This week John spends a few minutes sharing his thoughts on one of three popular full-time careers when preparing to “level up.”

Today John delves into the idea of “leveling up”- a journey of self-improvement that can lead you to a more satisfying and financially rewarding career. Drawing inspiration from professional athletes and attorneys he shares how to take stock of your strengths, identify areas for growth, and set new goals to help you become the best version of yourself.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career you love. To learn more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

For Podcast Listeners

• John hosts a short Weekly Q&A Session addressing any topic related to physician careers and leadership. Each discussion is now posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 per month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

Three Most Popular Full-time Careers for Physicians Seeking a Change

Suppose you’re a physician considering a career shift. In that case, John highlights three nonclinical roles that might be perfect for you: hospital Chief Medical Officer (CMO), pharma Medical Science Liaison (MSL), and insurance company Utilization Management (UM) Medical Director. These roles offer improved work-life balance, competitive pay, and full-time opportunities with major organizations. John describes each popular full-time career and how you can smoothly transition.

Your Network is Your Net Worth: Resources to Help You Succeed

Transitioning to a new career isn’t just about what you know, it’s also about who you know. In this section, Dr. John reminds us of the importance of building a strong professional network and leveraging resources like LinkedIn, the American Association for Physician Leadership (AAPL), and the MSL Society. He also recommends joining online communities like the Remote Careers for Physicians Facebook group, where you can connect with others who’ve made similar transitions and get advice on your next steps.

Summary

Sometimes it makes sense to level up your career to one that offers better pay and work-life balance. The three options described today have demonstrated that they generally meet those goals. If you're looking for full-time employment in a well-established industry John advises you to consider one of these popular options. 

Links for Today's Episode:

• How to Become CMO in a Year – 052
• 4 Things the CMO Should Never Say to the CEO – 251
• Hospital Management Career Bundle Tactics to Quickly Prepare for a Hospital Management Job
• Find Your Great First Nonclinical MSL Job
• Complete the Journey to Your First Fabulous MSL Job – 277
• Build a Rewarding Career as an MSL – Use Coupon Code HALFOFF to purchase for only $198
• How To Secure Your First Utilization Management Job
• The Truth About Medical Specialists and UM Jobs
• American Association for Physician Leadership (AAPL)
• Remote Careers for Physicians Facebook Group
• MSL Society
• Check out the 2024 Nonclinical Career Summit to learn about MORE career options.

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Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 368

First Consider the Most Popular Full-Time Careers

John: Okay, nonclinical nation, many of you are ready to make a change in your professional life. It may be because you're frustrated and your work-life balance is shot, or maybe it's just because you're ready to level up.

What do I mean by leveling up? Well, leveling up can be described as a process of self-development or to become a better version of yourself. This can include identifying weaknesses and strengths, setting goals, replacing old habits with new habits, focus on success, and possibly moving to a career that's more satisfying and financially rewarding.

As I was thinking about this concept, I was trying to get examples, and I have two examples that really come to mind.

The first one is professional athletes. Some professional athletes are forced to retire. Some just reach their peak and decide after they've done everything they want to do, they just retire, but they have a lot of notoriety and they have hopefully saved up some money. And again, it's kind of parallel to what physicians can do.

I think of examples like those of Magic Johnson's business ventures in broadcasting, music, film, and finance, or John Elway's investments in dealerships in the Denver area that he said later sold off, and then him investing in the Colorado Crush of the Arena Football League in 2002. And of course, many successful athletes have finished their careers as athletes, and then leveled up to do something else very powerful.

Now, those might seem like outliers. Maybe those are just a select few, but I also think of attorneys. There are many attorneys who never practice, or let's say they finish law school, they pass their bar, and they do work for a while in the industry, in law, doing something, but then they find that they can take everything they've learned in law school and with their early experiences as an attorney and segue into another career, which they level up.

You can look around and see a lot of attorneys working in C suite of various companies, not actually practicing law, but applying what they learned as leaders, as researchers, as presenters, and they apply to the new job. You're an attorney and you have a background in healthcare law, well, you can do that with a big firm, or you can actually go and become part of a team to run a healthcare organization, and obviously all those skills will come in handy.

I interviewed somebody who was trained as an attorney. He, for a little while, was helping physicians with their contract negotiations as an attorney. What he did was leverage that to become more of an agent. He helps physicians negotiate better contracts as an agent, but not as an attorney. In fact, he still has attorneys review the contracts. That's a way to level up.

I think the physicians can do the same thing. Healthcare is the largest industry in the United States, and there are positions for physicians in every major aspect of healthcare. Maybe it's natural to think after a few years of being in the trenches and seeing patients, at some point it gets old, and now you look for the next challenge, and that's what we call leveling up.

And so, I want to talk about three of the positions that you should consider, particularly if you're in a big hurry. Now, you can spend six, 12, 18 months researching all of the possible nonclinical careers out there, but if you're looking for a particular type of career that I'll mention in a minute, then maybe you should select from one of the three most commonly pursued careers and go from there, and that's what I'm going to talk about today, the pros, the cons, some of the tactics for doing this, and so forth. They definitely provide a better lifestyle, and they pay well, and so I thought I would focus on those today.

Those careers are those of a chief medical officer at a hospital or health system, medical science liaison, or UM medical director. Now, they're all full-time jobs. We're not going to mess around with starting a new business or getting a part-time job and then segwaying to maybe looking for two or three different part-time jobs that you can patch together like I've talked about before, but these are full-time jobs. They involve employment with a large organization. They have a lot of the usual benefits that only large organizations provide, and they're really seen by physicians as very, very viable options. And so, I thought, "Well, if I can provide examples of these three and tell you a little bit about each of them, maybe that can kind of jumpstart your process of leveling up."

All right, I have definitely interviewed multiple physicians doing all of these jobs. I personally have been a chief medical officer, know many other chief medical officers and other senior executives in hospitals that are physicians. I've interviewed many medical science liaisons, which represents the pharma industry. And then the third is, again, one of the most common, and maybe somewhat underappreciated, and that's being a medical director for a health insurance company, or you might call them a healthcare payer, one of the big ones. That's what I want to talk about today.

Let's talk about the chief medical officer first. What about that? How do we do that? And one of the things that comes up, because maybe I'm comparing these three directly, and it's a little bit, I wouldn't say disingenuous, but it's not correct to, let's say, talk about a new MSL and someone who's becoming a new CMO. CMO is a pretty high-level position. Now, I was going to talk about medical directors in the hospital setting, and it is the stepping stone to becoming a CMO. Both those jobs pay well, they have great benefits, and the lifestyle is much better than, let's say, a practicing physician as an anesthesiologist or an ER doctor in the hospital.

But most medical directors that work in the hospital setting are medical directors for a service line, which means they're usually practicing at least half-time as well. I wouldn't want to call that medical director position as a full-time position. Now, there are some full-time medical director positions. If you're in a large enough hospital and you can be a medical director for quality improvement or for informatics or for utilization management or, let's say, even coding and documentation, those can all be full-time jobs. They can pay well. You can replace your clinical salary for sure. And they do serve as a stepping stone, though, to the ultimate hospital environment job, which would be that of a chief medical officer or one of the other senior positions like chief medical information officer or chief quality officer, something like that.

Now, as far as getting from your medical director role up to the CMO role, which is that last step before, but you could eventually become a COO or even a CEO of a hospital. But in focusing on the CMO role, you're going to do some of these things that we will talk about with all three positions, really.

Maybe a little different here. You might want to get an executive coach or mentor. You definitely want to join LinkedIn because you're going to do a lot of your networking and looking for jobs on LinkedIn if you don't have a way to segue up to the current institution where you're already working.

One of the resources is the AAPL, which is the American Association for Physician Leadership, which is at physicianleaders.org. They have a bunch of books. There's a bunch of other books you can look at for healthcare finances and leadership and so forth.

And the question with that job is, "Does it require relocation?" If you're in a large metropolitan area, there's probably multiple systems where you could look for a job, but it's not uncommon to be able to work your way up an institution's hierarchy, work as a medical director, take on more responsibility over time while you gradually decrease your practice. And ultimately, while you might keep your license, you reach a point where you really don't need a license.

I would maintain it only because sometimes when you're looking to change to a CMO role at another organization, they want you to have the license. I think sometimes that's because they might be using your license for some things, having to do with the pharmacy or covering for ordering drugs for different units. But ultimately, you won't really need to have that license because you're no longer seeing patients. Although as a CMO, you can continue to see patients once a week or every other week or so if you want to continue to do that.

But it's one of those jobs that you should think of right off the bat if you're in a position that enables you to pursue that kind of job. It's not right for everybody. If you're a dermatologist working in an outpatient setting or if you've never had privileges at a hospital, it makes it difficult to start that job search from nothing as opposed to being one of these people in the hospital that are there all the time, the emergency physicians, anesthesiologists and various surgeons and so forth. Geriatricians and hospitalists are typical, very common to move up that path. So that's the first one.

With that, I think I'll move on to the next one, which is medical science liaison. We've talked about this before. It's a very common and attractive position. It really doesn't require any special background. I think it's helpful if you have experience in working with particular drugs or drug classes. It's kind of whatever's popular at the time. Oncologists typically can get into pharma very easily. They'll often go into more of the clinical research side of things, but as an oncologist, it would be very easy to become an MSL, but also pretty much anyone who's using certain drugs and classes of drugs, whether it's cardiology, even gynecologists and family physicians, internists for sure. There's a big push in GI drugs lately. So if you were doing GI work and wanted to transition to this role, it'd probably be fairly easily.

And there are even positions for people that don't have a residency and haven't been in practice, but we're really focusing on those who have been in practice and want to level up to something new with a better lifestyle, but actually paying equal to or more in the long run than what you're doing now. And as I said, we're going to focus on some of those drugs to help convince our new employer.

As far as resources to try and move into this role, you want to commiserate with others that are doing it, you want to go on LinkedIn, you want to have a great profile. This applies to all three. Great LinkedIn profile, networking on LinkedIn, engage with peers. You can join the MSL Society, which the link there is themsls.org. They have a lot in there for people who are already medical science liaisons, but you can imagine just taking a few entry-level courses and reading about becoming an MSL and being an MSL and exceeding and excelling as an MSL would be very helpful. And in addition, you'll learn the language that they speak.

And when you're doing interviews and submitting your resume, you want to sprinkle those and your LinkedIn profile with the vernacular that's not used outside of the pharma industry. And some of it's not even used by anyone other than medical science liaisons. I do also mention the Contract Research Organization, CRO, because you can work directly for a pharmaceutical company as an MSL, but a lot of MSLs work for contract research organizations.

A CRO has different names, it could be the Contract Research Organization, it could be Contract Resource Organization, but they provide resources to pharma companies for those things that they don't want to keep hiring for. And sometimes it's MSLs, it can be other things, it could be the components that actually provide the studies, that monitor the studies and so forth.

You oftentimes will find that CROs are hiring medical science liaisons a little quicker than the pharmaceutical companies go. And all of these things are dependent on what is going on in the industry, how much demand there is based on what new drugs are being released by various companies. And it's at that point of release that MSLs get heavily involved. It's an educational role, it's not a marketing or sales role.

I remember once talking to a guest who's a pediatrician and she didn't think there was any way she could be employed by a pharma company, but because of all the experience she had with vaccines, they happened to be looking for somebody that had that experience and she was able to get a job. And I think initially she was employed by a CRO and then later moved up to a full-time position either with the CRO or with the pharma company itself. That's the second one I wanted to mention today. Don't forget to look at the MSL Society to get some ideas on how to approach that goal.

The last one I want to talk about today, again, one of the big three, is working as a medical director for a utilization management company, working for a large payer. Again, that doesn't require any special background. If you've done chart reviews before in the hospital setting, particularly maybe you've been a physician advisor for UM in the hospital, that might help. All the big insurance companies hire these people, but they also sometimes farm this out to something called an IRO, which is an independent review organization.

And so, many people when they're starting out and becoming a UM or a benefits management medical director, they'll apply at an IRO first and they'll find a job part-time. This is the one that's a little easier to do, kind of the pilots where you're still doing your old job. You're doing some part-time chart reviews for an IRO and then some IROs will hire you full-time.

One of my colleagues really, he hasn't been a guest on the podcast yet. I'm probably going to have him on someday, but he was a surgeon and he just wanted to spend more time with his kids. And he thought, "Well, I don't know. I make a fair amount of money as a surgeon but I'm not having any time with my kids. I'm not spending enough time with my kids. They're growing up, I'm missing on that." And he said, "I'm going to level up to one of these different careers." And so, he did start working as a medical director for an independent review organization and he actually really enjoys it. In addition to doing general sort of chart review work, he's also serving as a resource for those surgical cases. So you can always get that. Even if you're a specialist, sometimes they have special roles for you. One of my other guests or the other one that was a guest as opposed to this first example, he was an invasive cardiologist for pediatrics.

And yeah, he's been working at a health system or a health insurer rather for gosh, at least five or six years now since I interviewed him. And he's very happy and he actually helps other people do that. The resources for that, besides looking around for IROs, if you want a list of some of the IROs, they're basically the ones that are certified. You can go to NAIRO, which is the National Association of IROs at nairo.org/members. You'll get a list of all the NAIRO members and you can go look at their websites to see if they're hiring the type of medical director that you might be looking at. And again, these can be for part-time positions to get you started, to get you exposed.

You can also go to Facebook and look for the Remote Careers for Physicians Facebook group. It's got at least 10,000 members now. It's pretty big group. And everybody in there is kind of talking about working as a payer or a health insurer UM medical director and other associated types of positions.

All the big insurance companies definitely will hire these people as well. Whether we're talking about Cigna or Centene or several others, any of the big ones, they all have them. But they also outsource some of the work to the IROs. Again, I will remind you that for all these positions, it's important to be on LinkedIn. It's important to have a complete profile. It's important to use LinkedIn and sometimes Doximity to locate your colleagues and network with them. See if some of them are already doing one of these jobs.

Like I said, maybe it's time to level up and this is how you can get started. And if one of these three positions sounds right for you, then you can just jump in now and start working on it and see what you think.

The other thing I would say is besides what I've already mentioned in terms of the benefits is they have great benefit packages in most of these places. You've got health insurance, disability insurance, retirement plans, four to six weeks of paid time off. And some of them will even give physicians deferred compensation benefits. So that can be nice for your retirement planning.

Well, I guess that's it for today's discussion. Thousands of physicians literally just in the last few years have found happiness in each of these three careers. They all offer full-time salaries, generally good benefits, and there are resources that can help you get started. Just check out those resources and get going. And if you have any questions, you can always contact me.

If you want to access everything that I've talked about today easily, you can go to the show notes. You'll also get a link to the podcast episode. You'll get related links, several related links actually and the transcript. And you can find all that at nonclinicalphysicians.com/popular-full-time-careers.

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Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career. 

The post First Consider The Most Popular Full-Time Careers appeared first on NonClinical Physicians.

Interview with Dr. Mark Olsyzk – 356

In today's interview, outstanding CMO Dr. Mark Olszyk provides his advice and that of his co-authors from The Chief Medical Officer's Essential Guidebook. 

He discusses the critical skills required for effective medical leadership and practical tips for navigating complex healthcare challenges. And he emphasizes the importance of continuous learning and collaboration among healthcare professionals to be successful.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast. The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

For Podcast Listeners

• John hosts a short Weekly Q&A Session addressing any topic related to physician careers and leadership. Each discussion is now posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 per month.
• If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
• The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

The Journey to Becoming an Outstanding CMO: Insights and Experiences

John leveraged resources from the American Association for Physician Leadership (AAPL), including its Certified Physician Executive (CPE) program, to enhance his leadership skills. That is where he met Dr. Mark Olszyk, a seasoned physician leader with a rich background in military service and medical administration.

