Creating position as PA ED manager?

[Boatswain2PA]

Looking for advice, trying to potentially develop a PA led ED.

Offered ED job (single APP coverage, >10K visits/year, 12-24 hour shifts) that I think I'm going to accept.  Seems like a good hospital, but the ED has probably been neglected (run by locums, revolving full timers, etc).

During negotiations (through an experienced (seemingly good/knowledgeable) recruiter) they asked if I would be interested in a leadership position in the ED.  "Yes, yes I would, but would want to be compensated for that"....but then they came back with "yeah, we would like you to do that....but not sure what that would look like" so that wasn't part of the offer.

I think I'm going to take the offer, but would like to cement the leadership position.  Current head APP is leaving, don't think ever had a job description/compensation/title/etc.  Was probably just the "go too" person for any provider-type issues that came up, including doing the schedule.

So, I think I have a blank slate to start with on that.  What I would like to do is accept the ED job offer, with a suggestion of creating (and filling) a secondary position with a specific job description and compensation for that.  
 

I'm looking for help with how to create the job description so I can sell it to management.  I think the medical director would let me have the ball and run with it (could be wrong of course).  Recruiting, hiring, training, and quality assurance of providers?  Work with Risk Management on provider issues?  Compliance with guidelines/protocols?  Interface with specialists?  Liaison with other facilities?  

Hospital just bought out by huge mothership hospital system a long way away.  In my experience, in large organizations like this titles are important, what would be an appropriate title for a PA manager of an emergency department?  Assistant ED director?  ED manager (head RN title is "ED supervisor")?  Lead ED PA?  I dunno, help me out.  

[ventana]

There is only one title

 

 

Medical Director

 

Anything else is useless

 

 

VA is now using PA's as medical directors, USA ski team has  a PA medical director......

[UGoLong]

It doesn’t sound like you have had a chance to meet the medical director yet to sound him/her out? Or meet the people you might end up managing?

I know times have changed, but maybe they would want to either meet and evaluate your management style now, or else wait until they’ve worked with you for a time before deciding to put you in charge. If the latter, then getting some agreement as to what the process will look like, who will make the decision and when, etc would be in order.

Good luck!


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[EMEDPA]

I had a position like this 18 years ago. I was "The associate chief and affiliated clinician lead in the dept of emergency medicine". I was in charge of all aspects of dealing with 12 PAs and NPs from hiring to firing to discipline to scheduling. I had to clean house from day 1 and got rid of a bunch of per diem folks who could not find their asses with both hands. I fired all the moonlighting IM residents(who at the time were getting $65/hr to see 1 pt/hr and refused to see kids)  and replaced them with EM PAs making $30/hr who saw 3/hr and saw everyone. Doing that job for 2 years taught me that I do not like being an administrator. I think I was good at it, but it ate my soul. Any holes in the schedule were my responsibility, etc. Off work at 2 am and at required staff mtgs at 7 am, etc.

Boats- we can talk about this offline if you want. would also recommend you touch base with George Brothers, Medic25, and Kargiver who have experience in these matters. In your situation I would be a little concerned about influence from the mothership hospital. I'm not saying don't do it, I'm just saying go in knowing what you can change and what you can't.

[medic25]

Our department has an APP Manager who oversees 50+ PAs/NPs that staff our 3 ED's.  It's a full-time administrative position, and we are currently working on making it a Director-level position with APP managers that report to the director (they'll be half clinical, half admin).  However you structure your proposal, I'd strongly argue for building in guaranteed protected time.  Trying to do all of the administrative work while still pulling a full clinical load is a recipe for disaster, now matter how much extra they pay you.  I currently do 50% admin and 50% clinical and it's definitely contributed to my sanity.

The main things to focus on in the role would be things like hiring/firing, onboarding/orientation (hugely important and usually ignored), ongoing education, CQI, etc.  It all depends on how big the group is and how much they'll let you do, but it doesn't hurt to ask for more than what you expect.  In the big hospital system, definitely shoot for a title of either Director (best) or Manager; even if it seems like fluff it makes a difference within big shops.  Feel free to DM me if there's anything else I can answer.

[sas5814]

Our system has 3 "Senior APPs" and they do nothing, attend no meetings , have no authority, and get no time off from clinical duties to attend to administrative matters....which seems OK because they don't have any. Some certification or gold star something or other said we needed them so the NPs got together and picked the 3 people they liked the most.

I was senior for a hospital district some years back and generally enjoyed it because I had a voice in how things ran. As EMED said it can be soul sucking and time consuming. My low point was firing one of my best friends from school.

[Boatswain2PA]

16 hours ago, ventana said:

There is only one title

Medical Director

Anything else is useless

Might work, might also rub some people the wrong way.  I would be fine with "Assistant"....but then again I'm fine being a Physician Assistant. 

