Author Archives: STFM News

An Innovative Way to Teach Hospital Leadership and Administration in Residency

by Andrea Heyn, MD, University of Arizona, Tucson.

As a family medicine resident, I have spent countless hours learning how to treat chronic medical conditions in the clinic, delivering and caring for newborn babies, and managing hospitalized patients. However, I have always wanted more experience in hospital leadership and administration, as I am fascinated by what goes on behind the scenes. I had the opportunity to participate in a leadership program offered by my residency, but it did not give me the firsthand exposure I envisioned, so I took the opportunity to design an elective that would give me experience to find out if this could be part of my career.

The elective was 2 weeks long, and consisted of two portions. I worked hands-on with Bethany Bruzzi, DO, one of the family medicine resident attendings, who was the hospital’s new chief medical officer. The first portion of the elective revolved around self-reflection and assessment. I received a 360 evaluation, completed by my supervisors, direct peers, those whom I supervise, and support staff such as the medical assistants and receptionists. This helped me identify my strengths and weaknesses with regards to effective communication and interpersonal relationships. Additionally, as part of this self-reflection process, I read several books and articles on personal development. One particular article, Connect, Then Lead, from the Harvard Business Review, helped me refine how I interacted with my co-residents as a senior resident, which was particularly helpful as someone who is a direct communicator.

The second portion of the elective involved my participation in various meetings and discussions. Each morning, we had daily hospital rounds with social workers, physicians, and nurses to discuss the discharge needs of patients. One specific example was of a patient who had been admitted for multiple weeks without a next of kin, awaiting a public fiduciary. We consequently spent hours working with the court liaison on streamlining the process of assigning a public fiduciary for future patients. We had phone meetings with the IT department advocating for physicians’ requests for changes and additions to the EMR system, with one particular meeting focused on revising discharge templates. We also met with representatives from various departments who were part of the Quality and Safety Council to discuss quarterly initiatives for the hospital.  This meeting was dynamic and progressive, with changes implemented as a direct result of feedback from staff and physicians. However, what I found most interesting was the budget discussion. I now appreciate the challenge of attempting to meet the needs of so many, from doctors requesting new ultrasounds, to the kitchen needing new stoves, while staying within the budgetary constraints. Finally, I got to sit in on the Executive Stewardship meeting and watched as the needs of the hospital were negotiated from a corporate level.

I am grateful for the opportunity to have worked alongside Dr Bruzzi. As a female physician, she is an inspiration to me as I prepare to graduate from residency and advance my career. Her promotion to CMO of this teaching hospital as a family physician speaks strongly to the dynamic role family physicians, particularly women, have in the medical arena.

This rotation has brought me to further appreciate the collaborative effort that is required to effect positive change in a multidimensional setting, where the needs of each player – patients, staff, nurses, residents, and attendings—vary tremendously. Furthermore, as I interview for jobs, prospective hires like to hear about my interest in future leadership positions, and discuss my goals and potential mentoring strategies.  I would encourage other residents to pursue leadership and administrative experiences via this direct approach. For those already in leadership roles, I ask you to create an opportunity for residents like myself to inspire and encourage us to become future leaders in family medicine.

Mi Gente

Figueroa_STFM-200

Edgar Figueroa, MD, MPH

I work as a solo-practice student health director at a target school (a medical school that lacks a department of family medicine). I’m located in a major metropolis and work at a very large academic/research medical center. Admittedly it feels a bit odd, then, to be invited to write a post on The Path We Took to leadership within academic family medicine, but STFM serves as my academic home, and being a part of this great organization has allowed me to find my people.

I won’t lie—I have a pretty good job providing direct care to a special patient population while managing to maintain work-life balance. There are drawbacks—my scope of practice has narrowed and I probably have forgotten a lot more than I realize; I’m not part of a department of family medicine and miss the rich exchanges that come from curbsiding a colleague or sitting in a faculty meeting; I don’t have residents on site to educate and learn from and medical school accreditation rules prohibit me from participating in the education of medical students at my institution. Lastly, the job can get pretty lonely. STFM has been invaluable in filling in the gaps.

I was a member of STFM as a resident but never attended an Annual Spring Conference until the first year of my faculty development fellowship. At that meeting, I led one of my first academic presentations, but more importantly got to connect with the most black and Latinx physicians I’ve ever encountered anywhere outside of a National Hispanic Medical Association or Student National Medical Association meeting.

And these were all family medicine educators—mi gente (my people)! I was hooked and have attended every STFM Annual Spring Conference ever since 2004.

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Resilient Faculty, Resilient Residents

Kathleen Rowland, MD, MS

Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.  

Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace.  We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.  

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