Dr. Olszyk, co-author and editor of “The Chief Medical Officer's Essential Guidebook,” shares his extensive experience in medical leadership. From his early days in the Navy to his decade-long tenure as a Chief Medical Officer (CMO), he highlights the importance of learning from successes and mistakes. The book serves as a comprehensive guide for aspiring CMOs, offering practical advice and lessons distilled from the experiences of various medical leaders.

The Role of a Chief Medical Officer: Responsibilities and Challenges

Dr. Olszyk outlines the multifaceted role of a Chief Medical Officer, emphasizing the importance of building bridges between various stakeholders in a hospital. He describes the evolution of the CMO role from the Vice President of Medical Affairs, focusing on credentialing, privileging, quality reviews, and regulatory compliance.

A CMO is a liaison between the medical staff, hospital administration, and the board of directors, ensuring effective collaboration. Dr. Olszyk also discusses his journey in medical leadership and the fulfillment he has experienced during his career.

Advice for Aspiring Medical Leaders: Steps to Take and Skills to Develop

Mark offers practical advice and steps to gain relevant experience for those considering a career in medical leadership. He encourages involvement in leadership roles within hospitals and joining professional organizations like the AAPL and the American College of Healthcare Executives (ACHE).

He also emphasizes the value of networking, seeking mentorship from current medical leaders, and continuously developing leadership skills through education and practical experience. By engaging in paid and volunteer leadership opportunities, physicians can significantly influence the future of healthcare while developing new skills, on their journeys to outstanding CMO.

Summary

In this interview, Dr. Mark Olszyk shares his extensive experience as an outstanding CMO and co-author of “The Chief Medical Officer's Essential Guidebook.” For those interested in purchasing the book, it is available on Amazon or through the American Association for Physician Leadership (AAPL) website, where volume discounts are also offered.  You can reach Mark directly via LinkedIn.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• Dr. Mark Olszyk's LinkedIn Page 
• The Chief Medical Officer's Essential Guidebook
• AAPL: The Chief Medical Officer's Essential Guidebook
• 4 Things the CMO Should Never Say to the CEO – 251
• 6 Important Assignments of a Hospital CMO – 218
• What Makes a Great Health System Chief Medical Officer?
• Purchase Your All Action Pass Videos and Bonuses from the 2024 Summit (Use Coupon Code 30-OFF)

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 356

The Essential Guidebook to Being An Outstanding CMO

- Interview with Dr. Mark Olszyk

John: During my efforts to improve my skills as a physician leader, I naturally took advantage of the AAPL, the American Association for Physician Leadership, including its CPE program. And it was during the final week of that CPE program that I met today's guest. He's a consummate physician leader, starting with way back when he was in the military. He may still be in the military, I'll ask him about that. But anyway, he's held numerous leadership and executive positions, and he's also the co-author and editor of a new book, well, it came out last year, The Chief Medical Officer's Essential Guidebook. Let's welcome Dr. Mark Olszyk to the show. Good to see you again, Mark.

Dr. Mark Olszyk: Good to see you, John. It's been too long, but thanks for having me and inviting me to your podcast. I'm really excited to be here.

John: Excellent. I have brought up the issue of physician leadership, and especially in the hospital setting, many times over the years on the podcast. And as far as I know, there are books written about the job and different aspects. But really, when I saw this book, with excellent collaboration with the AAPL and yourself with all your experience, this is just perfect for those in my audience who are thinking about moving along those lines, and actually a "how to" to get there. I really appreciate you putting this book out there.

Dr. Mark Olszyk: Oh, well, thanks. To answer your previous question, I'm not still in the military. I got out in 2003, kind of hard to believe, but I'm a proud Navy veteran, and my son is an Army ROTC. So, get that out of the way.

John: Nice.

Dr. Mark Olszyk: Yeah, yeah. The book, I think everybody at some point in their lives, reflecting on their experiences, and their travels and their journey, say, "Yeah, I should write a book about that." And I'm no different. But I've been a CMO, chief medical officer for about 10 and a half years. But I've been in medical leadership since the first year after finishing residency, I went into the US Navy. And the military, unlike almost any other sector, will put you in to leadership positions as soon as possible. And you find a way to get the skills and find the maturity and the leadership is thrust upon you and you have to rise to the occasion. I've always been grateful for that.

But I had gone to conferences at AAPL, others where I met other chief medical officers, and we would share stories. And I thought, boy, it'd be great to write this stuff down and distill this because these are some really valuable lessons, not just the things that we had done correctly, but all of the mistakes that we had made. And wouldn't it be better for other people to learn from our mistakes rather than repeat them themselves.

I guess it came to a head in our system. Physician was made chief medical officer of another hospital. And I just kind of casually passed along here's 10 things to do, like the 10 commandments, but not nearly as inspired, but just 10 things. And about six to eight months later, I guess he lost it. It was that impactful. But he lost it and said, hey, can you send it to me again? I just didn't have it. And I thought, "You know what? If I'm going to write some stuff down, let me make it into something." And it just kind of grew. And I talked to some of my colleagues and contacts. And I said, would you guys be interested in collaborating on a book? Because I think it'll be enormously boring if it's just me telling the stories. But if we have a whole chorus of voices, I think that might really strike a note.

I just had no idea how to publish a book. I just didn't want to do it on my own. I approached AAPL. And Nancy Collins was very gracious. We actually met in a Starbucks in Maryland. And she showed me some of her other publications that came out recently, one of which was a collaborative effort. And it just kind of grew from there.

I reached out to everybody I knew in my life who was a CMO or medical leader. And there was a lot of enthusiasm. I learned a lot in trying to shepherd people together for a collective effort where I was not their boss. They were not getting paid. And there was no way I could really enforce any sort of deadlines or standards. That in itself could be a book, a book about how to write a book. But it was a fun journey. I'm glad it's out there and I've received some excellent feedback.

John: Yeah, when I look through it, of course, most physicians, actually, most clinicians, of course, they like teaching, like helping their peers and so forth. And I think many, if not all, not all of the section writers or physicians, of course, you tapped into other expertise, which I like. There's a lot covered there.

And when I think about the CMO role, it's in my mind is like this iconic what does a CMO do? But everyone does it differently. Everyone does different aspects, more depending on each job. It's unique. But yet, I think you covered everything that I could think of in terms of what questions would I have if I was thinking about being a CMO or I was and I was missing something. So tell me a little bit more about the process. How did you herd all these cats and get this thing done? How long did it take you to do?

Dr. Mark Olszyk: From start to finish, it took about a year. Some of the author contributors returned their submissions in two weeks. Others took about eight months. Some needed multiple revisions, some needed none. I did recruit two co-editors, Aaron Dupree and Rex Hoffman. They helped out a lot.

I learned a lot about copy editing and all of the back office productions and placing it and formatting it. From what had existed only as a series of, I'll say, not too well organized Word documents on my desktop, to see that transform into an actual written book was pretty fascinating and eye-opening. But originally I had an idea for a structure and like all initial ideas, it went away pretty quickly.

And so I just asked people to write about what they felt that they were knowledgeable about or passionate. And the outlines of a puzzle began to come together. And then after about 75% of the submissions were in, at least an outline form, then I could actually target what was missing.

As a frustrated or wannabe classicist, I used the model of the medieval concept of the human being. The first set of chapters, the first section is about the anatomy of the CMO, the basics, the blocking and tackling, metrics and patient experience and all the quotidian day-to-day activities that were going to be the guts and the sinews and the bones.

And then we would move on to the heart, which is all about relationships and how the CMO relates to the chief nursing officer, the chief executive officer, to the board of directors, to departmental chiefs or chairs, and also their perspectives, what they think a CMO should be, or how a CMO should act to be successful in their eyes.

And then we moved on to the brain, the strategic thinking, extra hospital relationships, like how do you deal with third-party rating agencies and auditors and joint commission and dealing with the media, especially when the memories refresh from the pandemic, what if you're asked to appear on TV, on live TV, on the radio and newspaper articles how do you prepare for that?

And then finally, the soul or the spirit, which would be the transformational values and ethics and diversity, inclusion, aspirational type things. It was kind of a journey from the very basic things that a CMO would do day-to-day to the more long-range aspirational goals or values. And I think the way it's written, you can skip around. You can say, gee, I want to learn more about how to prepare for a media interview or how to relate to the board of directors. And you can go right to that section. So it doesn't have to be read in order. It can be used as a reference or it could be read as a story in itself.

John: I think it's pretty comprehensive. And probably in anyone who serves as CMO may not even be exposed to all the things that are covered. There's so much and again, because each role is slightly different. So it's awesome. One of the things I like to do when I'm bringing on an editor and author is pick their brain. So I have an ulterior motive for having you here other than just to talk about the book, although again, it's fairly comprehensive.

But just to keep what our audience's appetite here for this job because some are a little reluctant maybe they have a negative feeling about working in hospitals being abused by somebody or another, but there are good systems out there. And the other thing is being the CMO, you can make a big difference in how that organization is run. Tell me what you would say, if you were to boil it down, what are the most common areas that a chief medical officer is sort of responsible for? Maybe another way to look at it is like who reports to them, because it kind of makes me think about, okay, well, I do this because this person reports me. So however you want to answer that question in terms of the core roles of a CMO.

Dr. Mark Olszyk: I think the CMO role evolved from what was previously and still exists, usually in a hyphenated title, Vice President of Medical Affairs. That being the mechanics and the support staff for the organized medical staff. And every hospital per joint commission guidelines and through history, has had an independent organized medical staff who are largely responsible to establish their own standards for credentialing and privileging. And that was made ever more important back in the 1960s, when there were landmark cases, lawsuits, where patients began to sue hospitals. And the hospital said, hey, we have to really have some quality standards, and we're going to ask the medical staff, almost as a guild to police itself. But the medical staff have full-time jobs taking care of patients, and it's hard for them to keep the files and the minutes and the records and organize the meetings and stay abreast of all of the regulatory changes.

There is an Office of Medical Affairs in every hospital. And the Vice President of Medical Affairs, now the CMO, is largely responsible for ensuring the quality of the medical staff, making sure the medical staff leaders understand what they're supposed to do, making sure that they do it. And it's challenging in that the medical staff can be employees of the hospital or healthcare system. They can be contractors or vendors, or they can be completely independent. And when I started out at this hospital, it was about one-third of each.

To get all those different folks with their different interests aligned in a common effort proved to be a challenge, but one I thought was very fun because I had to look at their world through their eyes and also convince them that what we were doing was necessary and important and create a team not of rivals or competitors, but of people who didn't necessarily all fall into the same silo.

We're largely responsible for the credentialing, privileging, presenting those applications to the medical executive committee and to the governing body, which is usually the board of directors, making sure everyone is completing their FPPEs, their OPPEs, the ongoing professional performance assessments, making sure they're up to standards with joint commission, reviewing and knowing the bylaws. I probably know the bylaws better than anybody in the hospital. We've rewritten them 10 times since I've been here. Quality review, and then making sure that the medical staff were involved in all of the various intra-hospital, extra-hospital committees radiation safety, prescribing, that sort of thing.

What I'd like to say is that the chief medical officer is a bridge builder between the hospital administration and the medical staff, but also between the medical staff and the board of directors, between the hospital and the community. Sometimes the CMO, I found myself as the spokesperson during the pandemic especially. It was on local radio, on TV trying to break down in very understandable terms what was happening, but also bring back to the hospital and tell them, hey, this is what the community is concerned about. Here are the questions they have.

We have to be mindful of that, responsible for that. Also within the hospital, being a bridge builder between the various departments translating the needs of the hospitalist team to nursing or between medicine and surgery and sometimes refereeing, sometimes being just the host getting folks together.

But I always come back to bridge building. And again, if you look through history, through cinema, through literature, bridges always figure prominently in history, battles of the Milvian Bridge with Constantine changing the nature of the Roman Empire, Stamford Bridge, which ended the Viking Age in England. All these great events happen on bridges. Even if you've seen Saving Private Ryan, which came out, in 1998. The last ultimate scene, Tom Hanks losing his life is actually on a bridge. And if you're a fan of The Lord of the Rings, that's where Gandalf the Grey transforms into Gandalf the White. And again, Jimmy Stewart, It's a Wonderful Life. The transformational scenes occur on a bridge.

I was a scoutmaster. When the Cub Scouts become Boy Scouts, they cross over this bridge and they don't really pay much attention to it. But I gave a little speech to the parents, like, look, this is a special time, you're going from one part of your life to another. And this is punctuated by going over a bridge. Bridges represent liminal spaces, liminal time, when you're not here, or there. Bridges are a great metaphor, because they're very narrow. And they're very risky, because if you fall off one way or another, if you don't keep a straight path, if you don't keep your eyes on the goal, tragedy can ensue. And sometimes it's foggy, sometimes it's slippery. So, it takes somebody who's been back and forth a few times, who's surefooted, who is focused to to cross that bridge.

And bringing together all those communities, translating their needs and their goals and their concerns from one party to another, can be very risky. If you don't do it correctly, it can really backfire. That's why I consider the role as bridge builder. The Pope himself is the official title is Pontifex Maximus. The greatest bridge builder. I don't think the CMO is the Maximus, but I think it's a very important bridge builder, we can all build bridges. And hopefully, the CMO can exemplify that.

John: The ironic thing is that if you go back the last 20-30 years, for a while there, there weren't that many physicians in leadership positions, at least on the community hospital side you always had academic hierarchies. But I think in the 50s, up to half of hospitals might have been owned by physicians, and then over time, it just everything got split. And so I think what you just said, it's important that physicians be in those roles. So I'm glad that there are more physicians and when I started as VPMA, our hospital had never had a VPMA or a CMO. So many hospitals now do.

Building on that, tell me in your opinion, the pros and cons of being a CMO. Like I say, I have many people that are a little reluctant to make that commitment. But to me, it was a natural thing to pursue. So, what are your feelings and some of the challenges and also just what you love about it?

Dr. Mark Olszyk: Yeah, for me,this can sound a little pollyannish or saccharine, but for me, there's no downside. I guess it just fits my personality. When I was a brand new attending physician, I would see these larger forces at work in a hospital, budget, staffing challenges. And I'm like, man, I just want to be able to fix that I want to get involved in that. So it was kind of a natural course. I got my MBA so I could talk the talk and understand some of the discussions a little bit better, and then got more and more involved.

And it's just hard for me to resist trying to represent my fellow medical staff members, physicians, but pretty much trying to weigh in. If we're planning an expansion to the hospital or adding a new service line, or how do we go about on some major quality initiative, I really want to have a seat at the table and have a voice. So the best way to do that is to get into the C-suite, you get into medical leadership, develop those relationships and connections.

What I love most about the job is probably as a CMO, I'm an ambassador, plenty potentiary, I can go to any clinical department, I can go right down to pathology right now, talk to my chief pathologist. And he's got a two sided microscope, and he'll show me some slides which look like pink and purple squares. And he'll say, what is this, and I'll get it wrong every single time. Then we talk about his family. I get to know him as a person. And that builds a bond of trust, it furthers our relationship. I can walk out of there and I can go up to radiology and look at some of the images with the radiologists. And then I can walk in to the surgical suite and get gowned up and just see what the surgeons are going through, see what their day is like. Yeah, I can do the same thing for the hospitalists, for pediatrics.

I actually like being a medical student in my third and fourth years because you have a different rotation every month. It was always fresh, it was always interesting. And that's why I went into emergency medicine where you're expected to be somewhat proficient in almost anything because you don't know what's going to walk through the door. So, you have to know about pediatric medication doses, you have to know how to treat people struck by lightning or bitten by rattlesnakes or CHF in a hundred-year-old.

So, you have to know everything you have to know enough about every specialty. And then you wind up calling every specialty, sometimes in the middle of the night, but often during the course of your shift, either for follow-up or for intervention. And so, you have to learn how to speak their languages. And I just never really wanted to give that up. I didn't want to find myself just in one specialty and not continuing to learn and stay abreast of all the others.

