VPMA = Very busy day: Physician executive faces many meetings, critical decisions in typical day - Career Management - Michael Lachina - Interview

Physician Executive, March, 2002 by Barbara J. Linney

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I regularly get e-mails and phone calls from physicians who want to enter the field of management. They ask questions such as:

* What are the typical things you would do in a day as a medical director for a hospital, managed care organization or group practice?

* What hours do you work?

* Is travel involved and what does that mean?

* How often do you have to change jobs and why?

* What are the problems and rewards?

* What do you like or dislike about the job?

To find some answers, I am interviewing people who made the transition to medical management. First up, is Michael Lachina, MD, MMM, who's senior vice president of medical affairs at FirstHealth of the Carolinas in Pinehurst, N.C.

Barbara Linney: What kinds of things do you do in a typical day?

Michael Lachina: The role is very broad in scope and complex in our organization. First Health of Carolinas, a multi-hospital integrated health delivery system, has a lot of entities outside the hospital.

The facilities outside include 16 medical clinics, three dental clinics, two hospices, home care, private duty nursing and seven health and fitness centers to name a few.

As the administrative interface with the medical staff, I spend two thirds of my time in medical staff function meetings. Many of these begin at 7 a.m. because physicians want to get the meeting over and have the rest of their day to see patients and operate.

In those meetings we deal with issues such as utilization management, performance improvement and credentialing. In the monthly credentials committee meeting, I assist the medical staff leaders with reviewing applicants, responding to medical staff members who are asking for new privileges or who are coming up for reappointment.

Peer review issues may arise through the reappointment process. The medical staff meetings are chaired by medical staff leaders. The VPMA is there as a representative from administration to support the medical staff leaders in an ex officio role.

There are really very few meetings that the VPMA actually chairs.

Other meetings are with the senior management administrative team. The administrative council is a weekly meeting of all the vice presidents where we discuss operational issues of the hospitals and other entities, financial reports and any kind of clinical issues that the vice president of nursing may bring forth. It is the time for the administrative team to discuss major hospital related issues.

So two days out of five each week will start with the 7 a.m. meetings. The other three days, I'm in my office between 7 and 7:30 just to do routine administrative tasks -- answer voice mails and e-mails -- because most of the other meetings start at 8 a.m. Meetings are sporadic through out the day sometimes with a half hour to a hour break in between them.

BL: When do the days end?

ML: I work 12-to14-hour days, four days a week.

Mondays through Thursdays are intense. Three of those four nights are tied up with meetings in the hospital. They usually last until 8 p.m.

We have nine different boards and medical executive committees that meet in the evening because the lay people who are involved can only attend at night. So 7 a.m. to 8 p.m. is very typical of my work day. Some people would say, "No way I would do that."

However, I work no weekends and Friday is our lightest day. Every vice president and administrative person in the organization works very hard Monday through Friday noon.

Friday afternoon we schedule lightly and wind down. Sometimes we can go home early and you do look forward to your weekends. I take administrative call twice a year for a week. We have to be available for phone calls, but it is nothing like a physician being on call.

BL: I often hear people say they need operations experience to move up. What does that mean?

ML: I deal with the day-to-day operations of the system -- consideration of capital equipment needs, investing dollars in capital improvement projects such as renovations, additions to the hospital, adding new service lines.

Operational and financial issues are all part of the same thing because you are looking at your performance, your revenues and expenses, whether you are on budget or off budget.

I'm responsible for the operations of the medical clinics that are outpatient facilities staffed by employed physicians. I keep up with how many patients they are seeing, how much revenue they are producing, how they are performing against budget.

If there are patient satisfaction issues or providers are unhappy, disgruntled and not feeling like administration is meeting their needs, I deal with the daily management decisions to solve those problems.

Some VPMAs may not have those responsibilities if the hospital doesn't own medical clinics in their system.

I am the direct supervisor of all our 37 employed physicians. I am their boss. They report to me. I do their performance evaluations yearly. All performance issues with the employed physicians are my responsibility-- whether it is disruptive behavior, productivity, meeting their budgets or daily staffing issues.