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Hail to the chief

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Ramsey Hasan, MD, at 37, is the youngest chief of staff in the history of Hawaii-based Castle Medical Center. "For younger physicians it's a very challenging role," he says. "As chief of staff you are expected to be the glue between the different departments and to become a great communicator."

Ramsey Hasan, MD, at 37, is the youngest chief of staff in the history of Hawaii-based Castle Medical Center. “For younger physicians it’s a very challenging role,” he says. “As chief of staff you are expected to be the glue between the different departments and to become a great communicator.”

Throughout his career Ramsey Hasan, MD, has often been told he looked too young to be a physician. While he’s no Doogie Howser, Hasan holds an early accomplishment that would probably get a professional nod from the child prodigy doctor. Lining the halls of Hawaii-based Castle Medical Center are photographs of all the chiefs of staff who have served the hospital. Standing out among the gray-haired former chiefs is a boyish Hasan, the current—and youngest—chief of staff in the history of the hospital.

Young chiefs of staff

The role of chief of staff is one many doctors aspire to later in their professional careers, but anecdotally it seems doctors are stepping into it before they reach the age of 40. For Hasan, who specializes in emergency medicine, becoming chief at the age of 37 was never really on the agenda. He sort of fell into it.

“No. Never thought about it,” says Hasan. “Somebody recommended me as a nominee, and I said yes. I had no plans to run.”

There were multiple people in the running for chief at Castle in 2004, and along the way some people dropped out. In the end it was down to Hasan and a surgeon in his 50s. Once elected, Hasan served the customary two years as vice chief of staff, during which time he “learned the ropes” and then began his two-year term as chief of staff in January 2007.

“It’s at times a popularity contest, but it’s also ability and experience,” says Hasan of the election process.

Chief of staff job description

September-October 2008 - Hail to the Chief Survival SkillsCastle Medical Center, a 160-bed facility located on the Hawaiian Island of Oahu, employs a medical staff of more than 256 physicians in a wide range of specialties and subspecialties. Castle is a full-service medical center that serves all of Oahu and is the primary health care facility for the East Shore of Oahu.

“My role specifically is that I’m the chairman of the medical executive committee, the decision-making body for all policy and procedure for the entire medical staff,” says Hasan. “I’m responsible for peer review of all the medical staff, and all medical direction of the hospital. I am also a voting member of the governing board of the hospital.”

In all, Hasan does about 40 hours a week of clinical practice and another 10 hours or so of administrative work; however, the hours vary, and he sometimes works extra. “You’re always on,” he says.

Kremmling, Colorado-based family physician Lynnette Telck, MD, became chief of staff at the age of 33. She works at Kremmling Memorial Hospital District (KMHD), a community hospital about 100 miles from Denver and the only hospital in Grand County. A Level IV Trauma Center, KMHD provides inpatient and outpatient services in addition to 24-hour emergency care. Telck is well acquainted with the local community. In fact, she has the unique distinction of serving as chief at the hospital where she was born.

“It makes it that much more special,” says Telck, whose grandparents homesteaded in Grand County. “Many of my patients grew up with my grandmother or father, so it is an honor to me to be able to treat them. I have a special bond with these patients that most physicians never experience.”

Her current role came about when it was her turn to fill the position. Unlike Hasan, all physicians at KMHD serve as chief on a rotational basis. Coming from such a rural area, the medical staff must fill all the roles with few physicians, Telck says. As a result, she and others are afforded opportunities that may not be available in a more urban setting.

According to Leslie Jones, the medical staff coordinator at KMHD, the chief of staff directs all med staff meetings and attends other meetings, oversees the schedule, attends to patients—both clinic and hospital—and does ER coverage once a week in addition to the administrative duties that consume many hours on any given week.

Jones says Telck works at least 48 hours a week in clinical practice, plus her administrative time. All qualified physician staff members will take a turn as chief and serve a one-year term.

