Bridging the Gap: The Importance of Leadership and Physician Continuity in the Cardiac Setting

Consider this scenario: New projects are underway within your cardiovascular service line, initiatives that will change the department for both the short- and long-term, and one of the key managers or physician leaders decides to make a move. Will you need to put all these projects on hold while you search for a replacement? Ones you have worked so diligently to bring to the forefront? Will you need to stretch your staff even thinner to take on more? 

In brief: no! Corazon believes that such a result is not necessarily an inevitable outcome of a key position vacancy within a specialty program, especially one as significant to the overall hospital bottom line as cardiovascular. 

We have found there are indeed effective ways to successfully find qualified interim managers and/or locum tenens physicians to ‘bridge the gap’ until a full-time replacement is found to champion the service line at a time where financial stability, staff morale, and/or program momentum may be at risk.

Interim Program Managers

One crucial aspect of finding an effective interim manager is knowing exactly what you need to fill the vacancy.  For some, this may be difficult to do, but it is absolutely imperative to understand and then communicate what responsibilities this interim manager will be assuming. By doing so, the search for and placement of the best-qualified interim will be much easier.

After you have assessed your program’s needs and the role the interim needs to fill, you will then be able to more readily identify the defining talents of the “ideal” interim candidate. Corazon’s experience proves there are many industry professionals who have made a career of venturing to different parts of the country, assessing the current situation, and helping to maintain or rebuild programs that have recently lost a key leader or physician. Maintaining these relationships within our national pool of candidates and providing the needed resources over the course of many years has allowed Corazon to help dozens of organizations fill gaps in order to maintain continuity during times of turmoil.

After you have identified the responsibilities the interim manager will take on, the type of candidate you should be seeking will become clear. When interviewing, and ultimately making a decision on choosing your interim, it is important to keep in mind that, while qualifications and skillset is extremely important, personality may loom very large with much of your staff.  The overall culture of the service line will dictate if an outspoken leader is needed, or if a soft-spoken manager that leads by example is the better choice.

Once you have identified your program needs and the person that you have chosen to fulfill them, you may be ready to continue moving forward with the program development already initiated. Any efforts that are going to move your cardiovascular service line into the next generation of healthcare cannot remain idle. In fact, given the recent Supreme Court ruling on the healthcare law, continual legislative changes in many states and rapidly advancing technology, cardiac programs across the country have no choice but to remain on the forefront of program strategy and development. Doing so requires strong leadership at the helm. Corazon believes that a leadership vacancy as short as a few weeks can have profound negative impacts on your cardiac program. In fact, no program — especially one as critical as the cath lab — should remain ‘leaderless’ for any significant period of time. 

While finding an interim isn’t necessarily easy without outside assistance, placing a temporary leader can be very time-sensitive. The more quickly you initiate the process, the more quickly you can set a start date for the interim, which means limited down time.

This ability to secure the proper leadership for this essential service line or clinical area not only assures the stability of the program, but also the confidence of the staff, knowing that a capable leader is once again in place.

Locum Physicians

We often explain to clients that there are plenty of similarities between the placement of a program leader and identifying locum physicians; however, while all the steps outlined above are necessary, there is much more to the process with locum tenens.

First and foremost, be aware of and up to date on your state’s licensing requirements. You may find a qualified physician who is a cultural fit, but without current licensure in your organization’s state, the candidate isn’t viable. Not understanding the requirements can create a problem with timing — depending on state licensing policies, obtaining an active license can take between 2-6 months in the cardiovascular specialty (Figure 1). Some states, such as Missouri, for example, provide an option to have licensure expedited. Though if you are not aware of the state’s policy, you may miss a key step to achieving licensure for your physician.

Secondly, make sure to learn whether your oncoming physician will need to be added to your malpractice insurance. Many physicians that supply locum tenens only carry malpractice insurance in the state in which they practice medicine. This is not very taxing for the organization, as it is a “minimal” cost to add a specific individual; however, missing this key step can create significant delays in terms of when your locum can begin clinical or leadership responsibilities on site.

Lastly, it is essential to begin your hospital’s credentialing paperwork as early as possible. If you can fax or ship overnight the informational forms that your human resources department requires, you won’t need to be concerned about whether the physician will be sitting on the sidelines on a day that he or she is being paid to deliver care — a day that could also bring revenue to the bottom line.

All three of these essential steps are rather simple, but unfortunately, also very easy to overlook. Another critical cultural aspect of this process will be the acceptance of your own physicians. They will likely be looking forward to some relief for on-call, vacation coverage, etc., though it may be difficult to see another physician getting paid a rather large sum of money to provide temporary assistance.  Setting the stage early on can help to mitigate any negative feelings of current medical staff, and will work to bring all physicians on board with the locum coverage prior to his/her arrival. 

For many of these reasons, it is essential that either HR departments or physician relations professionals understand what it will take to bring a locum on board quickly and remain prepared for this contingency should the need arise.  Being proactive with physician licensing services, and informed on malpractice insurance policies and hospital credentialing can only maximize the time that the locums physician is working inside of your facility and bringing in revenue for the organization.

The Benefits of Interim Assistance

Interims can bring vast benefits to a cardiac cath lab or other area of a specialty program. For instance, Corazon believes that an interim program leader or physician can help to identify opportunities for the program, bring new perspective and energy, and alleviate existing staff overwork. A new point of view can often highlight clinical or operational issues, and provide unbiased solutions for such challenges, whether on the leadership or medical staff side of the equation.

In our experience, clients might struggle with the high price tag assigned to a qualified locum or interim manager. However, interims can aid the organization in continuing to provide quality patient care as well as maintain revenue that may have been lost from the a negative impact of a departing employee. 

The positive return on investment related to using interim management or locum tenens can be different at every organization. A current client has had tremendous success expanding their percutaneous coronary intervention (PCI) network through an interim manager. They had been unable to expand on their own.  This client also added a second interim manager specifically for implementing their cardiac registry, now thriving after being spearheaded by this temporary outside support. These initiatives will be invaluable to the short- and long-term success of the program, and may not have been possible without the help of an interim manager in the role. Moreover, the timeline was likely shortened, as these complex and involved efforts may have gotten lost in the day-to-day responsibilities of existing staff, thereby lengthening the time to completion. Delays would have caused the hospital to miss out on expanded program revenue and/or valuable data collection. 

In conclusion, the most important aspect to finding a successful interim manager or locum tenens physician is understanding your needs. Once you understand your facility’s needs, navigating through the next steps will be a much more rewarding process. Regardless if you are bringing on an interim manager or locum tenens physician, the groundwork covered beforehand can stabilize an organization during a difficult time and bring continuity amongst staff during times of transition.

Jason is an Interim Specialist at Corazon, Inc., offering strategic program development for the heart, vascular, neuro, and orthopedic specialties. Corazon offers consulting, recruitment, interim management, and physician practice and alignment services to clients across the country and in Canada. To learn more, call (412) 364-8200 or visit www.corazoninc.com. To reach Jason, email jbisesi@corazoninc.com.