achieve or maintain the Top 100 Hospital designation.
By getting involved in various roles such as a medical director, physician advisor, or on committees focused on quality improvement and patient safety, you can gradually build the expertise needed to lead a hospital to excellence.
Understanding the Key Metrics for Success
Dr. Jurica emphasizes the critical metrics that define a hospital’s success in achieving Top 100 designation. These include risk-adjusted mortality rate, complication rate, and patient satisfaction score.
As a physician striving for a leadership role, it is essential to have a deep understanding of these metrics. By focusing on improving performance in these areas, you will enhance the quality of care and position yourself as a valuable leader.
Strategizing Your Path to Leadership
For physicians looking to transition into leadership roles, John advises strategically planning your career. This involves volunteering for committees, gaining expertise in coding and documentation, quality and safety, and utilization management.
As you do so, gradually take on more responsibilities. Additionally, accessing mentors and making your career aspirations known within your organization can significantly accelerate your journey to Chief Medical Officer.
Summary
John provides a model for physicians aspiring to become Chief Medical Officers to follow. He shares his journey from family physician to CMO, highlighting the importance of mastering quality, safety, coding, utilization, and other important performance domains as a guide.
He emphasizes the significance of actively participating in committees such as Quality Improvement, Utilization Management, and Infection Control. He also recommends leveraging resources like the AAPL and specialty societies for healthcare management courses.
Links for today's episode:
-
- Fortune/PINC AI 100 Top Hospitals
- American Association for Physician Leadership
- How to Lead a Top 100 Hospital
- Why Hospital Leadership Jobs Are Both Challenging and Rewarding
- 6 Important Assignments of a Hospital CMO – 218
- Dr. Armin Feldman's Pre-trial Pre-litigation Medical Legal Consulting COACHING Program
Podcast Editing & Production Services are provided by Oscar Hamilton
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Transcription PNC Podcast Episode 369
How to Be the Best CMO Leading a Top 100 Hospital
John: All right, let's get into today's solo presentation this week. It's just me, as I said a few minutes ago. And I wanted to look at something that's kind of related to what I talked about last week, where I was giving you three nonclinical positions you could pursue, the three of the most common, give you a few pointers, so you might want to check out last week's episode.
But today, I want to dig a little bit into the CMO role and look at it from kind of a different perspective. And basically, to sum it up, I would say we're going to look at it from the perspective of what would the institution need to become the best hospital it could be in someone who was the chief medical officer, which hopefully for some of you might be a job you're going to pursue. As you heard at the beginning, it's called how to be the best CMO leading a top 100 hospital.
That can mean a lot of things. If you have a top 100 hospital and you become the CMO, how can you be the best CMO? But really, what I'm getting at here is looking at becoming the best hospital that you can work for and providing the best care for your patients.
What would you do to prepare yourself to be that CMO that could lead an organization to that situation? That's how I'm going to look at it today. What I'm doing is kind of starting with the end in mind. The end in mind is for someone to hire you to be the CMO and to help lead an effort to become a top one hospital or to continue to be a top one hospital if you already are one. It's less than 4% of the hospitals in the country are top 100 hospital any given year. So it's a difficult thing to accomplish.
And my experience in the past is that once you've done it, it's a little easier to continue to do it, but it's by no means something that will happen year after year after year. As the CMO, we achieved that designation six times. I think it was six years in a row, but we might have skipped a year in there. And if you can align your skills with understanding how to pursue and achieve top 100 hospital designation or 100 top hospital, they also use it to flip things around, that would be a good thing. We'll be able to put you in a position to pursue a lot of CMO jobs for the reasons we talked about last week.
So what was my story? What did I do that kind of had me ultimately fall into this situation where I was heavily engaged in preparing for and reaching the top 100 designation? Well, I was a family physician, I was working. And I liked to moonlight at the beginning, help pay down my loans and keep myself busy while my practice was growing.
And also, I just liked helping out. And I was interested in a lot of different things. And so I did spend time as a physician advisor for utilization management at my hospital. I also spent times as a medical director for different services like the family planning clinic that we ran, where we did pap smears and dispensed birth control pills for the occupational medicine clinic that we ran, where I worked seeing patients and also as the medical director for a while. I worked at a health clinic at a local college that had nothing to do with the hospital. Remember, I was in a practice with two other partners, and we were independent, we weren't working for the hospital as physicians.
I was doing things in my clinic, and I was also doing things at the hospital. And I was learning things as I went through that. And ultimately, that's what led to my becoming the VP for medical affairs, and then ultimately the CMO for this 300 bed hospital in northern Illinois.