So, I think that's the most fascinating aspect of being a CMO is, I'm pretty much given a hall pass to go wherever I want in the hospital and no one questions that. In fact, they kind of expect that. And that carries over. I get to go to the board meetings, to the finance meetings.

I can drop in on the chief nursing officer, chief quality officer. So for a person who's emergency medicine docs tend to be a little bit restless and always looking for some new stimulus, that was just a perfect job for me. So, that's my favorite aspect and one I would not ever want to give up.

John: Excellent. Now, it's interesting. We all have our own particular things that we like. I loved interacting with the board. I was on the every board meeting. I had an official presentation and I actually love spending an hour or two preparing that. I like being alone in my office and doing things to prepare for that. Whereas other people are like I want to be out there in the public. There's so many different things that one can do.

So, if there's someone in the audience who's either thinking about, well, would I like this or should I do this? Or I'm about 50% sure that I want to do this. What advice would you have for that person early in the thought process of pursuing a leadership position, let's say, rather than and it may be eventually CMO?

Dr. Mark Olszyk: Yeah, I'll approach that a little bit obliquely. So, I've given a number of leadership talks over the years and folks are always asking, well, how do I get experience being a leader? I'm like, there's no end of opportunities. Having been in the Boy Scouts, I have three sons, and they're all Eagle Scouts now. But people are always looking for leaders. And it might not be the thing you want to do forever.

But whether it's your church or civic group, the schools, they're always looking for someone to step up. And I said, boy, if you can be a Scout leader, and hold the attention of 60, 10 and 11 year olds for 90 minutes, you can do anything. First of all, brush up your leadership skills wherever you can find the opportunity doesn't have to be in the hospital.

Secondly, the hospitals are always looking for medical leaders. I've seen a ocean sea change in the last 10 years. It used to be that our medical staff meetings, our quarterly medical staff meetings, were raucous affairs, we would have 60 or 70 people there.

As our models have become more contracted or employed physicians, I guess they don't have the same feeling of being community stakeholders as when it was mostly independent physicians in the community who had been there for decades. Now the days are long. And I think after a 12 hour shift, the hospitalists want to go home. And there's also the opportunity to Zoom into a meeting. So we don't see as many people attend in person. And it's getting harder and harder to get people to volunteer to spend an hour or two, even if it's once a month, in a peer review committee, because it does take some commitment to read over the cases and then show up for the committee. And we don't stipend or remunerate anyone except for the chair or the chief.

So it's volunteer work. We're always hungry for that. I'm sure every hospital has opportunities. If you want to get involved in peer review or bylaws or credentialing, or on the pharmacy and therapeutics committee, there's definitely opportunities there. Or the foundation or fundraising, or there's lots of opportunities.

And then you begin to network. I guess the next opportunity would be just to ask your chief medical officer. You could probably shadow him or her for the day. We all like to talk about ourselves. I'm doing it right now. If someone came to my office and said, hey, I'm interested in one day being a CMO or an assistant or vice, what's the path? And it depends on the person, on their personality, what they would like to do. Everyone does it differently. Every hospital has a different set of requirements or needs. So it's dependent, but I would be very willing to talk to them. I think anybody would.

Next you could buy the book and look through that. A little selfish promotion, or you could join one of the organizations, AAPL, ACHE. States have their own chapters. Every specialty has its own chapter as well. I think there's lots and lots of opportunities. You can write articles. Journals are always looking for articles. So there's a lot of ways to just get more involved. I don't think anybody in a medical leadership position would be reluctant or hesitant just to make the time for someone who expressed an interest and wanted to learn more.

John: The other thing I found useful, I don't know if it's still the same, but talking to the CEO, hey, what's your perspective on physician leaders and what should I do if I want to get up and be part of the senior executive team? So there's tons of opportunities.

Dr. Mark Olszyk: Absolutely.

John: But we are going to run out of time. So let's talk about the book again. Let's start with what do you think is the best way to get the book? Should we go to the AAPL? Should we go to Amazon? Are there other ways of finding the book?

Dr. Mark Olszyk: Either one of those is fantastic. If you go through AAPL and you want to order a lot, there are volume discounts or you can go to Amazon, it's easy. You can type in chief medical officer or even my last name, which is not too common, Olszyk book, and it'll pop up. You'll see a couple of Amazon reviews. Unfortunately, some were written by my children. Ignore those. And if your listeners or podcast watchers do get a copy, please do leave a review. It's important. But yeah, either way, you go through AAPL. I think there are some other platforms out there, but those are probably the two most common and easiest to go through.

John: That makes sense. What if they have a question for you? Can they reach out to you?

Dr. Mark Olszyk: They can reach out to me. Yeah, I'm on LinkedIn, as you know so you can direct message me. People have done that and I've responded quickly.

John: Okay, good. Excellent. It's good sometimes just really to talk to the editor or author. Of course, you wrote several of the sections of the book in addition to being the chief editor and you said you had some help with that. But okay, well, any last bit of advice before I do let you go in terms of the future of medicine and physician leadership therein? Any other words of wisdom before I release you from this torture?

Dr. Mark Olszyk: No, it wasn't torture at all. I really enjoyed it. It's good seeing you again. And again, thank you for the opportunity. Clearly, like everything else, medicine is going to change more in the next 10 years than it has in the last two generations. So if you want to be part of that change, get into a leadership position, let your voice be heard. I think a pessimist is someone who takes no joy in being proven right. And an optimist is someone who thinks the future is yet uncertain. So if you want to help craft the future, get involved.

John: That's awesome advice again. And I think physicians do resonate with that for the most part. I want to thank you again for being my guest. I might have to have you come back and dig into one of these topics that's in the book, maybe in more detail at some point, but it's been great talking to you again. We appreciate you sharing your expertise with us today.

Dr. Mark Olszyk: Cool. Thanks, John.

John: You're welcome.

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The post The Essential Guidebook to Being An Outstanding CMO appeared first on NonClinical Physicians.

Interview with Dr. Adam Robison – Episode 333

In today's episode, Dr. Adam Robison explains how he was able to found a start-up, AI Medica, while practicing hospital medicine full-time.

This interview will reveal the impact of AI Medica's software on healthcare efficiency, its integration with Electronic Health Records (EHRs), and its role in enhancing clinical decision-making. Adam provides his firsthand account of navigating the complexities of healthcare technology while practicing medicine.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released.  The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, contact us at john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

Revolutionizing Healthcare Efficiency with AI Medica

During our interview, the founder of AI Medica discusses the journey of his software optimization company and its groundbreaking role in transforming healthcare data accessibility. With a focus on integrating with Electronic Health Records (EHRs), AI Medica streamlines medical calculations, provides coding review, and enhances clinical decision-making while using your EHR.

Navigating Entrepreneurship in Healthcare Technology

Adam also delves into the challenges of founding a company while maintaining a thriving clinical career. From overcoming the limitations of existing EHR systems to securing investments and building a business, he shares insights from his entrepreneurial journey. During our conversation, he highlighted the major steps he followed: 

1. Identifying a universal problem,
2. Leveraging personal experience,
3. Describing the technological solution,
4. Collaborating and investing,
5. Navigating the complexities,
6. Continuous learning, and
7. Balancing clinical practice and entrepreneurship.

These steps resulted in the creation of AI Medica, a company poised to streamline healthcare data accessibility and decision-making. Doing so, helps physicians work more efficiently and improve quality of care.

Summary

To learn more about AI Medica and connect with Dr. Adam Robison, you can visit the official AI Medica website. For inquiries and demonstrations, you can contact Adam directly via email at adam@aimedica.ai. Additionally, you can reach out to him on LinkedIn for further information.

AI Medica offers a revolutionary solution to streamline healthcare data accessibility within Electronic Health Records (EHRs), making clinical workflows more efficient for physicians. If you're interested in exploring how AI Medica's tools can benefit your healthcare institution or clinical practice, feel free to reach out and schedule a demonstration.

NOTE: Look below for a transcript of today's episode. 

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

• AI Medica website
• Apply Discovery, Innovation, Value, and Execution to Launch Your Business – 319
• Here is the Designer of the Best Medical Image Repository Ever – 125
• Top Five Start-Up Secrets for the Physician Entrepreneur – 087
• How Blockchain Technology Can Protect Your Credentials with Dr. Leah Houston – 045

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 333

How to Practice Hospital Medicine and Found a Startup

- Interview with Dr. Adam Robison

John: I'm really happy to meet today's guest because besides being a hardworking hospitalist, he's a hospital manager and leader and founder of an EHR optimization startup company, which we'll talk about for sure. Hello, Dr. Adam Robison. Thanks for coming today.

Dr. Adam Robison: Thank you so much for having me.

John: I am very happy that you're here. This is going to be very interesting. People know that I have an affinity for hospital management work. I was a CMO of a hospital and I know a lot of physicians are always trying to get away from it, but I always like to talk to people like yourself who are in hospital leadership positions and of course, also an entrepreneur. So this is going to be fantastic.

Let's just start by you telling us a little bit about your background, education and clinical career, and then we'll get into the other stuff after that.

Dr. Adam Robison: Yeah. My name is Adam Robison, like you said. I am an internal medicine doctor. I trained at the University of Louisville. I'm a big Cards fan. We did pretty good this year in football, so I was pretty happy about that. I've been working as a hospitalist clinically for the past seven and a half, almost eight years now. I work in a small community hospital out in the middle of nowhere in Idaho, in Twin Falls, Idaho. It's a great place to practice and I've been out here for a while and we are here for quite some time.

On top of that, I do work as a lead hospitalist for my group. There's about 120 providers and we cover about four or five sites right now. And so, that's been interesting work. I took that role all about almost three years ago, right at the middle kind of beginning stages of COVID. That was a very interesting time to take over as a leader of a large hospitalist group and try to navigate through that. That was good learning experience.

John: Yeah. I'm tempted to say, "Well, okay, how did you solve all those problems of people being too sick to work and not having enough PPE?" But we won't get into that. But it's been interesting, huh?

Dr. Adam Robison: Yeah, it's been interesting work. And then yeah, as you said I did found a software optimization company about five years ago, almost five years ago, 2019. And so, that's been a lot of work too. It's been a lot of interesting stuff that keeps me busy and a lot of different things to focus my attention on for sure.

John: Well, it's that second part that really got me interested. And I think our listeners are interested in things like outside work, side gig, side jobs, new careers, passive income, active income. Tell me what inspired you to start a new company? We'll see if your story jives with the others I've heard in terms of what makes people do crazy things like that.

Dr. Adam Robison: Yeah. I've been happily married for almost 20 years, and my wife, I asked her one day this crazy idea. I said, "Hey, I want to take some money. And I have this idea of how to make the EHR better." And she said, we'll have at it. And so, basically I remember sitting in front of my computer, I was using Epic at the time, using an electronic health record and going "I have to go to a third party website to finish some work. I have to go outside the EHR on a regular basis." I'm like "I have to take data from here and go kind of chart and go over here. This seems kind of stupid. Is there a better way of doing this?"

And so, initially I tried to do what I did initially within the EHR with some templates and stuff like that. And what I was looking to do wasn't actually possible within the EHR framework, the logic and the kind of advanced computing I wanted done. And so, that's what caused me to think about is there a way of doing this? And I did a lot of research. I was reading all sorts of websites, educating myself on interoperability standards. How does that work? Is there ways of doing this outside the EHR without really tight integration customized integration? And then that's what we came across. I came across something called HL7, which if you're out there is fire. And then we learned a lot about that. Really what was interesting to me was a problem that I had clinically and could I solve it. And that's what led me to found the company, realizing that we are founding a company to develop the software and to go from there. So, that's what we did.

John: That is the common thread that I've heard before. I talked to an urologist who started a company producing underwear for patients, and whatever, other different entrepreneurs. And it's always that itch that has to be scratched. You have a problem, but you're on your own, and it's like there's got to be a solution to this problem. That is very consistent. But I'm sure the way you went about it is going to be different from others because there's a myriad number of ways of doing that. We'll get into what it does exactly, but what was your next step? You had this idea, what did you do?

Dr. Adam Robison: Yeah. Whenever you have any idea, we're trying to find is there a market out there for it? Is this something that people would buy? Is this a universal or at least a broad enough problem that people run into it? I talked to lots of different physicians and people I knew, people at different hospitals I had connections with and asked them "Is this a similar problem you run into, or am I just dumb and nobody else has it?" And see if somebody else has already had a good solution for that. And realize, no, this is a fairly universal problem that everybody else has experienced. There's not a lot of solutions out there in the market. And so, that's when I go, okay. Now I don't know how to code or software. I don't have any experience with that. And I knew it would probably take me quite some time to do that. That's when I was looking around for people that knew how to do that and I was able to find some developers that had some of those skills. So, it's a lot.

There's stories about how to get licensing and getting approval through different EHR vendors. That was an interesting experience to go through, to try to convince a certain ethic that I was a company and that I wanted a license to put myself on there. Learning how to navigate all that, security protocols, yada, yada, yada. Just a lot of learning new things that I didn't know before.

John: Interesting. I just want to make sure I didn't miss another point. You checked around to see if this was a universal problem, and did that include other EHRs and the one that you were using?

Dr. Adam Robison: Yeah. I talked to a bunch of physicians because of what I have learned about, and it sounds like you talked to other doctors that have used this, but physicians are the best people at solving physician problems. Not some sort of a Silicon Valley startup by two guys out of their twenties. Like "Oh, they know how to fix our problems for us." It needs to be physicians fixing physician problems. And so, I talked to a bunch of other doctors that have been in a myriad of different EHRs. I talked to people that used the big ones in the market as well as like the VA. A bunch of colleagues worked at the VA. Is this something that you'd experienced out there? And it was a pretty universal experience.

John: Tell us about the company. Let's start there. Tell us what the company is designed to do, or what kind of product or service it provides. And then I'll come back to some of these little questions in here.

Dr. Adam Robison: Yeah. The problem that we're trying to solve was how to get data out of the EHR. It was the problem. That's a big issue. Healthcare data and how it's siloed right now is a big problem. And that's why I touched on briefly something called the HL7, which is a group, they develop these interoperability standards. It was very serendipitous timing with what I was trying to do, because during that same time, the 21st Century Cures Act had come out. And the 21st Century Cures Act for those that are familiar opens up the chart. For a lot of physicians, that meant that patients now could access certain notes in real time, which has got a lot of physicians from heartburn. All of a sudden the chart became a lot more. It used to be My Note, now it became the patient's note as well as My Note. And that was some heartburn around that.

But if you actually looked into what the 21st Century Cures Act was doing, it wasn't just making notes available to our patients, even though that's how we allowed, as physicians interpreted, it actually made the data in the EHR transparent and accessible. It had to be accessible. And it turns out, the government had adopted these things called the HL7, the standard called FHIR. And it just happened the same time while that was going on that I was trying to look to solve the same problem of how to pull data out of the EHR and do something with it meaningfully.

And so, what our tool does is it integrates directly with the patient's chart. It looks at what's going on with the patient's chart, and then pulls all the information that would be relevant to pull out, reviews the chart essentially for the user, and then provides information like MELD scores and things of that nature as well as coding recommendations all within the context of the patient's chart.

John: Interesting. Because earlier I was going to jump on the bandwagon and bad mouth some of the EHRs and EMRs. It's like you would think after helping physicians doing this for 10 or 15 years, they would've figured this out. But what you're telling me was the system wasn't necessarily ready for it and it became ready as this was implemented.

Dr. Adam Robison: Yeah. It's been interesting. I will tell a story. I have a good friend of mine who's not a physician, and him and his wife, they recently had a child and they were receiving care locally to smaller hospitals. But the child's medical condition required it to go to seek care at a tertiary care center. And what they described, even though both centers used the same EHR, they're separate EHR instances. And so, the mother and the child had two separate records that were actually very important, but then needed to talk to each other because the conditions they were seeking care for were the same at both sites. And this is just recently.

