One might think that after holding a "Director of Medical Informatics" position at a 1,000-bed major medical center a decade ago, a Group Director of informatics position in a major trans-national pharma with 50+ reports, and research/academic positions in informatics at an Ivy university as well as a non-Ivy but well-regarded university, companies such as the major medical insurers would come up with informatics job offers at a level higher than "Director." Further, one might believe they might think twice before sending such position offers to experienced informaticists.
Yet I find myself, as do my colleagues, presented with repeated offers at the manager or director level. The director positions most often have few to no reports, no budgetary authority, and an "internal consultant" perception by superiors. In other words, they are "Director of Nothing" positions without the executive presence to function effectively. Also, it does nothing to help us advance our careers to hold repeated "director"-level positions.
I believe this phenomenon has to do with a combination of a thorough misunderstanding of Medical Informatics, as well as a fear and bias against physicians holding leadership roles in healthcare.
I note that a few healthcare organizations are starting to "get it" and are offering roles at higher levels in the organization, but I believe this has to do with desperation more than anything else. Expensive clinical IT difficulties and medical errors requiring costly 'salvage' care (that Medicare and likely other payers are moving away from covering) are probably part of this slow change:
New York Times
August 21, 2007Medicare, the government insurance program for older Americans, has announced that it will soon stop paying hospitals for the extra costs of treating certain patients whose illnesses are compounded by preventable errors. The effort won’t save much money at first, and it will impose additional testing and documentation burdens on many hospitals, but it should promote better care. If the initial steps are expanded, it could yield greater savings as well.
Under current payment rules, Medicare typically pays hospitals more for treating a surgical patient whose illness is complicated by an infection than it would if there were no infection present. That is true even if the infection is caused by sloppy sanitary practices in the hospital itself. The perversity of a payment system that actually rewards incompetence rather than penalizing it seems self-evident. So Medicare is clearly wise to start changing the incentives.
I had outlined "leveling" issues in applied informatics positions -- almost a decade ago -- in this essay entitled "Ten critical rules for applied informatics positions."
The following email thread, featuring a "senior talent consultant" in the "Talent Optimization" department (what adorable corporate-speak!) at a major Medical Insurance Company is self-explanatory. Names are anonymized to protect confidentiality.
Paradoxically, recruiters seem to come back for more as a result of such confrontational (but quite true) responses. Note how this occured early in the exchange below after my first rather direct response, see below on Sept. 2.
From: MedInformaticsMD
To: Senior_Talent_Consultant@Major_Insurer.com
Sent: Tue, 11 Sep 2007 9:58 am
Subject: Re: Clinical Informatics Director
Dear Ms. Talent,On thinking about this, I see no "long term advantages" of an employee-at-will position in today's business environment. Perhaps you've leveled the position too low. I am interviewing for VP positions at other organizations.
The formally-trained medical informatics community is also aware of my concerns about leveling of medical informatics positions via my internationally-known health care IT failures web site entry on this topic.
Here is an essay you should pass along to those in your organization seeking medical informatics expertise. "Ten critical rules for applied informatics positions: What every Chief Medical Informatics Officer should know" (http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=tenrules). This was recently reprinted in Healthcare Informatics.
Best regards,
MedInformaticsMD
-----Original Message-----
From: Senior_Talent_Consultant@Major_Insurer.com
To: MedInformaticsMD
Sent: Mon, 3 Sep 2007 1:40 pm
Subject: RE: Clinical Informatics Director
I'd like to share the long-term advantages of the position. Are you available to speak on Wednesday of this week?
Ms. Talent
Major_Insurer Talent Optimization Department
1000 Dontpayem Highway
City, State 99999
Email: Senior_Talent_Consultant@Major_Insurer.com
Office:123-456-7890
Fax: 123-456-7891
http://careers.major_insurer.com/
-----Original Message-----
From: MedInformaticsMD
To: Senior_Talent_Consultant@Major_Insurer.com
Sent: Saturday, September 01, 2007 12:24 PM
Subject: Re: Clinical Informatics Director
Dear Ms. Talent,
Due to layoffs/reductions in force at my previous two corporate employers (Comdisco and Merck & Co., Inc.), I am not seeking industry positions except under an employment contract, as opposed to traditional employee at will arrangements. If this position offers such an arrangement, then I may be interested.
Best regards,
MedInformaticsMD
-----Original Message-----
From: Senior_Talent_Consultant@Major_Insurer.com
To: MedInformaticsMD
Sent: Fri, 31 Aug 2007 5:57 pm
Subject: Clinical Informatics Director
Hi MedInformaticsMDYour resume was forwarded to me regarding a Clinical Informatics Director position that we have. I would definitely like to speak with you as soon as possible. Please feel free to contact me at your earliest convenience.
Thanks
Ms. Talent, Senior Talent Consultant
Major_Insurer Talent Optimization Department
1000 Dontpayem Highway
City, State 99999
Email: Senior_Talent_Consultant@Major_Insurer.com
Office:123-456-7890
Fax: 123-456-7891
http://careers.major_insurer.com/
I have not yet recieved a reply to my latest message, but paradoxically do expect one, attempting once again to draw me in with some corporate HR mumbo-jumbo.
-- SS
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