And when I really pulled the plug on doing that and, and leaving clinical practice completely for about almost four years it wasn't because I was necessarily bored or frustrated. But the thing was, I was looking for bigger problems to solve, in a sense. And something that you know, some of you might be thinking of, like, I'm, you might say to yourself, well, I'm, I'm busy, and I'm successful.
But I've kind of been doing this for a while, it's become almost routine, even though it's busy, and there's a lot of responsibility, but maybe there's some bigger problems to solve. And if you're in the hospital, there are a lot of big problems to solve. They can be financial, they can be quality, they can be patient satisfaction.
And that's something that a physician who's interested can really get into. So let's talk about this issue of 100 top hospitals. If you go way back 30, 35 years ago in the heyday of lots of hospitals, and weren't subject to a lot of rules and regulations, oddly enough, it was very difficult to say whether a hospital truly was of good quality or not, or whether care was of good quality or not, because we hadn't developed all of the sophisticated methods internally to monitor quality.
We weren't really tracking length of stay, we weren't really tracking mortality rates, and certainly we weren't doing risk adjustment at that time. But with the introduction of DRGs, and the things improved over time, and how those were structured, and what they meant, and then they get really granular in terms of defining the levels of a DRG, and that's been redone several times over the years. Now, both internally and externally, using primarily billing data, we can measure and affect quality.
Nowadays, if you're looking at a top 100 designation, you're competing with about 2600 U.S. hospitals, they use all Medicare related data for the most part, so you've got Medicare cost reports, MedPAR data, data from CMS Hospital Compare, which you can look up online and see how your hospital is doing for different treatment of different conditions. And really, it's something worthwhile pursuing, because, well, of several reasons. Really, by pursuing something like this, you're learning, yes, how to code and document optimally, you're focusing on length of stay and other quality metrics, which I'll mention in a minute.
But you can really improve the quality of care by just working on this problem, even if you never reach the top 100 designation, by virtue of just focusing all of your clinical and some of the nonclinical areas on improving quality and satisfaction, your care will improve because you'll have to make changes that improve care that reduce infections, reduce complications, reduce errors, and that'll benefit you. And then if you so happen to occasionally fall into the top 100, then your hospital is going to get that status in your community, you're going to be able to use it for marketing purposes, and it has a lot of other benefits.
Just to, again, try and explain exactly what this means, the top 100 designation, this whole sort of contest or comparison has been around for a long time, and it's been owned by different things. I remember Solutions did it for a while, and Microsoft owned it for a while. And now it's under Pink AI, which is part of Premier. And who knows, maybe they'll change hands again in another few years.
But it's always been pretty consistent in who it measures. It breaks the hospitals in the country down to major teaching, which are teaching hospitals where they teach residents and fellows, maybe they don't have a med school, maybe they don't, you've got to have at least 30 major graduate education programs to consider a major teaching, it could be a large, medium or small community.
And those are defined again, by active beds, and some other parameters. And what they are looking at basically is the clinical outcomes, what are outcomes? Well, usually risk adjusted mortality and morbidity, you can think of it in general terms, operational efficiency that has to do with length of stay, and other measures of efficiency patient experience.
Some of it is subjective that the perception of the patients in the hospital, but again, this is something Medicare already collects and shares. And then the financial health of the organization, because you really can't be a good quality organization for very long if you're losing money consistently. If you dig in even deeper.
And again I'll just go through these quickly. But you're looking at risk adjusted, overall mortality, risk adjusted complication rates, they are going to include hospital acquired or healthcare acquired infections, as something that's monitored and included in this, you've got a 30 day mortality rate, because Medicare knows once you leave the hospital, they tie any death that occurs in those 30 days, or whenever they want to measure it, and identify it back to the hospital stay as well as a 30 day readmission.
Now, some people consider readmission, not necessarily to be a quality metric, others would argue that it is, I think both length of stay and readmissions are signs of a good measure of quality. And we can argue that point. The operational efficiency includes the length of stay, it also includes the spending on each patient, and then the expense of each discharge, which they have very sophisticated formulas for measuring.
Again, most of these are related, or are adjusted for the illness of the patient, the pre existing conditions, the age of the person, and so forth. As I said earlier, the patient experience is HCAHPS survey that's done across the country. And then the one financial measure that's in there now, and these things do change from time to time, but is the adjusted operating profit margin. And again, Medicare can do that just based on public data. That kind of gives you an idea.
