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Dear Director,
Our hospital has started enforcing a policy saying that every doctor has to participate in a hospital committee. I get paid by the patient, not to go sit at meetings. Why should I do that?
Signed,
A Clinician
 
Dear Clinician,The first question I have for you is why wouldn’t you want to participate in something that might make your job better, particularly given the amount of time you spend at work? After all, the purpose of most hospital committees is to improve the hospital and patient care. Hospital operations really count on the volunteerism of their medical staff for participation. It’s unfortunate that so many of us in the ED have a hard time getting beyond the paid-by-hour or by-the-patient mentality. Admittedly, as a medical director, I do get compensated to attend meetings, but I started doing this long before I was a medical director in order to improve my department. I volunteered to join committees throughout the hospital and worked with other departments to enlighten them as to the ED’s issues. We all want our work environment to keep improving, but are we willing to be a part of the solution?

Why Volunteer
Most private practice attendings participate throughout the hospital on their own time, taking time away from their patients, business and family. There’s a multitude of reasons why they do this, including professionalism, respect, reputation enhancement within the professional community and business development. These same reasons can apply to us in emergency medicine. Working with other departments, professionally communicating our issues and getting to know the medical staff outside of the patient care arena can only strengthen the ED and its interactions with the rest of the hospital.

A former colleague recently called me to say she’d been asked to be her department’s assistant director and asked if I thought she was the right person for the job. She had doubts about her ability to handle that role. However, as we discussed it, she could see that she was committed to improving her department, was already performing some of the work, and ultimately just wanted to make her department a better place. She realized that this was her formal opportunity.

The Time Commitment
Many physicians are afraid that they’ll get sucked into all kinds of additional work with a committee. However, most committees are only an hour a month, and rarely give homework. While I never try to work clinically and attend a meeting at the same time, I do try to work shifts that start just after committee meetings end. With effective calendar and shift management, your day won’t lengthen significantly.

Picking the Right One
Some committees require an appointment, others are elected positions, and still others happily take volunteers with a mere interest. One of the most important groups within the hospital is the board of directors. They usually consist of local business and civic leaders and a few physicians and is tasked with supervising the hospital leadership, including the CEO, (yes, they can fire him) and approving the business road map that the hospital will follow. While maybe not an aspiration of physician leaders within the hospital, it certainly is a great honor and responsibility to be selected to represent the medical staff on the BOD.

The medical executive committee consists of the physician leadership of the hospital—the medical staff officers (elected), department chairpersons (appointed), and usually a few other elected physicians. “Elected” is relative in this case since the hospital usually has a nominating committee that finds people who are interested in the position and puts them up for election, often unopposed. The MEC has the ability to impact hospital bylaws and the rules and regulations, as well as give opinions on issues to the hospital executive leadership team.

Next up on the hierarchy is the credentials committee. Getting permission to work in the hospital is of the utmost importance when it comes to hospital liability. This committee knows everyone’s dirty laundry. A colleague told me of a hospital that had credentialed someone to perform a particular surgical procedure. When the local tertiary care hospital started receiving numerous patients with post-op complications, they called the state to investigate. It turns out that not only was the person not a surgeon, he had never attended medical school. That’s a serious credentialing mistake and part of why so much time and energy is placed on our own paperwork during the credentialing process. This committee hits close to home as well as emergency departments look to credential their providers in ultrasound, it’s the credentials committee who first must give their approval. Having an EP who sits side by side with the other committee members can make this discussion much smoother. After this committee gives it approvals to your ultrasound credentialing policy, it then goes to the MEC for final approval. You can begin to see how essential it is that your ED medical director or chairman sits on the MEC so that they can lend another voice of support as well as a vote for approval.

Other very important committees that are usually open to people with an interest are bylaws (effectively the hospital constitution), pharmacy and therapeutics (don’t complain about not being able to use phenergan anymore if no one was there when the P and T committee removed it from the formulary) and critical care. With all the emphasis on the surviving sepsis campaign, sometimes the only way to get agreement that these patients should be expedited to the ICU is to put the emergency physicians and intensivists at the same table on a regular basis. The RAC audits are scaring your hospital administrators with the potential for lost revenue and hospitals are beefing up their observation status. Certainly, an emergency physician may be one of the most qualified people to work on the hospital’s utilization review committee to help manage observation care.

Perhaps none of those float your boat. Are you really interested in computers and information systems? Government stimulus money is available and most hospitals are looking at significant information system changes to take advantage of this money. Not only is physician input essential, but it could put you in the decision-making seat to help choose the next EMR that will be rolled out to your ED.  Other less glamorous committees that may require even less participation, such as quarterly meetings, might be a library (what text books to buy or journals to order, as well as what on-line information services are worth paying for) or forms committee (literally to review each for appropriateness).

If you want to get involved but want to have an even more direct impact in the ED, ask your medical director about creating your own committee for the ED specific to your interest. The committee can’t just be you going out to lunch on the hospital’s dime. It should be a group representing the department including docs, nurses, techs, and maybe unit clerks.  How about looking at your critical care supplies and doing critical care education monthly?

Emergency physicians were not designed to sit in committee. We are people of action, on our feet and ready for anything. On the other hand, I suspect that once you’re involved in a committee, you’ll see the positive impact you can have on your group and have a better understanding of why things work certain ways in the ED and hospital. Remember, the more involved and widespread the emergency physician influence is throughout the hospital, the easier it is to move your department forward. Ultimately, committees exist throughout the hospital that serve a variety of professional interests. You can probably find some way to actively participate in an area that you enjoy while seeing a little bit of the hospital world outside of your neighborhood.

Are you really interested in computers and information systems? Government stimulus money is available and most hospitals are looking at significant information system changes to take advantage of this money. Not only is physician input essential, but it could put you in the decision-making seat to help choose the next EMR that will be rolled out to your ED.

 Michael Silverman, MD, is chairman of emergency medicine at Harbor Hospital in Baltimore, MD and is on TEAMHealth’s Medical Advisory Board.
 

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