Medical Directorships

Medical director roles allow doctors to exercise their professional judgment while retaining authority. Hospitals, healthcare systems, and other medical facilities and programs — which are often led by non-physician executives — hire medical leaders to ensure quality of patient care and act as intermediaries between clinical and administrative teams.

MEDICAL DIRECTOR ROLE AND RESPONSIBILITIES

Medical directors are responsible for the overall clinical care provided by a healthcare organization, including administrative services, guidance, and leadership. The precise responsibilities vary depending on the organization type, although many involve activities related to quality improvement, cost containment, clinician training, performance improvement, and revenue cycle management. They may direct activities of other physicians, perform chart reviews to maintain care consistency, attend meetings with medical staff and organizational leadership, and participate in strategic planning.

Most positions include clinical decision-making on some level. Complex cases, emergency situations, adverse events, and circumstances with an ethical dilemma or patient complaint may require the medical director to get involved in patient management decisions. Ultimate responsibility for patient care and treatment decisions lies with the treating physician; however, medical directors may supervise APPs or have other clinicians functioning under their license.

The title medical director is not a standardized title across healthcare settings. The position is well-defined in some situations, such as when federal regulation mandates a medical director. This is the case with dialysis units and hospice agencies, for example. In other cases, it is simply a title used to differentiate the medical director role from that of an attending or treating physician. It is also commonly used for physicians working for companies outside of healthcare services delivery, such as with pharmaceutical and insurance companies.

Over time, medical directorships have increased in importance and broadened in scope with the heightened focus on quality in healthcare.

MEDICAL DIRECTOR JOBS IN CLINICAL SETTINGS

Medical directorships are found across the healthcare industry. Other chapters in this book discuss the medical director role for long-term and post-acute care facilities, medical spas, hospice and palliative care services, blood banks, and worksites. Several other medical director positions that are mainstream within clinical settings are described here.

Emergency medical services (EMS) agency medical director

The National Association of State EMS Officials, the National Association of EMS Physicians, and the American College of Emergency Physicians issued a joint position statement supporting the role of physician medical directors as an essential component of EMS systems. Paramedics and advanced life-support providers function under the medical director’s supervision.

An EMS medical director oversees the medical operations for an entire EMS system and is responsible for establishing protocols for prehospital emergency medical care for ensuring competency and performance of the personnel who follow the protocols.

The minimum qualification for the position is a state medical license. Other criteria differ by state but generally include board certification in emergency medicine or equivalent competency. Advanced life support certification and completion of an approved medical director training course are usually required.

Dialysis medical director

Under Medicare regulations, dialysis centers must have a medical director who is a licensed physician and assumes responsibility for ensuring the center provides high-quality patient care. Since its inception, the role has evolved from having a clinical focus to being more of an administrative and leadership role.

Dialysis medical directors must allocate a minimum of 25% of their total work time to fulfilling Medicare-mandated responsibilities, which range from water quality oversight to approval of involuntary patient discharges.

Home health agency medical director

According to the Medicare Conditions of Participation for Home Health Agencies, every health agency that provides nursing care or other therapeutic services in patients’ homes must have a medical director who is responsible for the implementation and ongoing evaluation of the agency’s policies and procedures related to patient care.

Behavioral health medical director

Medical directorships are available for a variety of behavioral health facilities and programs, including inpatient psychiatric hospitals, residential treatment centers, intensive outpatient programs (IOPs), substance abuse treatment programs, and community mental health centers. Many states and the federal government have established specific licensure and certification requirements for medical directors in this field. The Joint Commission also requires that there be a medical director for accreditation of certain behavioral health services.

Hospital service line medical director

Medical directors in hospitals oversee clinical, operational, and financial aspects of a designated service line, focusing on improving patient care and outcomes within that specialty. They may also direct Centers of Excellence or other designated care centers established by government programs, specialty professional societies, or consumer advocacy groups.

Larger hospitals often hire medical directors who oversee cross-disciplinary functional areas such as quality improvement, case management, and graduate medical education.

GETTING INTO A MEDICAL DIRECTOR ROLE

Given the leadership nature of the role, medical directors must have significant experience or specialized expertise. Regulatory and legal requirements can dictate qualifications; organizations may have internal policies on qualifications, as well. You may need to engage in self-directed learning or participate in committees or work groups to develop necessary skills like organizational transformation and financial performance.

Because many medical director jobs are not advertised, networking can go a long way. Executive healthcare search firms sometimes fill positions. Before accepting a role, carefully review the responsibilities, time commitments, company culture, employment terms, and compensation structure.

Professional liability

Medical directors need comprehensive liability protection. Determine which activities fall under the organization’s coverage policies and where separate coverage is needed. Although they do not directly treat patients, medical directors are accountable for regulatory compliance concerning patient safety and clinical administration. Standard medical malpractice insurance may not fully cover these responsibilities. Additional policies like errors and omission insurance or directors and officers coverage are worth considering.

Legal issues

Federal and state laws affect medical director roles, especially when services are covered by government programs like Medicare. Noncompliance negatively affects the organization, but also can put you and your medical license at risk if you are serving as their medical director.

The Stark Law restricts referrals to entities with which there is a financial relationship, while the Anti-Kickback Statute bans value exchanges for such referrals. The False Claims Act penalizes fraudulent billing, and the Civil Monetary Penalties Law restricts hospitals from incentivizing physicians to limit services to Medicare or Medicaid patients. For medical directors of nonprofits, IRS tax-exempt rules prevent personal financial benefit from the organization’s earnings. State laws may be more restrictive than federal laws.

The legal aspects of being a medical director may seem daunting; however, most medical directors do not face any legal issues related to their role.

COMPENSATION AND FINANCIAL CONSIDERATIONS

Medical directors can be employees or contractors. Compensation can be an hourly rate, salary, stipend, or even an at-risk structure tied to objectives. Pay varies by facility size, number of facilities overseen, scope of responsibilities, and level of expertise required. Do not expect the same rate you would earn for direct patient care. The median hourly rate for medical directors ranged from $112 for palliative care specialists to $216 for cardiologists in 2022.(1) Many positions come with the perk of having a flexible work schedule.

Administrative payments to physicians have historically been the subject of scrutiny by Medicare and other entities. Track your time spent on medical director responsibilities, even if you are not paid by the hour. Avoid billing for clinical services during the time you are providing administrative services. If you hold multiple medical directorships, be sure the cumulative roles as described on paper can reasonably be carried out by one physician.

Many physicians in medical director positions are also employed by the same organization for clinical services. In this situation, separate compensation arrangements may be necessary for the clinical and administrative aspects for billing purposes and legal reasons.

Excerpted from 50 Unconventional Clinical Careers for Physicians: Unique Ways to Use Your Medical Degree Without Leaving Patient Care by Sylvie Stacy, MD, MPH.

Reference

1. American Medical Group Association. Medical Group Compensation and Productivity Survey; 2022. https://my.amga.org/store/s/product-details?id=a1B2E0000079GooUAE