And you can see how as a physician, you're going to have a lot of input, and a lot of say in how these metrics go, how well you're performing. You're the leader of the clinical team as a physician. So you're going to know a lot about these things. If you're a surgeon, if you're a hospitalist, if you're an anesthesiologist you're going to be involved with these issues anyway, in the hospital setting. You know, we typically as physicians in the past have been used to doing basically chart reviews of cases that quote, fall out. You know, nowadays, we're looking at objective risk adjusted measures to identify trends that are going in the wrong direction and trends that maybe indicate poor quality of care.
But let's see, we can probably dig into a little bit more by looking at, okay, so if we're trying to address all those issues, and let's say you're a medical director, or you're looking to become a CMO, or you are the CMO, what other staff are involved and who would they typically report to? This is where, if you look at these factors, you'll see why it's important that most every hospital have a CMO that can address these issues, but also from the standpoint of planning your career.
Well, if this is what's important nationally, and this is what's important to my hospital, then how can I help? And how can I develop the skills that enable me to help? If you look at the people that are generally involved in improving, like let's say being on a committee to help shoot for that top 100 designation, these are the people that are going to be involved. You're going to have your, and these are people I worked with when I was CMO, the Director of Quality Improvement, the Director of Utilization Management, the Director of Coding and Documentation Integrity.
These are things that are critical to reporting and to managing. Infection control, that gets to the HAIs. The pharmacy is critical to costs and improving care. If you can't get your drugs to your patients in a timely fashion, in a safe fashion, you're going to have problems. Informatics, of course, because you're going to have protocols, you're going to have order sets. Obviously, everything comes out of the electronic medical record, everything needs to be captured appropriately.
You're going to need health information. It's separate from informatics, but it's basically used to be the billing department and the records department, health information, health records, the charts, so to speak. And then the patient satisfaction is going to be important.
And then the finance is going to be helping to make sure that these things are captured correctly. And they're going to be there helping provide some of those reports if you want to meet that one metric that has to do with finances. Well, when I was CMO, I had quality improvement reporting to me from day one. Utilization management was reporting to me. Pharmacy reported to me. In fact a lot of these were just part of my typical line of directors, or you call them direct reports to me or the quality improvement director. Infection control was actually under quality improvement. Utilization management, coding and documentation integrity, and informatics reported to me. Some hospitals might be to the health information or to finance or something.
These things do shift around a little bit. But then looking at it again from how can I perhaps set myself up to become a medical director? And then the CMO, what can I do? Well, you can volunteer for committees and involve informatics, pharmacy, infection control, coding, documentation, utilization management, quality management. You can become the chairs of those committees. You can become a medical director focusing on one of these areas.
Maybe you work as a physician advisor for utilization management. And if you're a big enough organization, you'll actually have to have a medical director over that who's maybe supervising a couple of other physician advisors part time. You need to know coding and documentation pretty much anyway.
And so the more information you learn about this, you can do all this learning on the job for the most part. And you can also learn through like the APL. Even your specialty societies will have information and training on quality improvement. What are never events? What's a sentinel event? How do you do root cause analysis? All these things related to quality and utilization, length of stay. And then you set yourself up to walk into that CMO role when it's open or apply at a new institution. And I think it's a good way to think about pursuing this kind of position.
That's basically what I wanted to talk about today. Things are different now than they were 10, 15, 20 years ago. I've been out of the hospital setting for 10 or 11 years now. Pandemic has had a huge effect. But I think if you are, even if you're a frustrated physician, feel somewhat overwhelmed and overtaxed because you're working as an employee for a large corporation that runs your hospital, you can really strategize to take what you've learned in that hospital environment and move forward in a direction that will bring you into more interesting type of work, more management, more leadership. It has its own headaches.
But if you can manage to sort of plan out something over the next one, two, three years, you can go from basically minimal involvement in your hospital by signing up for some of these committees, narrowing down the ones that are really most useful, most interesting to you, sharing the committee when the time comes.
And then the other things you do in the meantime is you get a mentor or two, maybe there are other physician leaders in the organization that you can talk to and think, get their advice and how to move up that ladder. And the other thing is letting people know that you're interested as things come up, if projects come up and say we need a physician leader for this, we need to do a subcommittee or a temporary planning committee.
Who can we get to lead this committee? Well, this guy over here, this gal over there has this experience in running these kinds of things. They understand risk adjustment and statistics in medicine, and they understand DRGs and ICD-10 and how we do the coding, maybe they should be involved. And you'll see that it's not as difficult.