And so, for whatever reason, there hasn't been a lot of interest in the major EHR vendors to make even within their own EHR network or broadly between EHRs, that hasn't really been an interest that they've wanted to go down either maybe for economic reasons or technical reasons, for whatever reason that may be. That interoperability standard piece has been a big problem. And they haven't been willing to fix it and the Cures Act did mandate they had to open that up. But it's going to be important on companies like mine and other companies out there to do that work for them.

John: Okay. That's good. That things are progressing, and like you say, your timing was perfect. Now, I was looking at your website and reading a little bit about this, so I just want to make it clear for the listeners because some of them might actually need to use this tool at some point or tell their hospital or somebody about it. There are different kinds of metrics, there's algorithms, there's sometimes formulas that have to be used by a clinician and trying to do something. And right now you have to either do that by hand or use a separate piece of software or an app on your phone or something, and you're integrating that. So, give us more about how that works and why it's potentially a profound app.

Dr. Adam Robison: Yeah. Our two applications right now, we have two software pieces called Aicalc, Aicode that live within our Aimedica platform. And what they do is the Aicalc, you can imagine it just being your medical calculator, your cirrhosis scores, your chads bask, you name it. There's a million of these out. And they're actually propagating pretty rapidly now. With the advent of big data and smart computers, these models are coming out pretty rapidly. And our software basically looks at the patient's context, what kind of medical problems they have, is there other criteria, and says, oh, not only we'll calculate, oh, patient's cirrhosis, you'll need a MELD score. And then we'll give you the most up to date MELD score, give you that sort of stuff. You don't have to click around. You just click the button. You don't have to think of why you need the MELD score. We'll just review the patient chart and give you all the relevant scores and pull the data in to calculate the scores for you automatically.

Again, one thing I say to people all the time, I use this tool every day in my practice. I developed it for myself, and so I'm constantly trying to improve it. And then we also do the same thing with medical diagnosis codes. We try to optimize the best highest weighted codes for DRG waiting for hospitalizations, which is important because we can look at a patient's chart and say, "Oh, the patient actually meets sepsis criteria and you are treating of infections. That should be the code you put in the chart. Let's provide that." And that has a huge ramification. And anybody knows in the healthcare space, those DRG waiting is huge for hospitalizations reimbursement.

John: Yeah, absolutely. And someone like you, or many hospitalists kind of have looked at the Medicare guidelines and they realize that for some DRG level, whatever, it's like a three paragraph description of what goes into it. Oh, yeah, we have time to really learn all that.

Dr. Adam Robison: Doctors don't care. I tell us that you've got to optimize it and make it easy for me because I don't care if the patient needs sepsis or pneumonia or what. I know they have an infection, I know I want to treat it and I'm going to treat them appropriately. And I don't really care what came from the chart. All I care is that my patient got better because I gave appropriate care.

John: Well, this is really going to impact the CDI people, if this is going to really help them a lot. So, that's interesting. It sounds to me this business really is like a software business. And you said you're not a programmer.

Dr. Adam Robison: No.

John: So, how did you overcome that issue?

Dr. Adam Robison: Yeah. It was interesting. I had this idea, I got to fix this problem. This is a universal problem, how do I fix it? Well, oddly enough, I had been reading in our local newspaper, and I came across this guy here locally that I knew. I didn't know him at the time that he had a development for hire company. And so, I just kind of reached out to him and I said, "Hey, I got this problem. What do you think?" And he said, "Oh, yeah, I could do that. And by the way, I'm a partner of a venture fund. Let's see how this goes. And we may invest in your company if you like the idea." And so, I pitch it to them. And then that was kind of very serendipitous. We build a minimum viable product. And after they were comfortable with me and they're kind of filling me out to see if I was not as a fly by night operation, they decided to invest in the company my idea with me as well. And so, that was how we got married with a venture fund. It was very interesting how that kind of worked out. But just from a paper article, I just happened to come across it.

John: Sometimes things just work out. I always say the RAS in our brain, the reticular activating system, once you're thinking about something, it finds things that you otherwise would never notice. Now, how did you sort of protect or did you the intellectual property of the fact that you had come up with this idea? Was it built in your partnership? How do you do that?

Dr. Adam Robison: Yeah. That's an interesting thing. That's something we've still wrestled. When you develop software, you really can't patent software unless your approach is really unique. If you developed blockchain, if that's a whole new software thing, you could potentially pat that. But just patenting software, it's almost like copywriting software. You can copyright it, but anybody can write a piece of code. It's not a unique idea if you're writing this code using a typical programming language. That was a difficult problem. We have now developed a proprietary knowledge base and an ontology, if you will, that is IP and that is patentable. And we will be patenting that.

What has helped us right now and why we're five years into this right now, or almost five years into it, is what I'm doing is so ends up being very technically difficult. We have a bit of a mode around us because even the developers I hired, they didn't know how to do this because it's not a skillset you can hire off the shelf. And so, it was going through a lot of that. It's ended up been, like I said, a lot of it is been very serendipitous that turns out this isn't something you can even hire very easily for. And we had to train a lot of people up and work through it. But I think one thing we did was when protected the IP, we had that written to our contract with the development company. This is our stuff. And we had all well demark within the contract negotiations.

John: On the plus side, the more complicated it is, the less competitors you'll probably have doing it.

Dr. Adam Robison: Yeah. And we're many years into this. At this point, in this SMART on FHIR space, and unfortunately I'm saying it on a widely broadcast podcast. It is a brand new space. People are starting to understand and realize that that's how you talk to these EHRs. And what's great about it's EHR agnostic. Every EHR has to be compatible with these standards.

John: Now, one thing I'm not an expert on at all, and I've heard there's different ways of getting investors, like venture capital, angel investing, this kind of thing. But did you end up just getting the one entity to support this when you got your partner? Or did you go beyond that?

Dr. Adam Robison: No. We've had a raise. We've done a few raises now. It's been interesting. That's been a lot of work to raise money. I funded the initial development of the minimum viable product, but to actually bring on employees full time, that's not something I could afford to do. I don't have those kind of deep pockets. And so, what we did, we raised it through the initial investor network that we were introduced for that venture fund, and then raise through their network. And that got us a certain point.

And then when you raise money, every time you raise money, you're looking to say, "I'm going to raise money to hit these milestones." And so, every time we raise money, "This money was raised to hit these milestones. We've hit those milestones, now help us, we're going to raise money again to hit these milestones." You're trying to show forward momentum every time you're raising money that you've got this money. We did X, Y, Z with this money, and now we're going to do these next set of milestones, which you're going to further grow the company or hit these metrics and milestones. When we've raised money through different networks, that's how we've done it. And so, that's where we're at right now. We've raised I think about a million and a half over the last two years to expedite development and move to things forward.

John: Nice. Yeah, it's not like something you can build in your basement.

Dr. Adam Robison: No. And it's a lot of learning. I think anybody looking to start a business, just be prepared to learn a lot, because even though you may be smart as a doctor and you're very intelligent, be prepared to be very humble because you have literally no idea. You're going to have to learn a lot, fly by the seat of your pants. And that's kind of why people become entrepreneurs. They are interested in learning that stuff. But yeah, I've had to learn a lot and I've made a lot of dumb mistakes and all sorts of stuff. Lots of stories to share about that.

John: Oh, I can imagine. But it can be exciting and physicians can learn anything really as long as you have the time. That might be an issue for you as the thing gets bigger. Tell us where it is right now. You've been doing this for five years. Obviously, there was a whole ramp up. Do you have clients? Is this being live? Is it working?

Dr. Adam Robison: Oh yeah. Like I said, we have two clients right now. We have two head systems right now. The biggest thing actually, we just finished up our installation at the VA. That was a big deal to get our software working. If you're familiar with the VA or worked at VA, they have an antiquated system called CPRS. It's been around for a long time. And they've just recently built on a platform onto their CPRS that's called Lighthouse, that's compatible with SMART on FHIR. And so, our tool, we're the first third party vendor. They were looking for a solution like ours, and we met them and talked to them and they talked to some other people that could do something similar, but we were a better fit just because of our tight integration with the SMART on FHIR standards. And that has allowed us to work with them.

We just finished our deploy there. We are in the process of several other health systems. We have relationships with the biopharmaceutical company as well as a clinical research company that's looking to use our tool to help automate and augment a data retrieval from the EHR to help expedite clinical research. And so, that's what we're working now.

John: Okay. Is it to the point now where some of the medical caregivers, the physicians, APNs, whoever, are they seeing the benefits at this point?

Dr. Adam Robison: Oh yeah, we have. People love the tool. It's being used. We have some business intelligence software. We monitor the use of software, how are people using it so we can make sure we can improve it. It's not quite exponential growth in users, but we're seeing lots of people using it almost on a regular basis. And it's now becoming the way you do things now with our sites, because why would you go to a third party website or go to some other site if it can go to HER? And it's a button click, you don't have to do more work. So, it's obviously much more efficient.

John: Yeah. Nice. Do you have different formulas or different tools available over time? Or is there a list of 10 or 20 or 1,000?

Dr. Adam Robison: Yeah. Right now we have 50 or 60 medical functions automated within the chart. The ones that are commonly used. We're adding more as they come out in literature writing more. We're branching up a behavioral health space now with some of those assessments that need to be done. They're often done on paper or through PDF forms, so we're bringing them to the platform as well.

We are really just looking depending on what the clients need. Really I tell people all the time, the hardest part with this is actually just being integrated in the EHR and getting data out of it. For building a medical function, a medical calculator form, you need to get data out of HER. That's easy now. We can build that in a few days. You name it, we can build it because that's not hard. The hard part is actually integrating the EHR. That's the hard part.

John: I like that interface. That might not be the right term. But are you doing studies to see if this improves the efficiency of the physicians?

Dr. Adam Robison: Yeah, we will be. That's going to be next year. We have a couple sites that are interested in doing that. Our Richmond VA site, which we're in the process of finalizing that, they're interested in doing that kind of work. We'll be working with them to hopefully show that this is efficient, which anecdotally, of course it is. But we'll be able to show that and prove that with the data collected.

John: Yeah. The thing I hear from physicians, I have to go home and do an hour or two of notes or whatever. Now that's oftentimes the clinic, but still even hospital notes sometimes, you just can't get them done. You have to go back. Do you have a lot of capacity now? If people listen to this, we don't have a million listeners, but a lot of these physicians might still be working clinically. How do they get ahold of you or the Aimedica to learn more about this? Is it ready for that?

Dr. Adam Robison: Yeah. We're ready. We're actively taking on clients now. Like I said, we're in the process. That's going to be our big Q1 push. We had a couple clients that we're working with. Now, we're ready to go live with everybody else. And so, that's Q1, we're working on lining them up. You go to website aimedica.ai. It's easy. Easy website to remember. Just go there to contact our page, we'll be happy to do a demo for our clients.

John: Okay, aimedica.ai.

Dr. Adam Robison: That's correct.

John: All right. And if they have more questions, they can throw a note in LinkedIn to you, perhaps. Do you have time for that?

Dr. Adam Robison: Yes. Or you can email me at adam@aimedica.ai. It's very easy.

John: All right. This has been very interesting. I don't think I have a lot of other questions. Let me ask you this. What if I was going to go to my local hospital and say, "Hey, this thing sounds pretty cool." Who would I go to?

Dr. Adam Robison: You want to go to your chief information officer. They would request us through. Most of the EHR vendors have some sort of app store lineup that we would go through.

John: And what kind of presentation do you do at a system or at a hospital in terms of do you go on site, do you do it online? Do you just send some written materials? I'm just curious about how you're handling that part.

Dr. Adam Robison: Yeah. Typically, we'll do a demo on Zoom or some sort of video conferencing site. Wherever they want to use, we'll use that and we'll demo the software in a real environment so you can see how it works.

John: All right. Did I forget to ask any questions or is there anything else you want to tell us either about juggling being a hospitalist and a co-founder? Technically you do have a partner, but you were the one that created it, so I guess you are the founder. Juggling those things or about Aimedica?

Dr. Adam Robison: No. I do have hobbies that I use to not do work. I think it's important to have those so you're not doing it. I play piano. I do a couple of things to get my mind off when I have a couple minutes of downtime, which is I think important as you're looking to try to do other things with your time.

John: What do you think is going to happen with you? If this gets really big, it's going to take more and more management. Hopefully your employer at the hospital is not listening, but they probably know you got this thing going on. What do you kind of think will happen long term? Are you going to become like a CMIO in a hospital informatics in this technology? Or do both for a long time? What do you think?

Dr. Adam Robison: I'll tell you John. I actually love being a clinical doctor. I love taking care of patients. Maybe not as much as I've had in the past. I'd probably wind that down a little bit because I do work quite a bit. What I see myself probably doing the next 5, 10 years as they see guys up and it's profitable and we're able to keep lights on, is probably work for them full-time and work for my company full-time and then still see patients. Because as a chief medical officer of the company and using the tool, I find by me using the product and practicing patients, I really understand what are the problems we're trying to solve. I feel like if I remove myself from clinical practice 100%, my utility, the company to help make these tools better, I think it becomes limited as well.

John: That reminds me. Cleveland Clinic, it's a pretty big place. And I don't know about the current CEO, but the former CEO is still clinically practicing while he was running that monstrosity. So, you can keep practicing probably as long as you like, and if you're enjoying it.

Dr. Adam Robison: I do enjoy it.

John: All right. Well, I think that's all the time we have. I really appreciate that. I'm going to put the links in the show notes. Again, it's Aimedica and I've been talking to Dr. Adam Robison. I'm going to have to have you come back in a couple years and see where things have gone. And maybe by then I'll have invested in it as it'll be a listed stock or something. All right. Thanks for being here, Adam. I really appreciate it.

Dr. Adam Robison: Absolutely. Thank you.

John: Okay. Bye-bye.

Dr. Adam Robison: Bye.

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In today's podcast episode, I present my take on things the CMO should never say to the CEO. 

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4 Things the CMO Should Never Say

There are probably many more. But here are things the CMO should never say because they reflect negatively on accountability and commitment to the success of the organization.

“We’ve tried that before and it has never worked.”

This is a common refrain of those who are unwilling to revisit old goals.  But leaders need to accept the fact that goals that were formerly unattainable might now be possible with new technology, new ways of doing things or renewed energy and enthusiasm. 

“I completed my assignments, but somebody else dropped the ball.”

This is a comment that would make us cringe. The COO, CNO, CFO, and CMO should never say these words.

A team member fails to complete an assignment and the plan does not come together as hoped. While that comment may be accurate, it demonstrates that the person making it is not a true leader. A leader is going to take the bull by the horns and get it done, even if it means taking on more responsibility or monitoring the other team members' progress and assisting them when needed.

It's not that you need to babysit everybody. The point is to get the project done. And a leader is generally the most proactive in helping others to meet their commitments.

“I disagree with the decision on this and I cannot support moving in that direction.”

The way it works on a good team, the leader of the team gives everybody a chance to chime in, and share their input. However, organizations are not led by consensus. Once everyone is heard, a decision will be made by the CEO or whoever is in charge of the project.

Then, even if you didn't strongly support it, or vehemently argued against it, once the decision is made, you must fully get behind the decision. And everybody should then work together to accomplish the goals of the project. If it fails, the team can revisit the other recommendations later.

“I’m sorry IF…” 

There are apologies for doing something wrong, and apologies for making mistakes, but we're talking here about apologies for not doing what you said you would do. Everybody on a senior management team needs to be 100% accountable for doing what they said they would do, when they said they would, the way they said they would.

There should not be any contingency in an apology such as “I'm sorry if you don't believe that I did this properly,” or “I'm sorry if things didn't turn out okay.” That's not an apology. The word “if” should never be used. You must take ownership.

It should be, “Look, I'm sorry. I dropped the ball on this.” Admit that you made a mistake. Then, “I commit to correcting this and I will come back in one week and have everything that I committed to accomplished.” And finally, “This won't happen again.”

Apologize appropriately and keep your word.

Summary

There are certain things that any leader including the CMO should never say to the CEO.

