Moving on up

Flashback: sitting with my mentors and Attendings as a new ID fellow. The division chief asks the question – “Where do you see yourself in 10 years?”

“Doing something like your job, ” I tell him.

He chuckles.

My boss, the Division Head for Infectious Diseases, has always had my career interests at heart. Several times during my first year here we talked about 5-year and 10-year plans for myself and the division. He would share difficulties, ideas, insights and experience – always with an implication that someday, maybe “all this could be yours”. As a junior faculty, fresh out of fellowship, it was somewhat flattering and dare I say intoxicating.

I remember the day, now nearly seven months ago, when he sat me down in his office. There had been unforeseen difficulties in the recruitment for the new Chair of Pediatrics. At the last minute the carefully crafted collaboration between hospital, university and State fell apart and with the existing Chair well on the way to his new role there was an upcoming void to be filled. Fingers pointed to my boss to act as Interim Chair – a role for which he was ideally suited, having been on the selection committee and knowing the needs of the role intimately, being a genuinely nice guy, and having buckets of respect from faculty and staff in the institution.

He was very frank – “That five-year plan? I need you to start next month.”

Despite being the most junior member of the Division (one other doc there in fact has been practicing medicine longer than I’ve been alive) I was, ironically, the one best suited to run the day-to-day business of medicine. I’m the only other full-time physician in ID, my colleagues all having responsibilities to other areas of academic medicine or simply working off-site most of the time. My office is located next to the clinic, next to the administrator, the nurses, and the office manager. I’m on service and in clinic more than any other ID Doc (again, the whole junior member thing). For minor issues and questions, people were already used to just popping in to run ideas by me. He assured me the role would mostly consist of organizing the faculty meetings, making sure everyone did what they were supposed to do and be where they were supposed to be. I saw it as a prime opportunity to test the waters, see what I could do, and get some experience. Expectations were a six-month temporary situation while the hospital worked on recruiting a new Chair, and I figured I didn’t have much to lose.

Within a week it was clear there was more to the role – I was handed a survey to complete, detailing expected 5-10 year staffing and office requirements, for a division that I was just getting to know in its current form. People came to me with personal issues within and between divisions, professional concerns, financial concerns. I suddenly had a budget to keep to and five (later eight) physicians to keep on track to meet it. We had a visit from the Joint Commission, and we were still in the middle of a rollout of our new EMR, for which our division was one of the very first areas to go live, and we were still not back up to predicted visit numbers. There were meetings – where I was not only privy to the inner workings of the hospital, but also expected to contribute meaningfully and bring new things back to the rest of my group, and make it happen. Organizing the other ID docs (a task best described as akin to herding cats) turned out to be the least of what I was doing.

The most surprising thing of all was just how readily everyone accepted me as the person to go to. I think it speaks a lot to the attitudes and spirit of the institution that at no point did anyone make me feel undermined or inadequate, and that was somehow very humbling. I think some of that was because there were already several other young physicians in leadership roles – our hospital is less than 20 years old, and much of the growth has come from people like myself.

I found myself going in earlier and coming home later – plans to work on my research goals and apply for funding were simply shelved as my time was sucked up by the administrative tasks needed to ensure that we could take care of our patients. But with all of this extra work (I later discovered they’d allocated me 4% of my time to do this – I laughed out loud on the conference call at that piece of news) I was genuinely enjoying myself. I’ve always been one to want to know how things worked and the inner, secret details of things. Here I was, handed all this on a plate – and more, being given freedom (a shocking amount of freedom I felt) to make changes as I saw fit. Initially reluctant to do much without checking in with The Boss first, I later reveled in the opportunity to take the division in new directions and start up new initiatives that hadn’t been on the cards. I felt my wings stretch.

So what has happened over the last six months? We became the division of Infectious Disease and Immunology, as we added two clinical immunologists to the team (a process admittedly envisioned and started long before I was on the scene), and then had to work on promoting the new services to community physicians and hospital faculty alike. We changed outpatient clinic scheduling policies and inpatient consult practices, improved billing patterns and brought the division back to year-on-year growth. We’ve been added to the State newborn screening program for SCID (severe combined immune deficiency) and accepted as a site for an antibiotic clinical trial. I started building a collaborative program to care for kids with velocardiofacial syndrome (a particular immune deficiency syndrome I’m extremely interested in). Along the way a myriad of tweaks, reminders and attempts at cat-herding have kept us on track for what has been a pretty successful year. I began to wonder what would happen if my boss stayed on in his interim role – what would that mean for me?

I look back at all this because last week marked the end of my tenure as Interim Medical Director for the division. The boss and I spoke on the phone (in-person meetings are horrifically difficult to schedule nowadays) about what we would do next. Cold hard facts and practicalities were brought up. I’m not even two years out from fellowship – running a division is really for an experienced academician, ideally one with research funding to take the division down a new path towards a fellowship program of its own. How could we attract new faculty – more experienced faculty, faculty with funding, when they would have to work under me? In contrast, my research background placed me ideally to start working on establishing a lab and getting some grant money in – it would take time but he would help me apply for funds and get lab space. He also recognized my teaching skills and rapport with the residents – perhaps I should focus on medical education and curriculum development?

I let him speak – I wasn’t sure if he was just letting a stream of consciousness flow or trying to convince me of something.

Eventually, after about 45 minutes, he stopped and asked the question, “So what do you want to do?”

I realized with sudden and utter clarity that I was at a crossroads. I was being given my future career choices, with the full support of the future clinical head of the hospital. In a weird flash-forward dream-sequence I saw myself in these roles, feeling them out, trying to experience what it would be like. What dreams could I fulfill, how long would it take for me to get there, what would I have to give up…? And then the obvious hit me.

I would miss this job. I’d never intended to find myself so soon in the position of having to lead and make decisions, interpret data and trends and make policy that would impact the working life of my colleagues and the care of our patients, but if I left it I could see myself learning about problems and *wanting* to intervene and take the reins, and there would be a part of me that would be empty after “stepping down” from doing it for these past few months. How would the other faculty feel about another change of leadership? Would they still come to me regardless?

So I drew a deep breath, and I told him what I wanted to do.

And here we are. The announcement has been made. My boss is now the Chair of Pediatrics, and my role as the Interim Medical Director of ID and Immunology….is no longer interim. We have much to do – we have to think about finding an academic Division Head, expanding faculty further, working again towards our goals of expanding research and building a fellowship program. The last six months have been a transitional period as the cards were shuffled and a new hand dealt out.

And I like to think it’s a pretty awesome hand.

  1. #1 by harriseve (@harriseve) on September 3, 2013 - 17:43

    MAZEL TOV, PedsIDDoc! Great news.

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