And then as you start to take on roles as a medical director what you do is you need to swap out your medical director time for your clinical time. And if you're employed by the hospital anyway, that's not that difficult. They might have to fill in some gaps, but if you cut down to 80% time or 50% time and the other 50% doing the medical director role, fine, they just replace your income as a clinician with that for as a medical director. And you find someone to fill in, you hire more staff to fill in or more physicians. And it's exciting. It's interesting. You're learning as you go. In the meantime, you can sign up for courses or classes online or live or annual meetings at the APL. And there's a lot you can learn even from your specialty societies, as I mentioned earlier.
So, that's what I want you to think about. When you're focusing on quality and satisfaction in the hospital, you're going to be improving the health and the lives of your patients and of your community. You're going to be assisting your organization and you're going to be learning new skills that will help advance your career in many new areas. With that, I will close this presentation and let me say a few more things before we go.
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Transcription PNC Podcast Episode 369
How to Be the Best CMO Leading a Top 100 Hospital
John: All right, let's get into today's solo presentation this week. It's just me, as I said a few minutes ago. And I wanted to look at something that's kind of related to what I talked about last week, where I was giving you three nonclinical positions you could pursue, the three of the most common, give you a few pointers, so you might want to check out last week's episode.
But today, I want to dig a little bit into the CMO role and look at it from kind of a different perspective. And basically, to sum it up, I would say we're going to look at it from the perspective of what would the institution need to become the best hospital it could be in someone who was the chief medical officer, which hopefully for some of you might be a job you're going to pursue. As you heard at the beginning, it's called how to be the best CMO leading a top 100 hospital.
That can mean a lot of things. If you have a top 100 hospital and you become the CMO, how can you be the best CMO? But really, what I'm getting at here is looking at becoming the best hospital that you can work for and providing the best care for your patients.
What would you do to prepare yourself to be that CMO that could lead an organization to that situation? That's how I'm going to look at it today. What I'm doing is kind of starting with the end in mind. The end in mind is for someone to hire you to be the CMO and to help lead an effort to become a top one hospital or to continue to be a top one hospital if you already are one. It's less than 4% of the hospitals in the country are top 100 hospital any given year. So it's a difficult thing to accomplish.
And my experience in the past is that once you've done it, it's a little easier to continue to do it, but it's by no means something that will happen year after year after year. As the CMO, we achieved that designation six times. I think it was six years in a row, but we might have skipped a year in there. And if you can align your skills with understanding how to pursue and achieve top 100 hospital designation or 100 top hospital, they also use it to flip things around, that would be a good thing. We'll be able to put you in a position to pursue a lot of CMO jobs for the reasons we talked about last week.
So what was my story? What did I do that kind of had me ultimately fall into this situation where I was heavily engaged in preparing for and reaching the top 100 designation? Well, I was a family physician, I was working. And I liked to moonlight at the beginning, help pay down my loans and keep myself busy while my practice was growing.
And also, I just liked helping out. And I was interested in a lot of different things. And so I did spend time as a physician advisor for utilization management at my hospital. I also spent times as a medical director for different services like the family planning clinic that we ran, where we did pap smears and dispensed birth control pills for the occupational medicine clinic that we ran, where I worked seeing patients and also as the medical director for a while. I worked at a health clinic at a local college that had nothing to do with the hospital. Remember, I was in a practice with two other partners, and we were independent, we weren't working for the hospital as physicians.
I was doing things in my clinic, and I was also doing things at the hospital. And I was learning things as I went through that. And ultimately, that's what led to my becoming the VP for medical affairs, and then ultimately the CMO for this 300 bed hospital in northern Illinois.
And when I really pulled the plug on doing that and, and leaving clinical practice completely for about almost four years it wasn't because I was necessarily bored or frustrated. But the thing was, I was looking for bigger problems to solve, in a sense. And something that you know, some of you might be thinking of, like, I'm, you might say to yourself, well, I'm, I'm busy, and I'm successful.
But I've kind of been doing this for a while, it's become almost routine, even though it's busy, and there's a lot of responsibility, but maybe there's some bigger problems to solve. And if you're in the hospital, there are a lot of big problems to solve. They can be financial, they can be quality, they can be patient satisfaction.
And that's something that a physician who's interested can really get into. So let's talk about this issue of 100 top hospitals. If you go way back 30, 35 years ago in the heyday of lots of hospitals, and weren't subject to a lot of rules and regulations, oddly enough, it was very difficult to say whether a hospital truly was of good quality or not, or whether care was of good quality or not, because we hadn't developed all of the sophisticated methods internally to monitor quality.