 

16 hours ago, UGoLong said:

It doesn’t sound like you have had a chance to meet the medical director yet to sound him/her out? Or meet the people you might end up managing?

I know times have changed, but maybe they would want to either meet and evaluate your management style now, or else wait until they’ve worked with you for a time before deciding to put you in charge. If the latter, then getting some agreement as to what the process will look like, who will make the decision and when, etc would be in order.

Yes I met with him, he seems like a stand up guy.  Also seems like he wears way too many hats, so maybe I could take one from him.  I know the current lead APP by reputation (has an outstanding reputation), but this person going to part time here.  I know another PA who was working full time and also gone to part time (this PA also very good).  I didn't get a chance to meet any of the other APPs.  

Certainly could be they want to get to know my work style before moving on....I think it's more of there are so many changes going on already with the merger, and they don't know what they WANT in an ED leadership role.  During interview it was evident they understood they are in a tight spot, and during negotiations THEY asked if I would be interested in leadership role.  

 

12 hours ago, EMEDPA said:

I had a position like this 18 years ago. I was "The associate chief and affiliated clinician lead in the dept of emergency medicine". I was in charge of all aspects of dealing with 12 PAs and NPs from hiring to firing to discipline to scheduling. I had to clean house from day 1 and got rid of a bunch of per diem folks who could not find their asses with both hands. I fired all the moonlighting IM residents(who at the time were getting $65/hr to see 1 pt/hr and refused to see kids)  and replaced them with EM PAs making $30/hr who saw 3/hr and saw everyone. Doing that job for 2 years taught me that I do not like being an administrator. I think I was good at it, but it ate my soul. Any holes in the schedule were my responsibility, etc. Off work at 2 am and at required staff mtgs at 7 am, etc.

This sounds similar to what I think they need, and I could offer.  Similar situation with staffing, but they currently use a regional locums group a LOT.  Pay is much, much, much better though! 

I will make sure that I will NOT be the one filling all the holes in the schedule.  I'll work hard on bringing enough people in so there are no holes, and if I can't then we will continue with the locums group, but I'm not gonna kill myself on the schedule.  I could see doing a 24 on, 12 off (sleep and leadership/management/meetings), then a 12 hr night shift, then going home.  Required staff meetings can be done via email.

I will certainly reach out to you and others if it looks like this will turn into a thing.

 

10 hours ago, medic25 said:

However you structure your proposal, I'd strongly argue for building in guaranteed protected time.  Trying to do all of the administrative work while still pulling a full clinical load is a recipe for disaster, now matter how much extra they pay you.  I currently do 50% admin and 50% clinical and it's definitely contributed to my sanity.

I think I will ask for a stipend for any leadership role.  Probably 5 full time (including myself) and as many part time people as I can get, with the goal of reducing reliance on locums.  What that stipend would be would be determined by what exactly they want me to do (full "medical director" responsibility versus "doing the schedule"),   Full "medical director" (recruit/hire/discipline/fire, interface with other departments, CQI, metrics, chart review, staff meetings, etc) I would likely ask for a $20K stipend.  With doing six 24s a month I would have time....but my time ain't free.

 

10 hours ago, sas5814 said:

My low point was firing one of my best friends from school.

Yeah, that would suck.  Already got a great friend/classmate on the hook for the job.  Talked to them today again about it and said there was one absolute rule that would HAVE to be followed:  Neither of us would allow the job, no matter what happens, to interrupt our great friendship.

[UGoLong]

Boats,

Sounds like you’ve got your head together on this and that it’s something you really want to do.

Being the boss has advantages and disadvantages and you’ll learn about both along the way. To me, the best part of management was mentoring. Someday you’ll look around and remember all the careers you helped to start.

Good luck!


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[EMEDPA]

6 hours ago, UGoLong said:

 To me, the best part of management was mentoring. Someday you’ll look around and remember all the careers you helped to start.

Good luck!


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Indeed, but you can do this just being an active preceptor. I almost always have 1-2 students from the 3(soon to be 4) local programs.  I know many/most of the PAs in town and have precepted many of them over the last 20 years.

[Boatswain2PA]

I've been in leadership positions before, including command of two multi-mission stations (think mix of police/fire/EMS department on the ocean).  

Since retiring from military I have just focused on practicing medicine and, being mostly locums, generally missing on management/leadership opportunities. 

I'm pretty excited about this, but will need some help from some of you about some of the regulatory stuff, etc.  That is, of course, if I can talk them into developing this position.  Otherwise I will be fine being "just" the provider.

 

 

 

[UGoLong]

Indeed, but you can do this just being an active preceptor. I almost always have 1-2 students from the 3(soon to be 4) local programs.  I know many/most of the PAs in town and have precepted many of them over the last 20 years.

Very true. And there are prices to pay in management. The plus is that you have some power to help careers beyond pure mentoring. I did it for 15 years or so back in the late 70s through the early 90s, enjoying some of it and not so much dealing with the internal stuff.


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