Curbside Consult with Dr. Jayne 2/13/12

Care and Feeding of the CMIO

I frequently receive calls, e-mails, and LinkedIn messages from recruiters looking to fill CMIO positions. This might be a good thing – a sign that hospitals and health systems are figuring out that they really do need a CMIO after all and are looking to fill newly-created positions. A wise man once told me that it’s a good idea to spend 10% of your time looking for your next job, so I do read or listen to everything that comes my way. Who knows? Someone could be offering a CMIO position in a tropical location with excellent benefits and an assistant to deliver a slushy adult beverage every day at 5pm.

Unfortunately judging from many of the position postings I see, not all of them are new positions. In fact, some of them have been vacant for a long time and the postings have remained unchanged despite being unfilled. Some employers are just not understanding what CMIOs are looking for as far as scope of work, compensation, and job satisfaction. Let me give you a few examples.

Ability to continue practicing medicine. This is important for a variety of reasons. Credibility is often linked to actually using the systems that we’re advocating for our colleagues. Being an actual user of the system is important in understanding the reality and magnitude of issues raised by physicians. I’ve been able to shoot down the “it takes 17 clicks to do this” rhetoric spouted by some of my colleagues because I’m a user – and I know for a fact it’s a gross exaggeration or an example of a provider not following the best practice workflow.

Additionally, requiring a current active medical license of applicants can also screen out physicians with drug problems, failure to pay child support, failure to pay taxes, criminal records, and other undesirable employee attributes. I recommend that potential employers offer this as an option rather than a requirement, though. Keep in mind there are a lot of good candidates out there who don’t have licenses – many never thought they’d practice again and let their licenses lapse – so don’t use it as an absolute yes/no test. On the other hand, watch out for resumes that show people were in practice until recently and or have unexplained gaps in their work histories.

Travel and after-hours commitments, meetings, etc. One recent job description I saw stated that the job involved 50-75% travel – mostly regional, but some national. Considering that most employers are looking for people that have not only a medical degree but also either an advanced degree (MBA, MHA, etc.) or an informatics certificate, plus three to five years clinical experience and three to five years CMIO or medical director experience, this could be a problem. You’re talking about a potential applicant pool that will be in their late 30s to mid-40s age-wise at a minimum. These are going to generally be people who have families, often with small children, and your position may not be very attractive to them.

Continuing education and meetings. This should be part of the offer. It’s extremely helpful to be able to have not only the time (either on the clock or as dedicated continuing education time) but the budgetary resources to travel to a couple of meetings a year. Although we’re all increasingly good communicators in the virtual world, there is still value in face-to-face interaction with colleagues and peers, especially if your organization is in a town where there are only a handful of CMIO types. An offer I recently considered had not only less vacation than my current package, but I was explicitly told that as an IT employee (rather than a physician employee) I was not entitled to continuing education days or funding because “only the physicians get that.” I decided right away that they didn’t “get” what a CMIO was all about, and that was the end of my looking there.

Administrative support. With everything your CMIO is going to be tackling along the lines of Accountable Care, Meaningful Use, and the acronym soup that is our lives, he or she is going to need some help. Even if it’s just a shared administrative assistant, it can be a huge benefit to not have to spend time each day juggling calendars and handling daily office “stuff.” At a minimum, I’d expect some of the same things I’d expect from a good practice manager – opening / sorting / prioritizing mail and phone messages; ensuring regulatory compliance (completing license renewals and credentialing if those are required for practice); coordinating support resources, and handling other ad hoc requests. I would never consider a position without some kind of administrative support. The ability to tackle spreadsheets, flow chart software, project management software, and the ubiquitous slide shows is almost mandatory as well.

Benefits and salary. If you’re committed to finding an experienced CMIO who can hit the ground running, you’d better be willing to pay for it. Someone with ten years’ experience is not going to settle for an entry-level physician wage. The same group I mentioned above was offering a salary that was barely commensurate with the guaranteed salary they were paying new physician grads who were joining practices. When asked for the rationale, this was the answer: the CMIO doesn’t see as many patients or generate as much revenue. Again another indicator of an organization who doesn’t “get” the CMIO role. We may not be seeing 95% of the MGMA statistics for patient volume, but what we do can allow your physicians to reach that level in a much more efficient fashion as well as to assist in increasing the quality of care provided. Government and payer requirements are increasingly complex, and if you expect your CMIO to be able to bob and weave along with the myriad of changes, you better be willing to pay for it.

Culture and autonomy. CMIOs may report to a variety of people – CIO, CEO, or someone else entirely. Some organizations have complicated dual-reporting structures. Yet others have a clear chain of command but a parallel network of “informal” governance that makes it difficult to get things done. The best way to alienate a new (or potential) CMIO is for them to feel they’re in a place without clear direction or support for their initiatives. Making them obtain approval for every little thing is another good way to disenfranchise your CMIO. For those organizations that refuse to use the CMIO title, making your director of medical informatics (or whatever you want to call it) feel like a second-class member of the leadership team because they don’t have the title is another good way to encourage your CMIO to leave.

I worked for a group like that for a while. It was unpleasant, and each day I felt like I had just played 20 rounds of Whac-A-Mole. Because there was no real organizational culture, there was little room for strategy and great need for firefighting skills. Everything was a crisis that had to be dealt with and the leadership was constantly in transition. It seemed like I had five different bosses at any given time and everything was a priority. Initially I thought it was just me trying to adjust (I was a Padawan Learner then rather than the Jedi I am today) but it turned out it was a vacuum in leadership and culture.

If you have a handle on these things, you’ll probably do pretty well trying to hire your first CMIO. If you’re an organization where that role is well established, it might be worth taking a little time to see how your CMIO thinks you measure up in these areas. The CMIO is still a relatively new addition to the corporate team and it’s certainly OK for the position to change and evolve over time.

I’m pretty happy in my current role. But if you do happen to be located in a tropical or otherwise fabulous place and can provide the aforementioned fuzzy drinks, e-mail me.

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