I have not written in about ten days. I have been busy living a dream. On May 2, I began a new job as the Director of Youth Psychiatry at The Royal. This is truly a dream come true for me: to provide guidance to the best team of mental health professionals and to consider how to address the mental health needs of the 16 – 18 year olds in Eastern Ontario.
As I embark on this challenge, I am buoyed by the good wishes of my colleagues. I have worked with many of the staff for fourteen years and their dedication to patients has always been inspiring to me. If it were not, it would have been impossible for me to even consider this new job. The staff go above and beyond their normal duties to ensure that patients get the best care and that their families understand that care.
In the few days since I started this job, I have found myself looking for extra hours in the day and extra weeks in the calendar. I do not quite realize that I’m going to have to give up some of my patient hours to get this new job done. As I set about managing my time, I thought, “I cannot give up the Thursday clinic” and “I’ll still be able to do Dialectical Behaviour Therapy”. “Are you still going to be able to see me?” is the most common question I hear from my patients. Everyone who knows me knows that I will not just drop anyone so the last question is easy to answer, but some clinical commitments will have to change – I almost get it.
Another interesting thing is that I have meetings – more meetings than I ever thought possible, for committees identified only by acronyms or letters. I asked someone today, ”What is the ABC Committee?” You know you are in serious difficulty when the acronym listed as words does not help you understand what a committee does.
The nature of a physician administrator’s work brings a doctor directly into the conflict between the patient and the system, with the necessity that the patient must get the best service and care at the same time as the system improves. Finding the best care often requires the system to be more flexible than is possible. Improving the system often changes many of the elements of care that patients and their families felt were helpful.
Doctors are the one link in the health care system permitted a degree of professional autonomy because of the mechanism by which they work in a hospital. Instead of being employees of a hospital, doctors are appointed to a hospital’s medical staff through a process in which they have privileges for certain activities, such as admitting patients. Balancing professional autonomy with a hospital’s public mandate is a conundrum that a physician administrator has to consider – it’s so much easier to fall back on clinical work.
Having said this, an administrative role such as my new job gives a doctor a chance to facilitate the changes that will improve care. I’ll decrease the paperwork, get electronic prescribing, improve the electronic health record…I’ll make a difference. That is the hope. Even if I don’t understand what my committees do, or how I’m going to do all the clinical work I want to, I know that having this new role is gives me a unique opportunity to help both patients and my local healthcare system. Someone said to me, ”I can see how pleased you are to have this job, you brighten right up when you talk about it.”
I hope that I’ll wake up gently as I begin to realize what I’ve gotten myself into.