We weren't really tracking length of stay, we weren't really tracking mortality rates, and certainly we weren't doing risk adjustment at that time. But with the introduction of DRGs, and the things improved over time, and how those were structured, and what they meant, and then they get really granular in terms of defining the levels of a DRG, and that's been redone several times over the years. Now, both internally and externally, using primarily billing data, we can measure and affect quality.
Nowadays, if you're looking at a top 100 designation, you're competing with about 2600 U.S. hospitals, they use all Medicare related data for the most part, so you've got Medicare cost reports, MedPAR data, data from CMS Hospital Compare, which you can look up online and see how your hospital is doing for different treatment of different conditions. And really, it's something worthwhile pursuing, because, well, of several reasons. Really, by pursuing something like this, you're learning, yes, how to code and document optimally, you're focusing on length of stay and other quality metrics, which I'll mention in a minute.
But you can really improve the quality of care by just working on this problem, even if you never reach the top 100 designation, by virtue of just focusing all of your clinical and some of the nonclinical areas on improving quality and satisfaction, your care will improve because you'll have to make changes that improve care that reduce infections, reduce complications, reduce errors, and that'll benefit you. And then if you so happen to occasionally fall into the top 100, then your hospital is going to get that status in your community, you're going to be able to use it for marketing purposes, and it has a lot of other benefits.
Just to, again, try and explain exactly what this means, the top 100 designation, this whole sort of contest or comparison has been around for a long time, and it's been owned by different things. I remember Solutions did it for a while, and Microsoft owned it for a while. And now it's under Pink AI, which is part of Premier. And who knows, maybe they'll change hands again in another few years.
But it's always been pretty consistent in who it measures. It breaks the hospitals in the country down to major teaching, which are teaching hospitals where they teach residents and fellows, maybe they don't have a med school, maybe they don't, you've got to have at least 30 major graduate education programs to consider a major teaching, it could be a large, medium or small community.
And those are defined again, by active beds, and some other parameters. And what they are looking at basically is the clinical outcomes, what are outcomes? Well, usually risk adjusted mortality and morbidity, you can think of it in general terms, operational efficiency that has to do with length of stay, and other measures of efficiency patient experience.
Some of it is subjective that the perception of the patients in the hospital, but again, this is something Medicare already collects and shares. And then the financial health of the organization, because you really can't be a good quality organization for very long if you're losing money consistently. If you dig in even deeper.
And again I'll just go through these quickly. But you're looking at risk adjusted, overall mortality, risk adjusted complication rates, they are going to include hospital acquired or healthcare acquired infections, as something that's monitored and included in this, you've got a 30 day mortality rate, because Medicare knows once you leave the hospital, they tie any death that occurs in those 30 days, or whenever they want to measure it, and identify it back to the hospital stay as well as a 30 day readmission.
Now, some people consider readmission, not necessarily to be a quality metric, others would argue that it is, I think both length of stay and readmissions are signs of a good measure of quality. And we can argue that point. The operational efficiency includes the length of stay, it also includes the spending on each patient, and then the expense of each discharge, which they have very sophisticated formulas for measuring.
Again, most of these are related, or are adjusted for the illness of the patient, the pre existing conditions, the age of the person, and so forth. As I said earlier, the patient experience is HCAHPS survey that's done across the country. And then the one financial measure that's in there now, and these things do change from time to time, but is the adjusted operating profit margin. And again, Medicare can do that just based on public data. That kind of gives you an idea.
And you can see how as a physician, you're going to have a lot of input, and a lot of say in how these metrics go, how well you're performing. You're the leader of the clinical team as a physician. So you're going to know a lot about these things. If you're a surgeon, if you're a hospitalist, if you're an anesthesiologist you're going to be involved with these issues anyway, in the hospital setting. You know, we typically as physicians in the past have been used to doing basically chart reviews of cases that quote, fall out. You know, nowadays, we're looking at objective risk adjusted measures to identify trends that are going in the wrong direction and trends that maybe indicate poor quality of care.
But let's see, we can probably dig into a little bit more by looking at, okay, so if we're trying to address all those issues, and let's say you're a medical director, or you're looking to become a CMO, or you are the CMO, what other staff are involved and who would they typically report to? This is where, if you look at these factors, you'll see why it's important that most every hospital have a CMO that can address these issues, but also from the standpoint of planning your career.
