Interview with Dr. Norm Chapin

My name is Dr. Norm Chapin. I am the Medical Director for Columbia Memorial Hospital in Hudson, New York.

How big is the hospital?  They are currently staffed for 120 beds.

Can you describe for me some of the steps you’ve made in rising through the leadership ranks?  I graduated from my residency in 1985 and for the first 5 years from 1985-1990 I practiced clinical emergency medicine.  In 1989, I was assigned responsibilities related to EMS education and ED quality management.   In 1990, I took a directorship position of a very small Emergency  Department near Detroit, Michigan and I worked there for about a year. I realized that I had taken that position maybe a little bit sooner then I was ready. I felt like I did not have adequate administrative experience.   My wife and I were looking to move out of Detroit at the time so we moved out of Detroit in 1991.  I went back to just practicing clinical medicine and emergency medicine again.

Then a couple of years later I was given the opportunity to assume responsibility for the Quality Management Program in the Emergency Department.   I started doing some administrative work again and in 1996 when I accepted a position as Assistant Director of an Emergency Department near where I had been working.

At that time, how much time was split between clinical practice and administrative practice? At that time, our normal clinical commitment was 144 hours per month, 12 – 12 hour shifts and I was doing 120 hours of clinical and 24 hours a month administrative time.

As time went on did you do anything in particular to improve your leadership abilities or management abilities?  At that time, other than having a mentor I really didn’t take any formal courses in administration and leadership. Most of my CME classes were straight clinical courses.  I was doing more teaching all the time and I was learning more about how to present data to people but it was pretty much seat of the pants learning.  I really didn’t get into any kind of formal education at that time.

When did you get into any kind of formal education?  In 1999, I was promoted to the Chief of the Department and I joined the American College of Physician Executives and I began taking some of their courses. I took my first course from them in 2000.  I also joined the ACPE list serve and began receiving their publications.  I was initially going to get my CPE Certification through ACPE and I took approximately 50 credit hours or so toward that but never completed it.

You are enrolled in a more formal program now.  How did you decide to do that?Well, between 1999 and now I had assumed additional administrative roles.  Within the hospital I was elected as Secretary and Treasurer of the Medical Staff. The Emergency Management Group that has the contract at our hospital had branched out and I had taken a leadership role in getting two new contracts for the group. I was involved in negotiations with 3rd party payers, involved in negotiating with hospital administrators about contracts, I was doing a lot of recruiting, a lot of human resources types of things and I just realized that I needed to have a better background on the business side of medicine and healthcare in general. I’ve been interested for the past 4 or 5 years and going for my masters degree I had been challenged to really find the time to do that.  I had looked at several programs that were completely self study.  There was a little bit of a deadline to them but most of them were studying on your own, taking full on-line courses with no residency periods and that just didn’t work for me because it was too easy for me to push off the deadlines and I didn’t stick with any of those and didn’t think they would be a good fit for me just knowing my own personality.

A couple of years ago I met Mike Stahl who is the Director of the Physician Executive MBA Program at the University of Tennessee.  I talked with him. I was very interested in the program. It had a good track record.  We got a new ED contract shortly after my initial contact with Mike and I became totally immersed in the start up. Last year, 2007, I met Mike again at a national emergency medicine conference and applied to the program. I t was just very good timing for me. I applied and was accepted at the MBA program. I’m not quite half way through yet but it’s going very well.

In your current position what percent clinical are you and what percent administrative?  Right now, I am only doing about 24-30 hours a month in the Emergency Department and the rest of the time I am Administrative.

Do you see your clinical time further decreasing or staying about that level?  Emergency Medicine is a pretty demanding specialty and I still feel comfortable clinically right now but I when I became the Director, I went to half time clinically. That was back in 1999 and there was probably only one or two months in there that I actually only worked half time.  I was always picking up shifts for people because of scheduling problems and things like that so I always felt like I maintained a pretty good comfort level with clinical medicine. In the last year my clinical time has gone down to 2 or 3 shifts a month it is getting harder for me to maintain my comfort with practicing there.  I think over the next year as my administrative role continues to evolve, I’ll probably stop clinical medicine completely.

What advice would you give to young physicians who are considering being involved in leadership activities?   I would discourage young physicians from making a decision regarding full time administrative too early in their career.  I think my first mistake was taking on an administrative role before I really matured enough as a clinician to sustain that.  I don’t think I had enough maturity to deal with physicians who have been practicing for 20 or 30 years.  I don’t think I had earned my stripes so to speak.  I also think I tried to go from a position where I had very minimal administrative responsibilities when I was a director of a department too quickly.  So I think the best advice is to go slowly, make sure that you enjoy doing the administrative things, make sure that you gain enough experiences clinically so you can really be assured that your skills and your understanding of how healthcare works either in your specific specialty or throughout a multi specialty physicians organization or a managed care organization or a hospital organization which ever your practice has placed you.  M ake sure that you really do understand the organization well before you decide to take a real significant role there.  Committee participation, involvement in medical staff affairs, participating in performance improvement projects in the organization are each excellent opportunities to gain leadership experience.

What special skills or unique insight do you think physicians bring to the leadership table than non-physicians would not?  Well, I think we really understand other physicians better than non-physicians do.  I think we also understand patients in a way than non-physicians don’t, because we have really been with them through a lot of medical crisis.  We really understand their fears and their concerns.

I think we understand what physicians and what patients expect of physicians in a way that non physicians might not understand.  I think that gives us an advantage when discussing strategic initiatives within a healthcare organization or discussing  the vision or mission of a healthcare organization.  We have a different perspective of the complexity and how difficult it is sometimes to meet patient’s expectations and needs.  There are also aspects of healthcare as a business that we don’t understand or have a very different perspective of.  I think a team where both of those perspectives are represented at the Senior Executive level ,   gives  organizations a huge advantage in   responding  to some of the pressures that they face.

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