Dear Director,
Our physician assistants are fantastic and have functioned independently for a long time, but recently we had a bad outcome and now the hospital wants us to supervise all PA cases. This seems like a waste of time and it will slow down our docs. What do we do?

Dear Director,
I’ve served as the associate medical director in a few different ERs, only to be passed over when the department needed a new chairman. What am I doing wrong and how do I find out how to reach that next level or should I just count on being an associate director forever.

My hospital is spending a lot of time talking about 30-day readmissions and how the ER needs to stop admitting people. Frankly, I don’t understand how a readmission is an ER problem. Aren’t we taught that a patient returning to the ED is like a red flag warning giving us an opportunity to correct something?

Dear Director,
I’ve been in my position for a while and while I’ve been able to make some improvements with projects, I don’t feel like our ED has hit its potential yet. Are there any secrets to getting my agenda moved forward throughout the hospital?

Dear Boss,
One of our group members recently came back from maternity leave. We are all very happy for her and her family. The problem is that due to the fact that she is currently breastfeeding, she has to “go in the back to pump” 2-3 times per shift. While she is gone, the charts pile up, her residents have no direction, and throughput stops for her patients.

Dear Boss,
As a senior resident, I was hoping to make a final decision about my future job by the end of the year. The problem I’ve found is that all  the offers I’ve gotten look similar.  What intangibles do I need to consider to be sure I make the best choice?

Dear Boss,
I was recently asked to resign from a job I had been at for years. My director told me he had been giving me hints for months that I needed to find a new job but I guess I didn’t pick up on it. What did I miss?

Building a team is one of the most important components of a medical director’s job, and it starts with finding the right people. Many factors come into play in this process, but in many ways it starts with timing.

Being an ED chairman requires a skill set that you may never appreciate until you step into the role. Clinically, there are few surprises; it’s the little things that make being the boss a unique challenge, like dealing with a troubled provider, learning how leaders get treated differently, and feeling the responsible of running a 24/7 business.

Dear Director,
I’m Facebook friends with a bunch of the nurses I work with and when this came up in a conversation with my chairman, he told me that I’m setting myself up for disaster and that I shouldn’t be social network “friends” with the people I work with. Is he right?