Well, if this is what's important nationally, and this is what's important to my hospital, then how can I help? And how can I develop the skills that enable me to help? If you look at the people that are generally involved in improving, like let's say being on a committee to help shoot for that top 100 designation, these are the people that are going to be involved. You're going to have your, and these are people I worked with when I was CMO, the Director of Quality Improvement, the Director of Utilization Management, the Director of Coding and Documentation Integrity.
These are things that are critical to reporting and to managing. Infection control, that gets to the HAIs. The pharmacy is critical to costs and improving care. If you can't get your drugs to your patients in a timely fashion, in a safe fashion, you're going to have problems. Informatics, of course, because you're going to have protocols, you're going to have order sets. Obviously, everything comes out of the electronic medical record, everything needs to be captured appropriately.
You're going to need health information. It's separate from informatics, but it's basically used to be the billing department and the records department, health information, health records, the charts, so to speak. And then the patient satisfaction is going to be important.
And then the finance is going to be helping to make sure that these things are captured correctly. And they're going to be there helping provide some of those reports if you want to meet that one metric that has to do with finances. Well, when I was CMO, I had quality improvement reporting to me from day one. Utilization management was reporting to me. Pharmacy reported to me. In fact a lot of these were just part of my typical line of directors, or you call them direct reports to me or the quality improvement director. Infection control was actually under quality improvement. Utilization management, coding and documentation integrity, and informatics reported to me. Some hospitals might be to the health information or to finance or something.
These things do shift around a little bit. But then looking at it again from how can I perhaps set myself up to become a medical director? And then the CMO, what can I do? Well, you can volunteer for committees and involve informatics, pharmacy, infection control, coding, documentation, utilization management, quality management. You can become the chairs of those committees. You can become a medical director focusing on one of these areas.
Maybe you work as a physician advisor for utilization management. And if you're a big enough organization, you'll actually have to have a medical director over that who's maybe supervising a couple of other physician advisors part time. You need to know coding and documentation pretty much anyway.
And so the more information you learn about this, you can do all this learning on the job for the most part. And you can also learn through like the APL. Even your specialty societies will have information and training on quality improvement. What are never events? What's a sentinel event? How do you do root cause analysis? All these things related to quality and utilization, length of stay. And then you set yourself up to walk into that CMO role when it's open or apply at a new institution. And I think it's a good way to think about pursuing this kind of position.
That's basically what I wanted to talk about today. Things are different now than they were 10, 15, 20 years ago. I've been out of the hospital setting for 10 or 11 years now. Pandemic has had a huge effect. But I think if you are, even if you're a frustrated physician, feel somewhat overwhelmed and overtaxed because you're working as an employee for a large corporation that runs your hospital, you can really strategize to take what you've learned in that hospital environment and move forward in a direction that will bring you into more interesting type of work, more management, more leadership. It has its own headaches.
But if you can manage to sort of plan out something over the next one, two, three years, you can go from basically minimal involvement in your hospital by signing up for some of these committees, narrowing down the ones that are really most useful, most interesting to you, sharing the committee when the time comes.
And then the other things you do in the meantime is you get a mentor or two, maybe there are other physician leaders in the organization that you can talk to and think, get their advice and how to move up that ladder. And the other thing is letting people know that you're interested as things come up, if projects come up and say we need a physician leader for this, we need to do a subcommittee or a temporary planning committee.
Who can we get to lead this committee? Well, this guy over here, this gal over there has this experience in running these kinds of things. They understand risk adjustment and statistics in medicine, and they understand DRGs and ICD-10 and how we do the coding, maybe they should be involved. And you'll see that it's not as difficult.
And then as you start to take on roles as a medical director what you do is you need to swap out your medical director time for your clinical time. And if you're employed by the hospital anyway, that's not that difficult. They might have to fill in some gaps, but if you cut down to 80% time or 50% time and the other 50% doing the medical director role, fine, they just replace your income as a clinician with that for as a medical director. And you find someone to fill in, you hire more staff to fill in or more physicians. And it's exciting. It's interesting. You're learning as you go. In the meantime, you can sign up for courses or classes online or live or annual meetings at the APL. And there's a lot you can learn even from your specialty societies, as I mentioned earlier.
So, that's what I want you to think about. When you're focusing on quality and satisfaction in the hospital, you're going to be improving the health and the lives of your patients and of your community. You're going to be assisting your organization and you're going to be learning new skills that will help advance your career in many new areas. With that, I will close this presentation and let me say a few more things before we go.
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