In large cities and academic centers, the prestige that accompanies being the medical/nursing director of a unit, department or hospital is widely spoken about. The larger the institution, the more of a weight this title may carry. Reasonably, large systems that require organization and movement of large parts and complicated infrastructure, are privy to this focus. However, once you leave the ivory tower and meander to the smaller sleepier towns, or even the ones in between, the role of the “Medical Director” is even harder and in my opinion, somewhat undervalued.
The implementation of protocols and guidelines throughout the medical landscape is increasingly difficult with a variation in resources, the speed of information spread, and the fact that staying up to date is nearly impossible. Per an article in 1998, pre-explosion of the massive spread of information through the interweb, a general practitioner would need to read a minimum of “19 articles a day 365 days a year” to keep up. A more recent podcast I listened to, estimated an upwards of 60 articles per day in the current climate with the vast increase in research productivity over the last decade. Regardless, it is hard enough to stay up to date to practice from day to day, let alone help make decisions to keep others on track. Herein lies some of the difficult parts of being the medical director.
Not only is the medical director responsible for ensuring coordination of the unit, policies/guidelines that are followed by the hospital, responding to higher up authorities in fighting for departmental allocation of funding/resources and making sure money keeps coming in, but he or she also is juggling active clinical duties simultaneously. The amount of support afforded to any single person is inversely proportionate to the size of the hospital. I have been privy to work at gargantuan iconic hospitals and hospital systems and at each level of administration or department-hood has several members to help with decisions, to delegate tasks to, and to help role out quality improvement projects. Sometimes, there are admittedly too many hands in play, but often times a benefit is that there are multiple people to go to with tough decisions.
In the small towns, staying up to date and convincing your coworkers that habits should change can be difficult to secure. In the world of pediatrics/neonatology, specific large changes that I have witnessed myself are changes in the protocol for Neonatal Resuscitation, the management of elevated bilirubin (which causes jaundice) and the evaluation of infants that have fevers. Sometimes, an advantage in a small hospital is the ability to make change quickly due to having less people to teach and to discuss big changes with – it is easier to have a meeting with 10 people versus 100. Yet, at the same time, if there is a bad outcome or something doesn’t work out, this can mean a significant workload may fall on the individual director.
At the end of the day, each hospital and each system strives towards being the best. Staying progressive and up to date is constantly difficult and the amount of juggling inherent to the role of a medical director should not be understated. A job I’m not sure I would want to do, but a job that someone needs to do, behind the scenes there is always someone that is working as hard as they can to lead and direct, and this should always be appreciated. To my favorite medical directors, thank you for your work, without you, we would be lost.
The Nomadic Pediatrician 