Curbside Consult with Dr. Jayne 4/9/18

It was a strange week in my little health IT world. I had my first prospective client call to ask about an “extension” in MIPS data submission. Although CMS extended the deadline from March 31 to April 3, my client had confused the deadline with the federal income tax deadline and thought that you could file an extension to get an even longer time to report.

Sorry, folks, but if you haven’t submitted by now, you’re out of luck. We’re in the 2018 reporting year, so if you haven’t started to get your plan ready, you need to dust yourself off from 2017 and head into the new year.

I also went on the strangest job interview of my life. I had been introduced to this potential position by a mutual friend who works for the medical group in question. The backstory I was given was this — a mid-sized medical group is looking for a blended CMIO / clinical role to complement existing CMO and medical director positions. The group is growing and realizes that they need more administrative leadership to move them through programs such as MIPS and to assist with managed care contracting and their transition into the ACO space.

It sounded right up my alley. The recruiter from the group validated the role by sharing a job description, doing a phone screen interview, making sure we were in the same compensation ballpark, and then scheduling me to come meet with the group.

My first conversation was to be with the group’s physician president, who apparently was “called away.” He didn’t give advance warning to the interview team, which is never a good sign. I was left sitting in a hallway for 20 minutes while they scrambled to find someone else to fill the time block, who of course was unprepared for the meeting and didn’t really know what the role was about. They were, however, a provider, so they could tell me what practice with the group was like, which was important since this role would involve a certain amount of time in clinic.

From a few things he said, though, it sounds like the president gets “called away” quite a bit, which sounds like either poor time management skills or a certain level of chaos that requires the group president to sort it out.

From there, I met with some nursing team representatives who told me more about the clinical aspect of the job as well as some of the pain points they hoped that the new CMIO role would help address. The discussion was candid, the interviewers were friendly, and I felt it was a good opportunity to share my philosophy of clinical practice as well as how I think teams best work together.

They handed me off to members of the informatics team, who met with me over lunch. It was a mix of interviewing and grilling, with many questions about whether I would try to restructure the informatics team or change how their jobs work. There were a lot of very pointed questions about how I work with technical resources. One analyst flat-out asked if I would automatically take a physician’s side in the event of a disagreement between the physician and IT.

The analysts seem to be a good group of people. Although they’re pulled in many directions, I think they are excited about the possibility of someone helping with governance and making sure they are doing well-considered projects rather than reacting to squeaky wheels or shiny objects.

From there, I met with the COO, who talked me through some of the nuts and bolts of the organization and how much she thought the new role would interface with the financial and operational aspects of the organization. It sounded like there has been some friction in the past among operations, IT, and the clinical stakeholders as they decide how to prioritize scarce resources and how they decide which initiatives to pursue as they create their annual planning and strategic roadmaps.

At this point, none of this was surprising or out of the ordinary compared to other interviews I’ve been on, except for the missing interview with the group president. At the end of the talk with the COO, she let me know that I’d have a brief break and then would be able to meet with the president, who had rearranged another meeting to accommodate our interview. It sounded good, so I grabbed a cup of tea and made some notes about what I was thinking so far about the position.

An assistant came by to escort me back to a conference room, which seemed a little strange that we’d meet there rather than in the president’s office. Regardless, I headed in and sat down. That’s where the wheels fell off.  Apparently, the group president wasn’t on the same page as anyone else about this new position. I’m sure my face betrayed what I was thinking about what I was hearing.

The conversation was fairly one-sided. It essentially sounded like he isn’t in support of the position, implying that the people I’d talked to weren’t supposed to be advocating the position I was interviewing for. He said that someone shouldn’t just get to “walk right in and be a leader of this organization,” but rather needs to be a staff physician first and considered for a leadership position only if he or she “falls in the top 25 percent of our productivity curve.” However, any potential CMIO would need to first be a medical director, then given a chance for a promotion if they prove they can “walk the walk.”

He then proceeded to explain that the medical director positions were “stipend positions” on top of a full clinical schedule, which basically means the job would be a 1.25 full-time equivalent. Being anything less than a full-time clinician would be non-negotiable.

I wasn’t sure I heard it right the first time since my brain was still trying to wrap itself around being at the top of the productivity curve, which is terminology I haven’t heard since value-based care started picking up speed. Most of the interviews I’ve been on describe evaluating physicians based on metrics that are scored for clinical quality, patient satisfaction, access, chart completion, cost of care, etc., but not outright productivity. I asked a few questions around that and it sure sounded like their docs are being incented on a cross between RVUs and clinical quality scores, but it wasn’t clear.

By this point, given the total disconnect between the group president and the rest of the people I had talked to, I knew this wasn’t going to be a process I wanted to take forward. Clearly this gentleman didn’t understand how CMIOs and other leadership-level physicians are usually brought into an organization. Can you imagine a hospital CMIO being told that he or she needed to work his way up through the ranks and maybe then he or she would get a shot at the C-suite?

I can’t help but believe that at some point during the conversation my mouth was agape. The rest of the interview ping-ponged around for awhile until the recruiter came back to pick me up and close out the day. She asked what I thought and I threw out some vague comments about it being an interesting opportunity and there being a lot to think about.

I’m not sure if they know how off-script their leader was or what was going on, but at this point, I don’t care if I hear from them or not. I hope they get their act together before they “interview” the next guy or gal (I use that term loosely considering how the day ultimately went). I can laugh about it after a glass of wine, but in retrospect it was rather bizarre.

What’s the weirdest job interview you’ve ever been on? Leave a comment or email me.

Email Dr. Jayne.