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Curbside Consult with Dr. Jayne 2/19/18

February 19, 2018 Dr. Jayne 2 Comments

From time to time, I contemplate heading back into the CMIO trenches full time. Although I do a lot of CMIO work in my consulting practice, it’s usually episodic and I miss seeing projects come full circle. I also miss being part of the strategic planning team, helping lay out the vision for an organization and how it plans to support patients and providers.

When I serve as an interim CMIO, I’m usually charged with keeping the ship afloat rather than deciding where the ship is going or what kind of cargo it will be carrying. Or perhaps I’m brought in as a consultant, tackling projects that the CMIO should be doing but doesn’t have the bandwidth to handle. There are some times where maybe the CMIO wants to do the project, but it’s politically charged and leadership feels having third-party assistance will help steer them through a rocky course. Those are challenging but often fun, although they can be stressful.

As I’ve talked to recruiters and looked at various job postings, I’m seeing some trends in CMIO job descriptions that I’m not sure I’m fond of. It might be a function of the duration clients have been using clinical systems, but I’m seeing more “maintenance” type job responsibilities and fewer “leadership” elements. Organizations are recruiting CMIOs to manage systems and data and people, but not necessarily for the ability to shape mission or to help architect strategies for delivering care in increasingly complex environments.

It feels like the role is being diminished somewhat, and the salaries are commensurate with that change. Of course, I have to remind myself that the positions I am looking at are sometimes in organizations that have struggled with even having a CMIO, let alone keeping one. If they were a great place to work and had found the right person, they wouldn’t have a vacancy.

Regardless of the situation, though, and the reason for the vacancy, it’s difficult to look at positions that are less C-suite and more director level, regardless of the title. Usually those positions have a salary range that is also less C-suite and more middle management. I recently spoke with a recruiter about a position with a salary range that was closer to that of a new graduate fresh out of residency than to an executive-level position, and certainly far less than one could earn in clinical practice. When asked about how they see the range as being supportive of the position, they mentioned that it was less than they pay their staff physicians “because it doesn’t have all the stress that comes with clinical medicine.”

When you hear comments like that, you know immediately that a position isn’t going to be a good fit. I would argue that anyone who thinks that being a CMIO is less stressful than other physician roles probably doesn’t understand what typically falls under a CMIO’s responsibility. I also didn’t like the fact that they were comparing the roles like that, because frankly being a physician is stressful and being an executive is stressful, but in different ways on different days. I don’t think that comparing stress levels across the organization as a means to justify salary shows that an organization is very progressive. It also highlights the risk that they might be in the habit of pitting various constituencies against each other in the hospital, which again is not a good sign.

I’m also struck by the lack of diversity in some organizations’ leadership profiles. At one organization, a large community health center that sees a very diverse population, the entire leadership team was composed of Caucasian males over age 55. I try to judge a potential job based on the job, but given the fact that I didn’t feel welcome during the interview, I didn’t think I’d feel welcome on the leadership team. Having grown up around many hunters and fishers and being fairly outdoorsy, I can talk hunting and fishing in a passable fashion, but it was nearly impossible to steer them away from conversations about who had the better deer lease and whether the wives would be coming to hunting camp this year or not. There were also conversations about how much money their stay-at-home spouses spent that were entirely inappropriate for an interview situation and made me concerned about how my potential peers viewed women in the workplace since none of the wives discussed work outside the home.

Another organization had an interviewer that asked me directly whether I had children. Although it was offered in a folksy tone under the banner of “help us get to know you,” it’s irrelevant to the job and role and was an immediate turn-off. It also said that this is an employer who doesn’t even understand the basics of employment law. As a seasoned people manager, that’s not something I want to sign up for. Given the desire of employees to have work-life balance along with the challenges of a graying society, rather than asking those kinds of questions, potential employers should be trumpeting whatever provisions they have in place to allow people to have children, build families, and participate in the care of aging family members.

Other organizations have been much more welcoming and have been proud to showcase provisions they have in place to keep their workforce healthy and productive. I’ve seen some fairly generous sick leave policies and concepts such as floating holidays to ensure that employees get time off on days that are significant to them and to their families. Vacation tends to still be a bit of a sticking point, though. Although I understand having people “earn” multiple weeks of vacation as they build tenure with a company, offering a senior-level applicant two weeks of vacation with the option to have a whopping three weeks of vacation after five years of service is a bit of a non-starter. We know the US lags behind the rest of the world with vacation days, and as a potential applicant who’s well established in the workforce, it’s a concern.

The issues I describe aren’t unique to finding CMIO positions and they apply to many other situations I see in the workplace. Potential employees want to feel valued and they want to feel like they’re moving to something better that offers more opportunity and/or rewards than their current situation. They don’t want to feel like they’re making a lateral move, let alone a downward move. I’ll be meeting up with some of my CMIO colleagues at HIMSS and will be interested to see how they feel about where they are in their careers or what the future holds. Until then, I’m off to the airport on my next adventure.

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Currently there are "2 comments" on this Article:

  1. Great stuff from Dr. Jayne as usual. One small typo, last sentence of second-to-last paragraph: should be ‘who’s’ not ‘whose’

  2. I absolutely love this article! I’m fairly new to following HIStalk and Dr. Jayne (and the various portions of the site), however this particular article was spot on. The part that I will comment on is the the level of authority that is given to an interim CMIO (even full time)….

    “…charged with keeping the ship afloat rather than deciding where the ship is going or what kind of cargo it will be carrying. ”

    I’ve had the pleasure of acting as been ‘acting CMIO’ at two organization over the past 3-4 months (now it’s just one)! I find the above to be very true regarding what one is asked to do – focused tactics or ‘be the CMIO’.

    However I’ve also been pleasantly surprised that my previous 15 years internal to multiple organizations as CMIO and VP has really served me well as I insert myself in the current companies ‘culture’ and adapt accordingly. Some companies are heavily physician run ie. CEO is a doc, etc. Others are more MBA-type companies where the physicians are ‘dyad’ or ‘as needed partners’. Overwhelmingly, the physician run healthcare systems seems to be more palatable and allow CMIOs more flexibility (if they feel you aren’t ‘too techie’ ie. speak english.

    Also I’ve seen and experienced many ‘interim CMIOs’ that do not really feel like they ‘own the role’. Even though it says 2-3 days a week in the SOW…it’s a full time gig and you have to treat it that way (even though you might not be able to bill that way 🙁 ). Go for the long relationship and be ready to burn the midnight oil to help the frontline docs, nurses and ancillaries.

    I’ve been able to really get in and do more work as the CMIO once i understood the companies mission, vision and yearly metrics ie. executive dashboard. Are they focusing on telehealth this year, pop health, decrease CAUTI, CLABSI, Readmissions, etc. Which one is the ‘darkest red’…be sure to focus some time there. This gets you immediate cred with the execs and the docs if you can deliver something to them into their live environment sooner than later that is easy to use, intuitive AND aligns to the execs dashboard.

    Lastly, never ever be afraid to ask them to speak with the vendor of their software. The previous CMIO could have been out of the loop with the vendor or an ‘anti-vendor’ CMIO…either way…you have the opportunity to force the conversation and re-engage the client with their EHR or other vendors (whether you are on the call or NOT)…its better for the client to know what new ‘freebies’ the vendor has to offer. Epic is very good at creating all sorts of resources and widgets and things…yet many FTE CMIOs may not always be able to keep up. So be sure to solidify a vendor relationship as well, which will then make you more of a value add without needing to know everything.

    Okay…just gave away all my tricks (smile)! Again…great article, and apologies for the long post! ✌🏾

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