The medical director’s role in same-day surgery

By Stephen W. Earnhart, MS

President and CEO

Earnhart & Associates

Dallas

Surprisingly, the role of the medical director in a surgery center or surgical department is confusing to some. This confusion is coming either from the medical director or those who work with him or her. Often, the problem is coming from the administrator who claims that he or she is not getting the necessary support from the director’s position.

This situation may become more pronounced when the medical director is not an anesthesiologist. I’m not certain why, but usually when the position is filled from a member of the anesthesia department, there is a greater sense of global understanding of the issues going on in the center as opposed to, for instance, a urologist who is in the facility infrequently. For the most part, the medical director is an anesthesiologist. In fact, the state of Pennsylvania is updating their new ambulatory surgery center standards and will require that medical directors be anesthesiologists.

So, in the example of the urologist, the administrator doesn’t think the medical director is doing what he or she was hired or elected to do for the facility. Not surprisingly, when I discuss the problem with the medical director (as tactfully as possible), I frequently get the same response everywhere: "I have no authority here, and everyone just gives me their problems. It is very frustrating." It’s a different story than the administrator is portraying.

The solution in this situation is easy: better com-munication. That solution and a comprehensive job description are requirements. In the vast majority of these situations, I find that there is either no job description, there is a job description but no one knows where to find it, or it is outdated.

There is a specific role the medical directors play in the same-day surgery program. You need to detail their responsibilities to eliminate that doubt. Some areas that should be included are:

• assist with the scheduling of cases to ensure that the needs of the anesthesia department and the facility are met;

• make sure that an anesthesiologist is on the premises until the last patient leaves the facility;

• oversee the recovery areas and ensure the medical standards are functioning properly;

• discharge patients (optional);

• serve as chairman of the quality assurance committee and participate on other committees;

• attend and contribute to the professional staff and board of directors meetings;

• work with the same-day surgery program on the development of policies and procedures, by-laws, and protocols of the facility;

• perform whatever administrative or supervisory functions are required to make sure the facility is in compliance with licensure and/or certification and accreditation needs;

• serve as a functioning part of the team of the same-day surgery program;

• use professional judgment to oversee the practice of safe, quality medicine, and surgery at the facility.

Clearly, there are other areas where medical directors can assist the program. Often special projects will come up that need their invaluable input in the decision-making process. However, to be effective, medical directors need to understand their roles.

A frequent question regards compensation for this important position. It is a tough one, and there is no right or wrong answer. I would guess that medical directors, (50% of the time, assuming they are working anesthesiologists) receive a stipend or compensation between $15,000 to $30,000 per year for their services. There are some who make significantly more, especially if they own the center or have dedicated their career to running the center. Like a good administrator, the medical director can be the difference between a good facility and a great facility.

(Editor’s note: Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: surgery@onramp.net. Web site: http://www.earnhart.com.)