As chief, Telck also represents physicians and mid-level providers and acts as a liaison between them and the administration. She manages all issues and concerns of providers or the administration that affect the group.

“I run the monthly provider meeting and medical staff meeting and help with scheduling when needed. I also am in charge of follow-up for tests on all patients that don’t have a PCP and the general medical paperwork that needs to be completed for the hospital,” says Telck.

Like Hasan, Telck never really gave much thought to becoming chief. Her true aspiration has always been to care for patients. “However, I have always been interested in trying to make programs work efficiently to benefit everyone,” she says.

Telck says she is grateful for having “a wonderful husband and son” who help with all the chores at home, which is especially important these days, because she is just back from maternity leave.

A natural role for leaders

Family physician Lynnette Telck, MD, is chief of staff at Kremmling Memorial Hospital District (KMHD), about 100 miles from Denver. Telck is well acquainted with the local community: KMHD is the hospital where she was born. “Many of my patients grew up with my grandmother or father," she says, "so it is an honor to me to be able to treat them."

Family physician Lynnette Telck, MD, is chief of staff at Kremmling Memorial Hospital District (KMHD), about 100 miles from Denver. 

Being a leader at the Rehabilitation Institute of Chicago (RIC) is something Colleen Fitzgerald, MD, always strived for, and although becoming chief of staff was not in her plans, she welcomed the opportunity. Fitzgerald, who specializes in physical medicine and rehabilitation, was nominated for the position by her chairman, elected by her peers in September 2007 at the age of 37, and will serve a two-year term. In her new role, she represents the hospital’s physiatrists.

“I serve as liaison for the medical staff to the chief medical officer, and also to our chairman, as the voice of the medical staff,” says Fitzgerald. “I’m also in charge of processes for the medical staff, determining processes that the staff need to follow, running the medical staff meetings, and I run the medical executive care committee meetings. Those are meetings where different committees of the hospital report at once,” she says.

Fitzgerald also serves as the medical director for the Women’s Health Rehabilitation program at RIC, which specializes in women’s health issues relating to musculoskeletal injuries and conditions caused by pregnancy and post-partum-related pain and dysfunction.

Fitzgerald spends a couple hours a week in her role as chief of staff and says 80 percent of her time is spent doing clinical work. She says her role as chief is different than at other hospitals because she is only representing one specialty, physical medicine and rehabilitation, which she says requires less time.

“I represent the people of my specialty, which is a great honor for me. It is a little bit less in terms of a time commitment,” she says. “I serve formally in meetings and in reporting to the chief medical officer about the direct experiences of the medical staff and how we can make things better for the medical staff. But I also serve as a sort of sounding board for the staff in a way that I can communicate the pulse of the staff.”

Becoming chief

Before becoming the chief of staff, Hasan says, physicians at his hospital typically are required to have some administrative experience such as being the director or chairman of a department or a committee. Hasan says the best training he received was as the chairman of the emergency department where he served for six years. He’s also currently enrolled in an executive MBA program, which has given him experience in leadership management.

Both Telck and Fitzgerald served as chief resident during their training—Telck at the University of Wyoming and Fitzgerald at RIC—and say the experience as chief resident greatly benefited them in their roles as chief of staff.

“That definitely helped prepare me for this position,” says Telck. Being in charge of scheduling, for example, has helped with some of the administrative juggling she does as chief of staff. “However, there are so many different situations that I deal with now, that nothing prepares you for it all. Being a mother also helps with the multi-tasking and handling disputes,” she says.

Fitzgerald agrees the chief resident training has come in handy. “It’s a very similar kind of role,” she says. ” [as chief resident] you’re there to be the voice of the residents. [Now] I’m the voice of the medical staff, to make sure things run smoothly.”

What it takes to be the chief of staff

Colleen Fitzgerald, MD, always strived to be a leader at the Rehabilitation Institute of Chicago (RIC), and although becoming chief of staff was not in her plans, she welcomed the opportunity. “(As chief resident) you’re there to be the voice of the residents," she says of her first leadership post. "(Now) I’m the voice of the medical staff, to make sure things run smoothly.”