If you're in a leadership position, you can undermine your standing by making one of these four blunders. It can be career-ending.

On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing appropriately, you'll be well on your way to being an exemplary leader.

NOTE: Look below for a transcript of today's episode.

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Links for Today's Episode:

• The Best Healthcare Leaders Never Give Up and Never Stop Learning – 196
• Why You Should Evolve From Victim To Leader – 043
• What Do Recruiters Look For In a Physician Leader? with Paul Esselman – 041
• How to Quietly Build Leadership Skills As You Serve a Nonprofit – 016
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 251

4 Things the CMO Should Never Say to the CEO

John: Now this week, I'd like to present a topic in what I'm calling my effective physician leadership series. I've done several other solo episodes where I talk specifically about leadership. So, I'm giving it a bit of a moniker here as an effective physician leadership series or effective physician leadership notes.

But I learned a fair amount about working in a complex management environment as chief medical officer for a 300-bed nonprofit standalone hospital, which I did for 14 years. And we spent a lot of time honing our skills as a team together to develop trust and to build a team that could really effectively run that hospital.

And I learned a lot. We had coaching. Our CEO had a coach. We as members of the senior's team had the same coach. And we did receive coaching as a group together. So, I did learn a lot that I think would be helpful to share with you. Many of you are in leadership positions or will be in leadership positions. Now pursuing a management or leadership career itself is a nonclinical or a nontraditional career for physicians, although many physicians do become leaders. I think also even if you start as a medical writer, an editor, or something in utilization management or any other alternative type of career, you will have opportunities to take management and leadership positions. And so, you should probably learn these principles if you don't already know them.

Now, whether you're a CMO in a hospital, pharma company, insurance company, or other large corporation, these concepts will definitely apply. But even if you're not, if you're running a smaller organization, if you're an entrepreneur and you're trying to grow your business, you're going to need these kinds of skills. And if you're in a lower management position such as a medical director, by demonstrating these leadership skills that will lead to you being recognized and considered for more of a leadership position. So, you have to demonstrate these kinds of skills early in your career. And that's what enables you to move up. Because in violating these leadership principles, you will be passed over because it'll be obvious that you're not ready for that kind of a position.

And when I decide to address a topic like this, sometimes it's more fun and instructive to look at it from the perspective of what not to do. I know I've done a presentation on eight big mistakes to avoid while pursuing a nonclinical career. That's one example, but it can be useful to do it from the perspective of things not to do, the common mistakes to avoid. And so, with that, let me describe the four things the CMO should never say to the CEO.

Before I get into the four things, I want to remind you of a couple of things. First, these apply to anybody in senior management. So, it's not just the CMO. It could be the CNO. It could be the senior VP for HR. It could be any of a number of senior-level positions, but these are the things that you don't want to say or express even to the rest of the team because it'll show that your leadership is failing.

Now, let me define what a senior management team is. And basically, when I use the term, I'm referring to the CEO and all the CEO's direct reports. So, I'll use a hospital as an example. In a small hospital, such a team may consist of the CEO, the CFO who sometimes also serves as a COO, the VP for HR, maybe the chief nursing officer, and there might be a VP for ancillary services who covers all of the lab testing and respiratory testing and imaging because it's a small organization. So, there might be five or six in that senior management team.

A larger hospital might have those positions, plus the chief operating officer, plus a VP for strategy or strategic initiatives, maybe a VP for post-acute services, and a CMO. And then the larger organizations might have those plus others like the chief legal officer, or the chief academic officer if it's an academic institution. The chief medical information officer might be a separate position and or a chief quality officer. But you get the idea.

The senior management team will consist of 6 to 12 members setting the vision and strategic direction of the organization under the leadership of the CEO and the direction of the board of directors or trustees, depending on if it's for profit or not for profit. And so, the execution of the strategic and management plans that are developed by the senior management team is done at the level of the directors and the managers, and the frontline employees. They're the ones that actually run the hospital per se day to day. But the role of the senior team is to be certain that each of the component parts does its job, follows its budget, and coordinates with the other components to meet its mission.

And the other thing I want to comment on here is counter to what some may believe. Each senior management member should be committed to the success of the organization as a whole, and not just the success of his or her own division. That's really one of the highlights or the hallmarks of a truly effective senior management team. You don't consider the people reporting to you to be your primary team. It's your team, but your primary team is the team that you work with on a day-to-day basis to coordinate all of the functioning of that organization, meaning your senior management team. And you'll sometimes have to give up certain resources to help the other parts of the team succeed so that the organization can succeed, even though it may take a little bit away from your part, your division, let's say. So, I wanted to mention that.

Given all that, here are four things, there are probably many more, but there are four things the CEO does not want to hear from any member of the leadership team.

One is this. "We've tried that before, and it has never worked." This is something I heard a lot when I was CMO, but it was usually from team leaders, managers, and physicians. And it's a way to try to stall things. It's a way to get stuck. Sometimes it's due to a fear of change, fear of doing things in a different way. Sometimes it might be that people really actually believe that, but it's usually because the stakeholders, whoever's in that group, again, whether it's a department or a part of a department, they don't want to try something new. They don't want to change the way things are done now because they've got it down, it's routine, they can handle it and it's not challenging.

I'll give you an example. We knew at our hospital at some point that several new things were coming down the road. For example, hospitalists. We knew that was a type of service that ultimately would be coming to our hospital because it was growing across the country and there were good reasons why it was growing.

Another was the institution of an observation bed unit. And the fact that the observation unit should be staffed by dedicated physicians. So, let me take that one. We, for several years, tried to create an observation unit because with Medicare changing its rules, it was saying that it would not accept having certain patients admitted to the hospital, particularly if they weren't going to be staying for more than a day or two. That by definition, meant they should be an outpatient.

And so, we tried several different ways over several years to make that happen. And we constantly would hear that "Oh, we tried that two years ago and it didn't work. The patients weren't treated well or the outcomes weren't good or the physicians were losing patients." There are lots of reasons, but this is a common thing that you hear when you're rolling out something new. It's that "We've tried that before and it's never worked." This is something that if I heard one of my directors say, it just drove me nuts, because look, there's a reason we're discussing this. There's a need that exists. And we are here as leaders of this organization to find out how to come up with a plan to discover how, or to make it happen, that this has to be addressed.

And in the observation situation, we had a lot of denials and we were actually writing off a lot of care because we would just keep patients in the hospital. And then we would after the fact change, convert the inpatient to an outpatient and not charge anybody anything, because patients weren't really being told that that's what was going to happen. The bottom line was, ultimately, we had to come up with a plan. We had to work together and make it happen.

And when you heard that comment, "We've tried that before, and it's never worked." That is basically looked at by the CEO and the other senior management team members as just dragging your feet. We can acknowledge that that's true, but that means we just didn't implement it the way we should, or we need to come up with a new way to implement it. So, that's the first, this is probably not the biggest one of the four I'm going to discuss, but it's an important one.

Now, by the way, these kinds of comments usually come up in the following setting, at least in my experience. Organizations generally have regular meetings of the senior executive team. That's one way they become a team is because they're constantly communicating directly and working together. Now they might meet by Zoom call more than they did before, but our team met in person at least weekly. And we would have a two-to-three-hour meeting. And some of them were devoted to strategic issues and some were devoted to operational issues and sometimes they would overlap. But we were face to face addressing these issues and hearing these comments sometimes maybe when we shouldn't have, but that's when they would be called out and then we'd learn. At those meetings, we're constantly planning and tracking our progress forward on management goals that we had set at the beginning of the year. That always meant that there were multiple people getting together that reported to us to work together to get these different projects going and completed.

So, this is a comment that we sometimes heard that would make us cringe. And that is on reporting back on their project, which we usually had a team working together. One of our members would come back and say, "Well, I completed my assignments, but it's still not done because somebody else dropped the ball."

This is one of those comments where you're assigning blame to somebody else because something didn't happen. I had managers and directors that would say this. Again, it would just kind of drive me crazy and I'd have to call them on it because it could be phrased in a different way.

But being phrased that way just doesn't sound good to the CEO or anybody in charge for that matter. And it doesn't sound good to the board if the CEO uses that comment. And a good CEO, never would. Even though I might be on a team as a monitor or maybe even chairing the committee. Let's say we're putting in place something like a new service line. And we have people from the lab and we have people from the pharmacy and we have people from nursing and people from credentialing all together. And one of my directors might come back to me after we had gone through a great planning process and we have these Gantt charts that tell us when things are supposed to happen and what each person is supposed to do.

And one of my directors would come back to me and would say, "Well, I had all my work done last Thursday and I knew we were getting back together early this week but somebody else dropped the ball. If it hadn't been for so and so, well, this whole thing would've been done by now. I just don't see why they can't do their job." Then I might ask my director, "Well, did you do any kind of follow up or did you reach out to find out what was happening along the way? Maybe you could provide them with some support." And then the director's comment would be something like, "Well, no. We each had our own work to do. I'm not their supervisor and I'm not their babysitter."

I think these things happen all the time because somebody drops the ball and then things fall through the cracks. While those comments are basically accurate, what that shows in that person is a great lack of leadership because the leader in this group, whether they're a chair or not, is going to take the bull by the horn and they're going to say, "Look, I've got my part done. I'm reaching out to the other members of this team. Hey Mary, did you get your part done? And if not, how can I help you? Joe, did you get your part done? Because I want to go back. We're all getting back together in a few days and I want to make sure that my VP is pleased and that we've done our job as a subcommittee on this team to get this part done."

I can tell you that there are employees that will argue at this point to the end of the Earth saying that as long as they're doing their job and they're part of the job, then they're a good employee. But that is a person who's going to be in that management position forever because they're never going to advance to be a leader. And so, that's why I'm telling you that I should never hear that from you if you're in a potential position to be looked at as a leader.

So, it's not that you need to babysit everybody. The point is to get the project done. It's not really important who does what work per se, but it'll become apparent who does what work and the people that are doing the most work and taking the most leadership, which means being the most proactive in getting things done, it will get advanced in that organization. If you want to just be someone punching a clock and making widgets, then so be it. But if you want to be a good manager and a good leader, then you need to be proactive. And when the project doesn't happen, it doesn't matter whether you did all your part, the project didn't happen. You are part of the team and you failed the team.

All right, the next one. Now this one, you don't hear a lot, but every once in a while, you might hear someone say something to this effect. "I disagree with the decision on this and I cannot support us moving in that direction." In other words, I bring this up because there's a situation, an understanding that when you're a member of a senior management team, you have to understand that sometimes decisions are made that are not going to be the exact decision that you would make in that situation.

But the way it works is that in a good team, the CEO or whoever's leading the particular team gives everybody a chance to chime in. And generally, to make that happen, you have to be proactive and you have to elicit responses from everybody in the room. Because you can make a situation where the team doesn't work cohesively because only two or three people pipe up. We always had people on our team that were very vocal. They were very extroverted. They always had opinions. They could hear something and then within three seconds they had an opinion.

Now I'm the type of person that needs to think about things. So, I would come back a week later sometimes with a really serious consideration on a topic we were discussing. And I always felt bad that I couldn't be more spontaneous, but that's just the way my brain works. I need to think about things and then come back with my thoughts rather than just my knee-jerk reaction, which may or may not be valid.

But we definitely had people on a team who always had an opinion and that's fine. But the CEO was pretty good about saying, "Okay, now I want to hear from Pete and now I want to hear from Sarah. And now I want to hear from everybody." And that's another sign of a good leader by the way. A leader will elicit input from everybody, even those who are not naturally expressive about their opinions.

So, the point on this is that none of these organizations are run by consensus. None of them are really a democracy depending on how you define that. Somebody has to make the final decision ultimately. Now sometimes you all may come to the same conclusion on your senior management team and say, "Yeah, this is fantastic. We came up with a great plan. Let's do it."

But a lot of times you're going to have disagreements about the best approach or when you're selecting a strategic initiative you might have to choose from among two or three, and you're going to be fond of one and somebody's going to be fond of the other. They're feeling it's the best thing to do, but it can't all happen. You have a budget. You can only spend so much this year. So, one thing's going to have to be put aside. And when you're in a team like the ones I'm talking about, everybody has to fall in line once a decision is made.

We assume that the decision, whether it's a board decision or a CEO decision, that the decision is made for the best of the organization. And it's not always a hundred percent clear, which is the best way to go. But the thing is with a team in order to trust one another and to work collaboratively going forward, what the CEO is going to demand, what the board is going to demand is that everybody gets on board with the plan.

Even if you didn't strongly support it, and even if you vehemently argued against it, that's fine. And everybody should have that input on that senior management team. That's what that team is for. To inform the CEO, to challenge the CEO. The CEO is usually going to have an idea of what they want to do and why it's the best approach. Just like the chair of any committee or team is going to have their opinion. They're going to come to a meeting and ask your opinion and your input, but they're going to have what they think is the best approach to take.

But the thing is until they hear from everybody on that team on that committee or on that senior management team, they don't really know everything. And that's why they need to be challenged because they may be working off assumptions that aren't a hundred percent accurate or that might be missing something. Again, the idea here is not that you can't disagree, you can, but it's the second part of the statement stating "I cannot support moving in that direction." The whole statement is "I disagree with the decision on this and I cannot support moving in that direction" or something similar.

And the point here is that once you've all had your say, whoever's making the decision, makes a decision, and then everybody gets behind it 100%. Then one of several things can happen. It's going to go great and it's going to be wonderful and the outcome is going to be just like everybody wanted. And that's good. Or it's not going to work or it's going to partially work. And then you just learn from that. And then you redirect and, in the case where there are multiple competing projects, well, then next year we'll do your project once this one is going.

But you don't remain as a squeaky wheel or a thorn in the side going forward once a decision for one of these big plans is made and we're moving forward. So, let's say we decide we want to do a hospitalist program, and the CMO myself, or maybe the CMIO or some other advisor says, "I don't think it's a good idea. The doctors aren't going to like it. The patients aren't going to like it." Okay. Give us the information, the support, the evidence. We'll discuss it, we'll consider it. But if we decide to move forward with it, then you're going to need to help us institute this hospitalist program.

Enough on that. The last statement I would say, the last thing the CEO doesn't want to hear from the CMO or anybody else on the team is, well, here's the short version. "I'm sorry if..." This is really just a comment on how to be accountable and how to apologize.

Now there's apologies for doing something wrong, apologies for making mistakes, but I'm talking about really apologies for not doing what you said you were going to do. That's one of the things. You need to be accountable. You need to keep yourself accountable. Everybody on a senior management team needs to be one-hundred percent accountable. Now, we're human and things can fail and falter, but the expectation by the CEO and by all the other members of the team is that if you say you're going to do something, you're going to do what you said you were going to do in the timeframe you said you would do it, the way you said you were going to do it.

Now, most people don't care too much about the way that you do it. But again, you're in a meeting. You've got a big project going on. Each of you has your part of that project. Let's say that as a CMO, since the pharmacy reports to me, the part of the project that depends on the pharmacy and the pharmacy director then is my responsibility. And I'm in a meeting. And I said, "Yes, we were going to deliver this protocol and set up the use of this medication for let's say this new unit. And that will be ready to go when I report back here in two weeks."

Then let's say two weeks rolled around and I got sidetracked. I let the ball drop and then it's my time to be accountable. Part of that is admitting that I didn't do what I said I was going to do. And that's where the apology comes in. But this is true of any kind of apology. There should not be any contingency in the apology like "I'm sorry if you don't believe that I did this properly or I'm sorry if things didn't turn out okay." That's not an apology. The word "if" should never come in there. You have to take ownership.

In this case where I didn't deliver the pharmacy protocol and maybe get the meds and get things cleared by the pharmacy and therapeutics committee and all those other things, there should be no "if". It should be, "Look, I'm sorry. I dropped the ball on this." That's number one, admit that you made a mistake. Number two, "I commit to correcting this and I will come back in one week and will have everything that was expected of me for today. And it'll be in place and it'll be ready to go. By the way, this won't happen again."

