Curbside Consult with Dr. Jayne 1/26/15

I know many readers are on the edge of their chairs waiting to find out the answer to the career question I pondered in last week’s Curbside Consult. I spent several days out of the office last week putting my thoughts around whether I want to join our health system’s migration to a single vendor platform or pursue other career options.

Although I enjoyed the day I spent thinking about nothing work-related, things became complicated mid-week when I received an unexpected phone call. One of my CMIO colleagues knew I was off the grid and not checking email while I weighed the situation. He wanted me to know that a draft organizational chart was circulating and it had some interesting features.

First, the physician leadership is remarkably absent. We knew that there would be consolidation in the leadership, but not to the degree represented. My colleague wanted to know if I thought there was some kind of supplemental organizational chart that would have us on it. I don’t think there is one, but seeing it confirmed the fears of some of our medical leaders who have already jumped ship.

Second, although the number of mid-level administrators was as bad as we expected, they didn’t seem to be arrayed in a way that will be effective given our history and culture. With all the work that needs to be done, we almost need two teams for each hospital or entity, one for managing the transition and conversion and one preparing the new system. Of course they would have to work closely together, but given how we’ve worked historically, I can’t imagine a team being able to focus on two things at once and not end up cutting corners in favor of one side or the other.

Third, we were surprised to see a senior leadership level that was much smaller than anticipated. I’m not sure how they think a handful of top executives will have enough bandwidth to deal with the magnitude of change we’re expecting. The “Chief Culture Officer” I hoped would materialize was nowhere to be found. It looks like, at least to some degree, that we’re going to continue to try to do things the same ways we have always done them, yet are expecting they will have different outcomes.

Depending on where the organization is thinking about plugging some of the other CMIOs, there may not even be a place for me. Those of us that came up through the ambulatory ranks have a little less status than those who are purely hospital CMIOs.

The good thing about my time off is that I was able to come up with a self-employment business plan that makes sense, at least in the short term, if I end up being downsized. I bounced it off of some smart people I know and they agreed it was viable. My clinical group is willing to let me flex my hours as much as I need. It doesn’t hurt that they just opened a sixth location and are a little short covering some of the weekend and evening shifts, which I’m happy to do.

Since we don’t even have a signed vendor contract yet, I still have some time. I have to admit I’m leaning towards staying if there ends up being a position that is a good fit. Knowing I have a fallback plan (as well as a respectable nest egg) makes it a little easier to handle the uncertainty. Regardless of how it turns out, it will be entertaining and educational to watch all the players jockey for position.

In the mean time, I can find my entertainment with the reader responses to my question from last week: If you could do anything you wanted, what would it be? So far, early retirement, gardening, and travel continue to be themes. I haven’t had a lot of people saying they’d stay in healthcare, information technology, or the wild and wacky universe we call healthcare IT. Of the clinicians who have responded, no one wants to go back to direct patient care and that’s a sad commentary about healthcare in the US.

I saw patients two days this week and was reminded how miserably our system has treated some of our patients. I was also reminded of the sacred trust our patients place in us and how things that are not a big deal to us can make us look like superheroes to others. If you’ve ever seen the look on a parent’s face when you reduce their child’s Nursemaid’s Elbow, you know what I’m talking about.

What makes you feel like a superhero? Email me.

Email Dr. Jayne.