How to replace a medical director, other quandaries

By Stephen W. Earnhart, MS

I often receive multiple questions from Same-Day Surgery readers, but they’re on the same topic. I’ve addressed several below. I always welcome your e-mails. All are confidential and deleted from our server when read, so you can speak honestly!

Question: The medical director in our surgical department refuses to come to meetings, stating they are a waste of his time. The hospital administrator doesn’t want to get in the middle of it, and as a result, many of the tasks that we need him to perform do not get done. How can we replace him in a manner that is politically correct?

Answer: In all honesty, many of the surgical department meetings really are a waste of time. This is especially true when you are meeting on a monthly basis just for the sake of meeting. Your bylaws (upon review) require meeting on a quarterly basis or "whenever an event or series of events" require a special meeting. I would consider approaching the individual and work out a schedule that meets all of your needs.

If that does not work, ask your medical director to use his authority to have another individual speak on his behalf at the meetings. Make sure your medical staff bylaws grant him this authority. It also could help the medical director if you prepare in advance a list of items that you need his input on or that you need him to approve.

Question: Many of our patients come to the operating room without the required H&P (history and physical) examination. Our anesthesia staff used to do them before administering anesthesia. However, one of the patients ran into trouble during a case, and the surgeon blamed the anesthesia department for not doing an adequate H&P. Now the anesthesia staff are refusing to do any of them. Can we replace the anesthesia department for refusing to do them?

Answer: Actually, you should buy them lunch everyday in gratitude that they formerly did them for you! They did you a great favor by doing them before this incident because they don’t have to do that. Plus, if they do the H&P as you describe on the day of surgery, they don’t even get paid to do it! I don’t blame them for not doing them. I wouldn’t either. It sounds as if you have a great anesthesia department that got tired of being taken advantage of by the surgical staff.

Question: I have heard you speak at conferences where you say that same-day surgery programs do not have the time to deal with "difficult employees." You said that same-day surgery margins do not allow the ability to deal with this issue. We recently hired a new business office manager who listened to your tape on the subject. She said, "Our employees are a huge asset to us, and we need to do everything in our power to maintain their confidence in us to stand by them." She said the cost of dealing with problem employees is cheaper than replacing them as you suggest. Any thoughts?

Answer: Of course. Fire the new business office manager, and hire one who understands you are not an employment agency or rehab facility.

Question: How much money should the hospital budget for new equipment in the coming fiscal year for the operating department?

Answer: Find out what you spent last year, and use that as the baseline. Get with the chief of each department, and write down their upcoming equipment needs for the coming year. That will give you some idea of what you will need. Submit that amount, but expect that you will probably only get half of it. When you ask the department heads to list their needs, make sure you get their priority on each piece as well. That information will make it easier to decide who gets what in the budget.

Question: How many cases can we do in our hospital per year per operating room?

Answer: On average, plan on about 800 per year per OR. It varies greatly, but you were not specific on the types of cases.

(Editor’s note: Do you have more questions? Contact Earnhart at 8303 MoPac, Suite C–146. Austin, TX 78759. E-mail: Web: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.]

Stephen W. Earnhart, MS, President and CEO, Earnhart & Associates, Austin, TX.