That's really part of a good apology. And unless you know how to apologize appropriately, you can't be a good leader. So, you're going to accept what went wrong, that it was your responsibility, that you're going to correct it usually within a certain timeframe, and that it won't happen again. This is pretty concrete and becomes a way to identify those members of the team that need to be let go.

If there's a member of the team who simply cannot keep their word, continues to commit to things that they don't complete, then makes mistakes, and then doesn't apologize appropriately, then they're not really worthy of being an ongoing member of that team. And take the steps needed to eliminate that person from the organization. And that's true of working with people in any business. So, if you're an entrepreneur, if you're a consultant, whatever it might be, you definitely want to follow that process with people that are reporting to you.

Those are the four statements or four things that the CEO doesn't want to hear, or four things that the CMO should never say to the CEO or their senior management co-members.

If you have any questions, feel free to contact me by email at john.jurica.md@gmail.com. If you're in a leadership position, you can really undermine your standing by making one of the four big mistakes I mentioned today. On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing in the appropriate manner when it's warranted, you'll be well on your way to being an exemplary leader.

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The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career. 

The post 4 Things the CMO Should Never Say to the CEO – 251 appeared first on NonClinical Physicians.

Today I will present factors affecting your decision to become a Certified Physician Executive.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

What Is the Business School Mindset?

Dr. Patty Fahy states that the BSM reflects these beliefs:

• “…graduates are assured that an MBA degree has prepared them to manage in any industry: a tattoo parlor, a government entity, or a hospital system (emphasis mine – JJ).
• “Managers are an elite caste, separate from those who are managed, monitored, and controlled.
• “Efficiencies gained by controlling the behavior of professionals and other workers garner financial rewards…
• “The principle that… an action is rational only if it maximizes self-interest…”

Not all hospitals are managed in this way, all of the time. But, when I was Chief Medical Officer, there were definitely times when I could feel the BSM “vibe” coming through… even though I worked at a non-profit hospital.

This leads me to believe that Business School Mindset leads to a different kind of BSM… Bulls**t Medicine. – Dr. John Jurica

To counter this, I implore my colleagues to pursue a career in hospital management. Such a career is intellectually stimulating, pays well, and is the only way we’re going to steer this industry in a new direction.

Getting Ready to Become a Certified Physician Executive

One way to accelerate your career progress as a leader is to become a Certified Physician Executive.

The Certifying Commission in Medical Management grants the Certified Physician Executive designation. It demonstrates to employers that the holder of the certification has the knowledge, skills, and core competencies to be an effective manager and leader.

Listeners have asked me to compare earning the CPE to obtaining an MBA. However, one should not compare the two, because the CPE can only be obtained after completing the MBA or equivalent business and management training.

Summary

There is evidence that employers use the CPE as a factor when considering job candidates. And there are several ways to meet the requirements for the CPE. But they all include getting the basic business and management education, plus real-world healthcare management experience. Physicians should consider several factors when deciding how to best acquire the CPE designation if they choose to pursue it.

NOTE: Look below for a transcript of today's episode.

Links for Today's Episode:

• 3 Reasons to Pursue the CPE Qualification – 033
• The Ultimate Resource to Spark Your Transformation to Physician Leader with Dian Ginsberg – 024
• Certifying Commission in Medical Management
• Canadian Certified Physician Executive Website

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Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 219

Are You Ready to Become a Certified Physician Executive?

John: Today, I thought I would discuss another topic related to the pursuit of a job in hospital management. I mentioned this topic in a recent daily email and episode #33 of the podcast back in 2018.

Let me paraphrase what I wrote in the recent email related to this topic. It's really related to physicians working in the hospital environment, both as a clinician and then possibly as a leader. This is what I wrote about. I had read an article on Kevin MD by Patty Fahy MD. So, Dr. Patty Fahy. In it, she said that she was talking about BSM. It's an acronym for Business School Mindset. She thought I had a big impact on physicians and how they're working and the environment that they're in, which oftentimes is not very favorable.

The author, Dr. Fahy gives examples of the BSM mindset. Here are quotes from her article.

"Graduates are assured that an MBA degree has prepared them to manage any industry, a tattoo parlor, a government entity, or a hospital system. Managers are an elite cast, separate from those who are managed, monitored, and controlled. Efficiencies gained by controlling the behavior of professionals and other workers garner financial rewards. And the principle that an action is rational only if it maximizes self-interest".

Those are the characteristics that Dr. Fahy says represent BSM or the Business School Mindset. I don't know if all hospitals are managed in this way all of the time, but when I was chief medical officer, there were definitely times when I could feel the BSM vibe so to speak coming through, even though I worked at a nonprofit hospital.

This leads me to believe that the business school mindset leads to a different kind of BSM, what I call BS medicine. The approach that doesn't recognize a physician-patient relationship, or that puts quality safety and dignity behind the bottom lines. That's the BSM that I'm talking about. And I think we're caught in that. We're caught sometimes in that business school mentality and it leads to really miserable working conditions.

And so, the question is what are we to do? And I see three logical answers to that question.

The first is to keep working in the medical-industrial complex until we can't take it anymore and then retire. I think I've had a lot of colleagues that have done that. They've toughed it out and then just retired as soon as they could.

Number 2 is to leave for a nontraditional career, which of course, that's something that I talk about all the time.

And number 3, is to work your way into hospital management as either CMO, COO, or CEO and fix the system from within. And you probably already know that I'm partial to option number 3 because I believe we need a whole lot more physicians leading health care if we want to reduce both forms of BSM in our healthcare system.

Please consider a career in hospital management because it's intellectually stimulating, it pays very well and is the only way we're going to steer this industry in a new direction.

And by the way, as far as the income goes, I just went to salary.com today. And the median salary for a CMO is $418,000 with a range of $319,000 to $549,000. When I say it's lucrative, I'm really serious. It pays well over any primary care practice. And even for specialties, it's a much better lifestyle and you still make a good income.

One of the things that I'm convinced of is that if you want to consider a hospital management career, it's important for you to understand what the CPE is. That's what I want to talk about today. We all know what an MBA is. An MBA is a business degree. And then there is the MMM and MHA and other types of business degrees.

But the CPE comes up from time to time because it represents something that employers are sometimes looking for in the hospital setting. CPE stands for Certified Physician Executive.

As I was going through some CMO job descriptions before preparing for today's presentation, I looked specifically to see if the CPE was listed. And I found two hospitals in North Dakota and one hospital in Pennsylvania, just in a short review of the job ads that I saw. And they listed the CPE as a preferred designation. And the reason is that it represents something that puts the holder in a position perhaps a little bit better than simply having completed a business degree.

But the thing is, it takes more time and it takes some money to achieve. And so, I want to talk about this. And part of this came from a question that I received from a reader or listener back a few months ago, specifically asking whether I thought it was important to proceed with getting the CPE.

I want to try and answer that again. I addressed this, like I said, back in 2018, but let me bring things up to date today and really take a moment to walk through this for those of you that might be interested. This is how I look at the CPE as compared to an MBA. And it's not a fair comparison, I'll explain why in a minute. And these are my thoughts. These are my opinions as a holder of the certification and a former CMO and a member of the American Association for Physician Leadership, which is the AAPL, which originally created the certifying commission in medical management to create and to provide the designation of CPE.

Keep in mind, I am not speaking for the AAPL, although I've been a member of the AAPL for more than 25 years. And I have actually been involved in several of the committees that are involved with evaluating those that are sitting for the CPE, so to speak, by participating in the capstone.

Let's back up and talk about some definitions, and then we'll get into some more detail on this.

What is the CPE? The Certified Physician Executive designation. It's granted by the certifying commission and medical management. And it's designed to show that the holder of the certification has the knowledge, skills, and core competencies to be an effective manager and leader.

And to me the CPE is valuable because it demonstrates that not only does a holder have that MBA training. Now, remember MBA is a degree. It's kind of book learning, but the CPE has the MBA or the equivalent degree or the equivalent training and demonstrates experience in management and or administration.

And also, has sat through what they call a capstone, which is an opportunity for these applicants for the CPE to demonstrate that they can apply all of these principles in real-life situations, rather than simply take some curriculum and pass a few exams.

Let me get into a little more detail on it. An MBA is granted like any other degree. You complete a certain core curriculum plus some electives, and it ensures a certain level of knowledge. It's usually finances, marketing. In the programs that address physician executive MBA, they do focus on things like healthcare finances and the situation that we find ourselves in, the business principles in healthcare itself. Some programs do have a mandatory project that gets completed during the term of the schooling. So that gives them a little bit of real-life application of what they're learning.

But again, I'm going to mention why the CPE is distinguished from that. Because the CPE requires not only the knowledge base, which you can get from an MBA and MMM, and MHA or a similar degree, but it also requires that you have at least a year of clear management and leadership experience that does not include running a small private practice. And it has to be in a setting where you're really in a matrix with lots of other people. You're interacting. You're applying your communication skills, your marketing skills, your finance skills in a real-life situation. And so, it's more than just the book learning.

And in fact, you have to get a letter acknowledging and attesting that you have demonstrated these skills that are being sought for the CPE during those activities. If you've served as a medical director for a year or two or three, or you've been a CMO already, or you've done other things, let's say chair of a big committee at an academic institution and you've had exposure to management, to finances, to HR issues, to legal issues, then you can qualify for the CPE.

And on top of that, then you also need to spend four days doing what's called the capstone where you're getting a little bit more education about some of these topics, just to pull it all together. And you're actually being assessed for your ability to communicate and to lead teams and other skills of that nature.

To compare the CPE to the MBA is not really valid. The MBA or its equivalent is required to be even qualified to request certification for the CPE. That's why it's different. It does give you a little edge. If you have the CPE, it indicates that these skills are demonstrated, and it gives you a little edge. As I said, there were at least three hospitals just to my 10-minute review earlier today that said that the CPE would be recommended or preferred.

If you're competing with two or three or four people, and they all have the equivalent of an MBA or an MMM or something like that, and you have the CPE designation, which really attests pretty well to the fact that you've got the skills and experience to apply those skills, then you're going to have a bit of an edge over those others. That is I think primarily where it comes in handy.

The other thing to keep in mind, though, when we talk about this is that you can meet the requirements without having one of those degrees. In a way, if you were going to get the MBA or the MMM, or MHA, anyway, my case was actually an MPH. I got some credit for that. Well, then that's fine. And you can use that as the basis for proceeding onto the CPE if you're in some kind of leadership or management position.

But sometimes you can meet the same requirement by taking the equivalent courses through the AAPL. The AAPL is known for providing education and training and management and leadership for physicians since it was called the American College of Physician Executives.

They have a lot of ultra-high-quality courses that many physicians have taken. You can use this alternative pathway. Many hospitals and health systems provide leadership training through the AAPL, or physicians themselves will seek the training on an as-needed basis through the AAPL. And so, they do these courses and over time, there is a core curriculum through the AAPL, that if you accomplish that, then you've basically shown that you have the equivalent book learning that would be obtained through the MBA or other similar degree.

You can think of different scenarios here. If you've already taken, let's say one half to two-thirds of the CPE coursework through the AAPL, it may definitely be quicker and less costly to simply complete the curriculum through the AAPL than to enter an MBA program and spend $50,000 - $70,000.

I'm not saying that the AAPL courses are cheap, but even if he had to do another 5 or 6, 7, 8 courses, it's going to be much quicker and less expensive than matriculating in a business degree program.

The other thing to keep in mind is that sometimes the AAPL, or actually the certifying commission on medical management, which grants the CPE will accept courses done for a business degree that maybe you didn't complete. That's the other way that that can be effective.

You want to be efficient. You want to use and get the information you need. But there is no reason if you've already taken a course in healthcare finance to take another course in healthcare finance as part of your MBA or vice versa. You should be able to get credit for that in whichever direction you go.

It can be complicated. If you find yourself in a situation where you have some of the AAPL courses and you're contemplating going to a degree program, then you would check with the degree program, see if any of those courses would apply to the degree, and then you might get a reduction in your tuition, and it would speed things up.

And vice versa, if you've done let's say six months on a business degree, and now you've already got some other AAPL courses and you want to apply for the CPE, you can find out if those courses from the other business degree would apply to that.

There are certain business degrees that are aligned with the AAPL. For example, the master of medical management is a specific program geared for physicians only. And there was a lot of overlap in the content of the MMM and the courses through the AAPL.

So, you would want to really ask both sides of that if it would apply. In other words, you would check with the AAPL. They have a career or education department that will tell you if you've done some of the work for the MMM that would apply for the CPE if let's say you decided to finish it up with the AAPL courses.

Now, if I was just getting started, I would investigate my options. I would look at the cost, the location, the time commitment, and I would just figure out which one is the most efficient way to go. If you haven't been exposed to any of those, then you can make a valid decision.

On the website at the AAPL, which I'll put a link to in the show notes, for those that are listening to this on the podcast, you can go there and it will give you pretty clear which direction to go in. And it explains which of the business degree programs have courses that would cross over, or which ones would accept the AAPL courses.

Again, to find out for sure, it'd be best to check with staff at the AAPL. I think if I were starting out, this is like the master plan you might have in your mind if you were going to do this. I would look around, find a good low-cost convenient option to get your business degree. I would probably go to something like the University of Illinois, or even a smaller public university.

There's one nearby that's called Governor State University. And I know many people that have gotten their MBA through that. It's a four-year college. It's not a big-name college, but you get the MBA. And then if you want to go ahead and move on to the other requirements for the CPE. And then while you're doing that, you should acquire some clear management experience either by finding a paid medical director position, being on one or two really important, big committees where you're involved in big projects, let's say in a hospital.

And that way, when the degree is done, or the coursework is done, then you'll have the management experience. And then you can apply for the capstone and things will move forward very smoothly. If you get the MBA, but you really don't get any management experience in the meantime, you can't apply for the CPE.

Before I go, I do want to mention, I found this just recently. I didn't know this existed, but there's something called the Canadian Certified Physician Executive - CCPE. I don't know that it's exactly equivalent to the CPE that we're talking about today, but I know it does exist and you can look that up online. I will put a link in the show notes, again, for those who are listening to the podcast.

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Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career. 

The post Are You Ready to Become a Certified Physician Executive? – 219 appeared first on NonClinical Physicians.

Today I will describe my experiences with the assignments of a hospital CMO. These are based on my 14 years as a senior hospital executive. There was a lot to like about that job, with lots of fond memories. More than I can cover in one podcast episode.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. 

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

6 Assignments of a Hospital CMO

In this episode, I will describe in detail my experiences with typical assignments of a hospital CMO, including:

1) Leading the CME program, supporting the residency program start-up, and working with Lisa Zipsie, Director of Physicians Services.

2) Selecting and implementing the first Quality Management Tool, achieving Top 100 Hospital Status, and working with Mary Schore,  Director of Quality Improvement.

3) Implementing the hospital’s first Lean Process Improvement Initiative and working with Stephanie Mitchell, Director of the Lean Process Improvement and Laboratory Services.

Each CMO in any given organization will fit into the org structure in a unique way. – Dr. John Jurica

4) Overseeing the implementation of physician order entry, the medication safety program, and working with Jim Shafer, Pharmacy Director.

5) Establishing the first hospitalist service.

6) Recruiting physicians, purchasing local physician practices, and expanding the medical group to become the dominant multispecialty group in the county.

Summary

That’s a glimpse into the life of the CMO, and a sample of my assignments while in that role. It was exciting, challenging, and impactful. The CMO in each organization will fit into the org structure in a unique way, with different direct reports and areas of responsibility.

In the hospital setting, they will usually have QI and Patient Safety, Physician Services, and CME (if there is a CME program). But beyond that, it can vary considerably.

In a future episode, I will share more about the day-to-day work of the CMO, and what it is like working with a senior executive team at a not-for-profit hospital.

NOTE: Look below for a transcript of today's episode.