Colleen Fitzgerald, MD, always strived to be a leader at the Rehabilitation Institute of Chicago (RIC), and although becoming chief of staff was not in her plans, she welcomed the opportunity.

The chief of staff role is notorious for being a high-stress position. Hasan says the number of phone calls, emails, and letters from staff asking for help fixing problems can get stressful and consume quite a bit of time. Telck agrees.

“Being chief of staff takes commitment, tact, and requires insight into an array of issues. It is wonderful to represent my colleagues but difficult to deal with the politics,” says Telck. “Some of the disadvantages are that I have to deal with a lot of the mundane paperwork and have to make unpopular decisions on occasion.”

Overall, Telck says her colleagues have been supportive and will jump in to help when needed. She says she has enjoyed working with the administration to determine the direction of the hospital.

Apart from the stress of the job itself is the issue of having to prove yourself as a young doctor. Hasan says young physicians must show they are effective and credible in the position—and as effective leaders compared to experienced physicians.

“For younger physicians it’s a very challenging role. As chief of staff you are expected to be the glue between the different departments and to become a great communicator,” he says.

On the positive side of the job, Fitzgerald says that chiefs of staff get to interact with a variety of individuals and gain practical experience as leaders. They also get to “really make a difference” in their hospitals and in what the hospitals and medical staffs can do for their communities.

During his term, Hasan began a hospital newsletter as a means to convey ideas among staff members and to provide easy access to information affecting staff. He has also moved the hospital toward being a teaching hospital, which has never been done before. “We now have medical students roaming the halls, and we have plans to start having residents and interns on a regular basis,” Hasan says. “It’s a huge change.”

Is age just a number?

Hasan and Fitzgerald feel that a younger chief brings fresh ideas and enthusiasm. They say that what a young doctor may lack in experience, he or she makes up for in energy. For the physician who’s a born leader, the chief role may be a perfect fit.

“Chief of staff is a leadership position for physicians,” says Nancy Ascher, MD, an organ transplant surgeon and the department chair of the University of California-San Francisco department of surgery. “If a physician aspires to be a leader, this position would be attractive.”

But Peter Axelrod, MD, of the section of infectious diseases at Temple University Hospital in Philadelphia, says the chief of staff may not be the right career path for a young physician. For a doctor just starting a career who is interested in developing clinical skills, “the administrative duties would get in the way.” Axelrod says the position calls for “political skill and statesmanship,” something the younger doctor may not yet have.

“There are a lot of disparate interests among doctors at an institution, and doctors’ desires and egos are often in conflict with one another and with the hospital administration,” says Axelrod. “An ‘older,’ seasoned doctor with a lot of experience and a lot of connections within an institution is often best at this,” he says.

However, for those young docs determined to make chief, Axelrod recommends looking into MBA programs, citing the degree as beneficial to the job. Both Axelrod and Hasan also advise joining several committees and attending meetings before pursuing the chief of staff job to show an interest in moving the hospital forward.

“It can blossom into many more opportunities because as people find that you are interested and you develop credibility, you will find that your career will move forward,” says Hasan.

Fitzgerald advises identifying a mentor. When she first began at RIC, her mentor was part of the medical staff and today is the CEO of the hospital. She says her mentor has provided her with immeasurable support and advice, something Fitzgerald passes on to other young doctors.

“I would suggest being a leader in other smaller ways first, whether it’s being chief resident, the chair of a committee, organizationally being involved, getting that experience to know if its something you want to pursue,” advises Fitzgerald. “Don’t let your age stop you from pursuing what it is you believe you could be great at.”

Anayat Durrani is a Los Angeles-based freelance writer. She has been published in magazines, newspapers, and online, including California Lawyer magazine, P.I. magazine, and Cairo’s Al-Ahram Weekly.

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Anayat Durrani

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