Links for Today's Episode:

• 10 Reasons Why You Should Pursue a Hospital Management Career – 20
• How to Become CMO in a Year – 052
• 5 Steps I Took to Be a Hospital Executive – 175
• How to Pursue a Nonclinical Career in Hospital Management – 080

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 218

6 Important Assignments of a Hospital CMO

All right, Nonclinical Nation, today I thought I would discuss my work as chief medical officer. I spent 14 years as a senior VP at my hospital, and there was a lot that I liked about that job. Actually, much more than I can cover in one podcast episode. I already spoke to you way back in episode number 20, about the positive aspects of hospital management that I think you should consider if you're looking for a nonclinical career.

But today I'm going to focus on something a little different. I'm going to talk about the specific projects I worked on and the directors I worked with while I was chief medical officer. And I think this will give you a better idea of what a CMO does and how enjoyable the work can actually be. And I'm hoping it will inspire you to consider a hospital management career.

Even for those not considering such a career, you should listen anyway, because what I'll be describing applies to a senior leadership position in almost any industry, certainly many healthcare industries such as pharma companies, medical device companies or the insurance industry, but even in your own business in other non-healthcare related fields.

I think I'm going to come back again on a future episode where I'll focus on the other aspects of the job, such as what it's like to work as a member of a senior executive team. The so-called C-suite. That will be interesting as well.

For today, I'm going to just focus on six assignments that I had over my career as a hospital chief medical officer. And really in some ways, it's just scratching the surface. Although the areas that I'm going to be talking about today are definitely areas that I was involved with for almost my entire career, while I was CMO with a couple of them coming in later in the final 5 to 10 years.

Now, for two of the six, there is definitely no distinct director to mention for reasons I'll explain when I get to those assignments, but the other four definitely include working with the director for the whole term of my employment there and sort of how we work together on these major projects that I'm going to highlight during the rest of today's discussion.

Let me just give you the list of the six assignments right now, and then I'll go into them in more detail individually. Number one is leading the CME program and supporting the residency programs startup and other things related to physician services, which was led by the director of physician services, Lisa Zipsie.

The second is selecting and implementing the first quality management software program and achieving top 100 hospitals status while working with Mary Shore, the quality improvement director.

The third is implementing the hospital's first lean process improvement initiative and working with Stephanie Mitchell to help the lab expand and improve its services. She was the director of the laboratory services department, and she recently retired.

Number four is overseeing the implementation of physician order entry and medication safety programs at the hospital while working with the pharmacy director, whose name is Jim Schafer.

Number five was establishing the first hospitalist service. Now there wasn't a particular director that handled that with me. I was the lead on that, and I had to work with various departments at the hospital to get that project up and going. And so, I'll describe that.

And the number six is something that I took on during the last four or five years of my tenure, which was the multi-specialty group. I spent a lot of time in those years recruiting physicians, purchasing local physician practices, doing all the negotiation, all the contracting, and working with the attorneys. And again, there was no individual director that helped lead that, but I had to work with a number of directors over the areas that impacted or were impacted by the growing group, including the facilities department, which had to find space for us.

You may have already noticed that all of these activities involve big projects that have a direct impact on the safety and quality of patient care and the financial success of the hospital.

In all of the projects, I will describe where major initiatives straight out over our annual strategic planning and management goal-setting process. We did that every year. We began by developing a set of goals for all 80 plus directors and VPs running the hospital. And some of them span more than one year if they are especially costly. But that's what drove us to do what we did.

Also from a process standpoint, the way that these goals were met, generally involved me and other VPs sitting on committees and teams addressing the initiatives, meeting with our directors regularly and keeping forward progress. We'd receive updates on their progress, provide them with feedback, lend them support by shifting resources from one area to another one that was needed.

My other role, doing all of this, also involved helping each director who reported to me to prepare a yearly operational budget that we would present and defend to the CFO and COO.

There was also a capital budget with requests for major and minor equipment. And this could include everything from a multimillion-dollar information system, let's say for the pharmacy to new carpeting for the medical staff lounge. And every year everybody had their requests. And of course, there was a cap on the capital that would be spent. So, we had to demonstrate why ours was worth funding.

Now, the other side of that coin is that I was then responsible for reporting back to the CEO and to the senior management team in our weekly meetings on the progress being made on the management goals that we had all agreed upon at the beginning of each year. Let me get into some of the specifics and I'll start with number one, leading the CME programs, supporting the residency program startup, and working with the director of physician services.

This is normally a core responsibility, the CMO, because we interact so directly with the medical staff through its governance, through facilitating and supporting the medical staff structure. But we had a CME program. I was the chair of the CME committee, even before I became employed by the hospital. I continued in that role.

And so, if you have a CME program, then you're probably going to have it fall in this area and maybe standalone. But oftentimes, it's under the medical staff department.

We were responsible in the committee and under this director for maintaining our accreditation as a CME provider. And of course, all the credentialing and staff appointments were done by this department.

Now, late in my tenure, it was decided by the senior team and particularly the CEO was interested in doing this, was to help us with our recruitment of physicians, which seem to be getting more difficult every year by adding an internal medicine residency and fellowships in GI and cardiology. Those were added in part to help drive people to come to the IM residency because then they would have a slight advantage at getting into one of the fellowships, which were definitely very popular.

Now we were not an academic institution. We had affiliations with some institutions, one of which Rush University Medical Center, and particular of course is an academic medical center. But we chose to align with an osteopathic medical school. We were able to get our internal medicine residency and fellowships going through them. And of course, now all of those are going to be blended into one entity under the ACGME. That was fun. That was great. That was part of my core responsibilities for many years.

The second big project and an area that I had responsibility for was quality improvement. And it was one of the things that I really wanted to be sure was happening when I joined back at the beginning of my tenure there, was to be sure that we had a tool to measure risk-adjusted complication rates, mortality rates, quality measures that we could then share with the medical staff and monitor our progress and making improvements in quality and to some extent patient safety.

That was one of my first projects. I had a chance to look at what was available then, and we purchased a tool that was very effective and gave us some really good results that we could share with the medical staff individually and as groups or departments.

By using tools and creating protocols and teams to address any quality issues that we identified, we were able over a period of time, along with help from the CDI department and utilization management become a top 100 hospital. Because to do that, you must have really good measures in your quality metrics, you also have to have a good financial standing and good length of stay. All of that also depends on excellent coding and documentation.

So, just like in management, you manage what you measure, also in QI and patient safety, you manage what you measure. When other tools came out later, we actually adopted some of those as well because they were a little easier to use. And then we started working with other organizations to combine our data so that we'd have a larger pool to compare outcomes to.

Over a period of time that led us to achieve top 100 hospital status. I think it was originally through Solution and then Truven, and now I think it's under a new moniker, but we had five or six years in which we achieved that. And that was very rewarding. Again, that was through the help of the QA director, Mary Shore, and others in her department.

The third big area is the laboratory. I worked with Stephanie Mitchell, the director of laboratory and lean process improvement. That was the most exciting project that we did. Now I had a laboratory the entire time I was there. It was obviously very important that we had a lab that was efficient, that was accurate, that had good turnaround times. And so, that was the first lean project we ever took on at the hospital. It was one that was really typically geared for laboratories. There is always a very good one that could benefit from streamlining and changing from a batch process to a sort of continuous flow process.

And so, we learned how to do lean performance improvements. We implemented that. We got our routine lab results to a point where they were being returned within 30 to 40 minutes, no matter what time of day or night that they were ordered. And it was awesome. It also helped a lot, obviously with the quality improvement projects that I mentioned earlier. So again, a very rewarding project.

We moved on to other departments, including the pharmacy to do some lean projects. And so, that's the next one, number four, that I want to mention. I did have the pleasure of having Jim Schaefer, the pharmacy director, report directly to me for my entire term at the hospital. We work mostly on improving medication safety.

Although we also had to be certain that we kept our formulary up, that we had access to the drugs that our physicians needed and that we can keep the costs down.

In other words, you can't necessarily stock 10 different versions of the same medication. You usually have to pick one or two. And it does lead to some problems when patients are being admitted and discharged, because they may be on a medication, a different version of the medication that you've gotten your formulary in, and you have to make those substitutions, which can be difficult.

But the best projects that we did we're eliminating essentially many forms of medication errors resulting from physician handwriting by basically implementing a mandatory physician order entry, which meant that everything had to be built. And once it was built and implemented, physicians go order their labs and their meds. And the issue of someone having to read the handwriting was almost completely eliminated. There were some instances where people might send in written orders that had to be transcribed, but we pretty much eliminated that.

I think it's great when the CMO and the director of the pharmacy worked together because the pharmacy and the others I've mentioned so far, really have a lot of clinical implications without having to stretch the imagination. They have direct clinical implications and of course, medication safety also improves the quality, which also helped reach that top 100 status.

Now, the fifth project I want to talk about is the establishment of the first hospitalist service. And this is not something that the hospital medical staff came to us and requested. In fact, it was one of those things that they probably didn't really want to see. They really weren't ready for it, but we had so much data showing that the performance at other hospitals was improving so much. And that particular delays in care could be avoided if we had an on-staff in-house hospitalist service that we decided to implement.

I had to communicate that to the medical staff, of course. I think I sent a recent email out about that process. And we had to figure out how to staff it and how to bridge that gap from going from none to what we felt we needed at the beginning was at least six plus somebody to cover vacations. So, we struggled with the idea of whether to hire our own. The problem there is if you hire someone, but you don't have a hospitalist service to put them into at the moment, then how do you pay them for not working? How do you keep them waiting while you're trying to get the rest of your team together? So, we decided after looking at the options to contract with an established group, which was nationally doing what we needed and had a very strong recruitment arm, and then we designed the way it would be modeled.

And I did most of the work on the contract with the group, again, working with the attorneys and the CFO. And ultimately, we were able to get that off the ground. It's been very successful. It has morphed over the years to different groups and different staff.

The other thing is the planning meetings that we were using to develop the program, morphed into management meetings with the medical director and others involved and seeing to it that the hospitalist service was efficient. It was prompt and had good outcomes.

Finally, something I got involved with for the last four or five years of my tenure, which you would think maybe I would have been involved with earlier, was the medical group. The thing was we had a small group. They were very independent. And so, they weren't really treated as a group. They were more or less treated as individual small practices in some of the outlying towns. Maybe one or two actually near the hospital itself.

But once we made a strategic decision to expand the group and add other specialties that were lacking in the community, then we really tried to find some super-qualified directors to run that process. However, we went through two or three, and at some point, the CEO thought, "Well, I'm going to have John take it over. We'll continue to try and get a director to work under John. But in the meantime, we can get things moving". And so I went on a binge, so to speak of hiring new physicians and of purchasing current practices, usually, they were one-, two-, or three-person practices, did a lot of contracting, a lot of employment agreements and renegotiating of contracts. I learned a lot.

And over time we added a lot of new staff, new physicians, many specialists that were not previously on the staff. And we also expanded the group geographically to a much larger area where we could help patients.

Well, I think I'll call it quits at that point. I think I've given you somewhat of a glimpse into the life of the CMO. It's kind of hard to separate the day to day from the project-oriented activities. Although I think in a future episode of the podcast, I'm going to talk about the day to day and how I interact with directors on the one end and on the other side, how I reported up to the CEO and the kinds of reports and discussions that we had as well as the regular meetings of the senior executive team, which usually were at least once a week and how we did some strategic planning and also did operational activities in that process. But that'll be for another episode.

I think it's important to acknowledge and remember that each CMO in any given organization will fit into the organization structure in a unique way with different direct reports and different areas of responsibility.

While what I've discussed today applies to many chief medical officers, if you're in hospital management and you get to that point where your CMO or chief integration officer or chief safety officer or anything like that, you're going to have different direct reports and different responsibilities.

But for most of my tenure, everything rolled up into what we called the medical affairs division. And sometimes I had to go to the nursing home. Sometimes they had home health. Sometimes I had the radiology department. The ones I talked about today are most of the core that I had ongoing. But I had to back off a little bit, particularly when I became very involved with the multi-specialty group.

In a hospital setting, usually you're going to have QA and patient safety, physician services, and CME, if you have a CME program, but beyond that, it can vary considerably.

All right. Thanks for listening today and I hope you've enjoyed it. If you have any questions as usual, just reach out to me at john.jurica.md@gmail.com.

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The post 6 Important Assignments of a Hospital CMO – 218 appeared first on NonClinical Physicians.

In this week's interview, Dr. Dan Field explains how he went from retirement to ardent CMO.

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By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

How to Go From Retirement to Ardent CMO and Medical Expert

Dan points out that most of us do not truly retire. We may phase out of clinical medicine, which can be intense and emotionally draining. However, by applying transferable skills, we can often move from retirement to ardent CMO or another equally rewarding position.

I advise you to listen as Dan talks about how he pursued interests that satisfied his desire for autonomy, variety, accomplishment, and reward. And he notes that humans are not made to BE happy but, rather, to PURSUE happiness.

Stacking New Skills

Then he provides practical advice about stacking new skills to prepare for your next career. A pertinent example he provides is to work as a state medical board reviewer to gain experience before embarking on a medical expert consulting business.

I think building a skill stack it's like opening up your tool chest and putting tools in it that are going to be useful to you. – Dr. Dan Field

We cover two important topics today: preparing for the transition from retirement from medicine to your next career, and how to prepare to do medical expert consulting. One way to learn necessary skills and find your first clients is to join a company such as MDstaffers.

Summary

I have no financial relationship with the company, but I think exploring MDstaffers at mdstaffers.com is a good place to look for locums jobs and medical expert witness consulting engagements. And from what Dan says during our discussion, he or one of his colleagues can help you to prepare to get started.

NOTE: Look below for a transcript of today's episode that you can download or read.

Links for Today's Episode:

• MDstaffers
• Dr. Dan Field's LinkedIn Profile
• MDstaffers Expert Witness Page
• MDstaffers Locum Tenens Page
• Top Reasons to Become an Expert Witness Now – 163
• How to Develop a Side Gig as an Expert Witness with Dr. Peter Steinberg – 053

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

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PNC Podcast Episode 189

How to Go from Retirement to Ardent CMO and Medical Expert - Interview with Dr. Dan Field

John: I'm always looking for chief medical officers who don't work in the hospital setting. So, I'm really glad today's guest is here. And it's kind of a twofer because we're going to talk about his career as a CMO and talk about the company that he works for, which also provides opportunities for expert witness and other types of clinical, but some nonclinical. So, with that, I'd like to welcome Dr. Dan Field to the PNC podcast.

Dr. Dan Field: Good morning. Looking forward to our time together today, John.

John: I'm really looking forward to it because again, I use the term CMO. It's kind of like the term medical director. It just can mean almost anything, but the one thing it does mean is it's a physician. So, tell us a little bit about your clinical background. I've done a separate intro with a lot of the details, but if you want to give us a little bit about your clinical background and then how on earth did you sort of segue into this role as a CMO?

Dr. Dan Field: Okay. Well, I started out as a Kaiser baby and I went to medical school and came back and became a Kaiser doctor and now I'm a Kaiser retiree. So, in that time I did my premed at Irvine and Edinburgh University. I did a little diversity there. Medical school in San Francisco. And I finished up with an emergency residency in Cincinnati before returning home to California.

John: All right. And you did that for a few years, correct? 

Dr. Dan Field: Correct. Yes. 

John: And a lot of things along with it, right? 

Dr. Dan Field: Yeah. Yeah. So, I did 30 years in the emergency department and when I say it like that, I feel like I'm saying I did 30 years in prison. But during that time, I kind of was trying to list some of the things that I did to kind of break out of the standard operating procedure. So, I ran for office, I started a manufacturing company. I engaged in a medical startup. I built a solar-powered home. I became a demo doc for a major CPOE company and I became a deputy sheriff on the SWAT team. So, I tried a variety of things. 

John: Oh man, we're going to have to like have another three podcast episodes just to go into each one. But now that's a pretty broad spectrum of things. Now, did you actually completely retire and then kind of search out the CMO role? Or was this something that came up while you were still practicing? 

Dr. Dan Field: It took retirement to find it. And it's kind of as serendipity. I was heading towards retirement, and I must have clicked on an advertisement. There are all these online things being thrown at us. And this one probably said something like work in the wine country, $200 an hour. And that probably went into a database and a nice young man, reached out to me and said, “Hey would you like to consider these things?” And he kind of took me by the hand and brought me back into some clinical because that was the contact locums. But then it turned out they had a spot open for a CMO and after our engaging conversation, he said, “Why don't we think about you joining us as a CMO?” And then I said, “Well, I have this idea for a med-legal panel”. And he said, “Well, let's see, we could call that MDexperts”. And we have a hundred thousand doctors in our Rolodex. So, if somebody needed a specialty, wow, we've got it. 

So, serendipity led to the situation and I should say, the things that really made it work, is that I personally had a low barrier to entry. I did not say you need to start out with a quarter million or $300,000 a year and no defined value. So, I came into it with the attitude that I was going to create my own value stream in this situation because MDstaffers was a tiny company at the time. And they were rapidly growing and I was right there at the beginning, but there wasn't a way to really pay me out of sales or commissions or so forth. So, I developed a value-added stream sort of approach. 

John: Okay. So that means this is kind of like a unicorn or a black swan event, I guess. But I've heard of actually many other physicians who either they're interested in startups, or after retirement looking to be on a panel, to be an advisor. So, in retrospect, MDstaffers looking at it online, it looks like it's into a lot of things. It looks like it's got a lot going on, but you're saying it was pretty much in the early stage when you found them and they found you. 

Dr. Dan Field: Yeah. So, they had been growing steadily, but actually, with the advent of the pandemic, our mission is to plug the holes in the healthcare system, the manpower gap. We work mostly with physicians and advanced practitioners and now we do mental health as well. We all know there's a huge gap and it's our mission to fill that. And suddenly with the pandemic, we had a lot of doctors actually being idled, which was a stunning outcome of that to all of us and a need to shift to online health care. So, it was another serendipitous moment. 

John: Yeah. When you look at companies like this recruitment and related things, it's always a chicken and egg. You need the bodies and you need the jobs and what do you get first and lots of companies just die because they can't do it. So, there you were, just boom. All of a sudden, we had a lot of people that were ready to look for something. And so, you could just soak that up as you built more and more opportunities. That's fantastic. 

So, looking back, what kind of advice could you come up with in terms of someone who thinks “Wow, that sounds pretty interesting. Is there any method to the madness? How can I possibly try to do the same thing?”

Dr. Dan Field: There are so many ways of approaching that. And with our limited time, I'm trying to distill in my mind. I think that you have to know what it is that makes you happy, or at least satisfied. And keep in mind, we are not made to be happy. We're made to pursue happiness. But happiness never occurs. So, it's the pursuit. Now in that pursuit, what makes you feel the best? What tickles your brain and gives you a certain amount of joy and enjoyment? So, I think it's autonomy, variety, accomplishment, and reward. I think those are the four things that tickle my brain the most and give me the most satisfaction. So, something that gives me the autonomy to be able to get up in the morning and go for a run before I settle down, or get up even earlier and do some hard cognitive work and then go for a run and come back and do some more. 

So that kind of autonomy, the variety. I'm coming at it from clinical ops, I'm doing med-legal, I'm doing clinical work, variety accomplishment. One of my biggest satisfaction moments came when I built my house because there it was, I did that. I did something. I brought all these parts together and I made something. 

And then, of course, reward. Getting some money for what you do. Having people say, “Hey, doctor, you made a real difference on my LinkedIn”. It's especially rewarding. It’s ridiculously rewarding how pleased I am to have somebody just say like, or insightful, or go beyond and say, thank you for stepping out there and making these comments. So, my reward comes from so many different directions now. 

John: Yeah. Well, people sometimes call it a purpose or passion and other rewards, but you're right. It's the journey, not so much like you've landed there. But I like you talking about your house because they have a physical representation. That thing is done. We don't always have that in medicine because our patients go away, they get better, they get worse. But if I could build a guitar or build a house.

Dr. Dan Field: Exactly, that's exactly right. Even a well-crafted medical-legal opinion to me where I took an issue. I refined it. I researched it. I made points. I justified those points and I presented them. That is something that's concrete. When I worked in the emergency department and I see the same person for a drug overdose three times, I don't feel like I've made a lot of progress there. 

John: Yeah. Really, I can remember those experiences in my office as well. It's frustrating. That's kind of the patient you hate to see. You look at your schedule, you didn't have a schedule to look at, I'd look at a schedule and see the person who was coming back in two hours. 

Okay. So, we're going to move to the meadow medical expert in a minute, but I want to ask you because I think this is an interesting transition. Physicians aren't really going to retire. I mean, they might retire from clinical, but our minds are going, we have energy, we have so much knowledge. Do you think that most physicians that practice as long as you did and that kind of environment, whether it's internal medicine, emergency medicine surgery, do you think we should pick up a few new skills at the end of that to anticipate this next? Should we do little pilots or do we have enough of the knowledge and skills that are really going to translate into some other jobs already?

Dr. Dan Field: I think preparation is the way to go. I think building a skill stack it's like opening up your tool chest and putting tools in it that are going to be useful to you. So, I knew that I liked med-legal. For some reason, I was attracted. In fact, when I applied to medical school, I applied, my thought was to do an MD/JD. That was 35 years ago. And it was too startling for most of the medical school admissions committees. And I didn't get accepted when I led with that. But I knew I liked it. And so, I began to add tools along the way. Kaiser doesn't allow you, TPMG, the Permanente medical doesn't allow you to do outside work for a monetary reward if it involves your license. But what they do allow you to do is public benefit. 

So, I actually started working as a California medical board reviewer, and here they're asking us to look at medical cases and say was the standard of care met? Was there an education deficit? And I began to develop the evaluation capacity, which actually translated very well to my next stage as an expert witness. 

John: Yeah. I think you don't always know where those are going to go, but those extra experiences can be very helpful. Not only because you've learned new skills, but then when someone's looking at you, they say, “Oh, wow, that's something interesting that might be useful for what we need”. So now, from what I understand when you joined MDstaffers and they had never had a CMO. They were small enough that they have a similar position. 

Dr. Dan Field: They did have a CMO previous to me. It didn't work out the way they wanted it to and there was a parting of ways.

John: Okay. So, then there you are. And then you were the one I think that introduced this concept of adding the MDexperts to their growing kind of array of topical areas. So, tell us about that. I know you have that interest, but tell us how that transpired and what it is today. 

Dr. Dan Field: Let's go back a step to MDstaffers business model. So, they have two clients. They have physicians and advanced practitioners, and that's one group of clients. And on the other side, they have the Adventist selves or the major healthcare organizations who are looking for manpower or person power support. 

So, we are recruiting on the one side for those big company clients who need volume and we're prospecting for the workers on the other side, and then we're going to match those. They might say, we need a hundred mental health care workers for our telemedicine product. And we'll say, okay, are you ready for a hundred of them next week? And we've broken the bank there, or the processes for some of our companies because we give them so many high qualities. Well, we now got a hundred thousand plus physicians in our Rolodex and it takes an older person to know what a Rolodex is. 

The concept is really simple. Somebody needs a specialty in Hackensack, New Jersey. And they call us up and they say, “Who do you have in Hackensack who is a pediatric pulmonologist?” So, we just go into our tracker database and type in 50 miles from Hackensack and a pediatric pulmonologist. And I get four names and I have the CVs. I have everything ready and we shoot them a CV and they say yes. And then we match the two.

John: What's the experience for the physician? Are they a subcontractor for you and MDstaffers or directly for the attorneys that are looking for them or the insurance company or whatever it might be? How does that work? 

Dr. Dan Field: Well, that's a good question. In many of these circumstances, it's a handoff once the connection is made and somehow the value has been extracted before that stage. And then it's up to the physician to work out with the requester. Our model is that we manage the process. We do the invoicing, we guarantee the payment, we pay the liability in this case. And in exchange, we take a less than typical market share. So, it'll be less than 30% for our margin. So that's the model. 

John: Do you have a sense of the physicians? Do you get many physicians starting out that haven't done this before and contact you about signing on, or do you generally use more experienced people or both? What feedback do you get from the physicians that are involved?

Dr. Dan Field: A lot of physicians come to us through the recruitment process. So, on MDstaffers side, where we're talking to them and we're engaging in conversations, our recruiters are really good, and we really develop a nice relationship with their doctors. And along the way, we say, “And by the way, are you interested in this line of work over here?” And a high proportion of the people that we talked to say, “Yeah, yeah, I might like to do that, but I haven't had any experience”. Well, we have a little process that we go through to help them begin to build the experience. And in those cases, you can volunteer for your in-house quality assurance committee. You might get paid for that in-house, and you begin to build some variety inside your current practice, which is a very nice longevity tool because again, variety and autonomy and reward. 

So, you begin to build some of those inside your current lifestyle. You reach out to your medical board and see if they have a reviewer program. You touch bases with the public defender's office. They're dying for experts, but they can't afford them. And so, we created a government rate basically to help the justice system, and it's much lower than the commercial rates, which we charge at-large criminal product, liability, and so forth. And that is beneficial to society and its benefits to us because it builds experience and volume. So, that's what I tell the new physicians. I say, take them through this route. 

John: I had a conversation with one of my colleagues who does a lot of telemedicine. He's licensed in multiple states. And he said that he had discovered that many of the state licensing boards need physicians to review records, review quality, review complaints. So, you're saying that kind of thing could set them up to take the next step and move maybe more directly into an expert witness type of activity.

Dr. Dan Field: Yes. And since a lot of physicians are not looking to leave clinical practice entirely, they're trying to build a side gig inside their current lifestyle, where they can take some of their non-program time and turn it to a monetary reward and then perhaps reduce their clinical. And as we all know, when you reduce clinical, you reduce exposure. 

John: That's a good part. 

Dr. Dan Field: Well, it's a great part. And it has two parts to it itself. This is a little segue, but not only are you reducing your personal exposure, but the very act of studying these things teaches you how to avoid exposure. So, it's a total win-win and perhaps triple win situation. 

John: Yeah. I guess if you're gaining expertise on how to be an expert witness and then you know “Oh, my documentation needs to be spruced up a little because obviously, this is what they're asking me to look at”. Or if you happen to go through a deposition, you learn those things pretty quickly. 

Dr. Dan Field: Okay. So, let me throw one more thing at you along these lines, because you were asking how we prepare our new doctors for this kind of career. Another thing is just an education on what an actual expert witness is and does. So, we all have kind of our TV imagery. Yep. But what is the reality? And my reality is that I have found that I am an interpreter. That's how I look at my expertise as that of interpretation. 

So, I take a medical record and other information that might be confusing and are out of the area of expertise of the judge, the jury, and the attorneys. And I interpret this for them in an ethical, and, what would be a good word? It's somewhat of a blinded fashion. I kind of walk into these cases without a preconceived notion or with the openness that my preconceptions and biases might be changed by the facts of the case. And that happens a lot. I had a great case with the Air Force, where I went in thinking “This guy's a scumbag and I'm here to defend him”. And in the course of the case, it turned out not to be in my opinion. So, you were an interpreter.

John: Now, what I've heard others ask about as well, “How much actual record review am I doing as opposed to actually ended up doing a deposition? And am I likely to ever end up in court in a trial?”

Dr. Dan Field: The answer is no. 

John: It's pretty rare. 

Dr. Dan Field: Yeah, just like with malpractice cases, mostly favoring the physician. Probably 95%, something like that. That same applies to your chances of actually getting into the court. So, I've probably reviewed a hundred cases by now. Not huge, maybe even 200. And I probably made it into court a total of 15 times, and I love depositions. I love sitting in court. I love that part of it very much. I don't like malpractice. I don't think anybody does, but personal injury and criminal is really nice because I go there as a nonpartisan and I'm here to help and advise.

John: No, I think that's a good picture of how things go. You have to have a certain personality, I suppose. You can't be a hothead that flies off the handle. You have to be able to listen, stop and be calm basically, and give a measured response. But if you can do that, I mean we're well-trained, we should be able to do it in most cases. So, I think it's something that practicing physicians rather than just, say, dumping clinical completely, maybe cut back on the clinical because you need to stay in clinical if you're going to do this anyway, most likely because they want you to know the standard of care. And do this. It's a good side gig. And like you said, it could balance out things.

Dr. Dan Field: Variety and reward and some autonomy. You know what? You really hit upon it, John. I think you were touching on a valuable tool - You need to be a team player. And think, for instance, a physician such as yourself, a family practice person, perhaps with an office or a team, have some nurses, you have an assistant. They're your team and you're working with your team to bring about an end. And when you are an expert witness, you're part of the team. You're not house. You're not the prima donna that everybody's going to come and bow to. You are part of the team and you're working to get to the end to go deliver a product. 

John: So, if I was interested, I could get on the phone and call MDstaffers, MDexperts, and just talk to somebody about what it would take to become one of your physicians that do that. And if they have to do some other work first, that's fine. But at least I can learn more about how to get there.

Dr. Dan Field: I'm happy to talk to anybody who wants to discuss this. I've benefited from those who have gone before me. And I will be paying it forward as the phrase goes and helping the people along the way. I’ve got some good ideas for them. 

John: All right. I want to remind everyone that the website is mdstaffers.com. That's one word and everything that you've talked about and everything that MDstaffers does is somewhere on that website. And there's probably a contact form to reach out if you'd like to do that. Is there any other thing? Like the mention about MDstaffers, you say you've got a locum’s component as well. So, a lot of people use that as a temporary or permanent change from what they're doing. 

Dr. Dan Field: Yes. You should keep in mind, those of us who are near retirement. And if you think, “Well, I might take a couple of years off and travel to Fiji and Bora Bora” and so forth. At least in emergency medicine and probably the same for surgery and some other areas. If you haven't practiced in the clinical setting in the last 18 months, you're out. The process to get back in and to get on staff becomes much more onerous than people would consider.

So, I really advise people to keep their foot and their toe in the bathtub here and keep a little side clinical going. And that can extend your career until as long as you want it to go. I frankly don't know what I would do if I didn't have this to get up to every day. I mean, I could not sit there and read the paper and drink coffee all morning, and then go meet my buddies at the coffee shop for more coffee. I need more than that.

John: No, everyone I've talked to, I haven't really seen a physician. Most of us either practice till we drop, or we do something else. And that's healthy. You need that, I think. All right, well, we're going to run out of time here. So, I guess I would ask you if you have any other advice, maybe for a physician who's maybe not quite ready for retirement, but thinking about those few years down the road. Any specific advice or other comments you would have for us? 

Dr. Dan Field: Yeah, yeah. Realize that failure equals experience. Don't be afraid to go out and try something. You're going to learn. You're going to learn as you go. So, when I went out and worked in the business world, I learned some business concepts and I learned how important it was to be a team player. Don't quit your day job. Find a way of diversifying your day job internally and pick up skills so that you have something to offer when you get out. 

I think you should try to find out what tickles your brain and then make that the direction that you're going to move. So, you're going to build your skillset around those things that bring you that happiness or satisfaction. And there are ways to do that by taking baby steps. So, I'm an incrementalist. I like job security and a paycheck, so that's my advice. 

John: All right, Dan. Well, this has been very interesting. We've learned a lot about the two major topics that I think we're going to be able to learn from and apply. So, I really want to thank you for spending the time. Again, that's mdstaffers.com. I'm sure they can track you down there, or you can go on LinkedIn and probably get a hold of you and contact you that way. 

Dr. Dan Field: Absolutely. 

John: All right. Well, with that, I guess I'll just have to say goodbye. 

Dr. Dan Field: Okay. Thank you. 

John: You're welcome. Bye-bye.

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