The Medical Informatics Glass Ceiling: Chief of Nothing?

I have written a number of times on this blog such as here, here, here, here, here, here, here and here about difficulties Medical Informatics specialists have in securing positions with a future: that is, positions with career advancement opportunities into higher levels of healthcare management, and roles that ensure some degree of stability instead of fancy-sounding titles that translate to “[cheap] internal consultant.”

The "Director of Informatics" role has been transformed into numerous fancy sounding titles including "CMIO" (Chief Medical Informatics Officer), "VP of Informatics", "Senior Informatics Specialist", etc. However, as I wrote several years ago:

Rule 3 [for CMIO's]: Avoid 'internal consultant' positions, a way for organizations to get expert help cheap (i.e., at your expense, with limited career advancement opportunities).

Career advancement routes for "Directors of Medical Informatics" are not yet well-defined. A candidate for such a position should consider the issue of career advancement very carefully and raise questions about it before accepting these positions.

If you start as an 'internal consultant', an organization may be strongly motivated to let you remain as an internal consultant. Good external consultants are very expensive. Unfortunately, an 'internal consultant' position does little for a person's career advancement.

Such roles usually have no direct reports (i.e., MIS, performance improvement, or other people reporting to you). It must be remembered that the number of direct reports a person has had is a key factor evaluated for advancement in healthcare management roles. Internal consultant roles are therefore not good long-term prospects for clinical people who have made the sacrifices to become informatics specialists.

In addition, informaticists should think carefully about organizations that believe informatics physicians do not need, or should not have, direct reports. This may be a litmus test of the true beliefs of the organizational leaders about informatics.
In the worst case, 'internal consultant' can become 'glorified errand runner.' Such glass ceilings are best avoided.


Rule 5: Avoid project management roles that lack clear, direct control of resources. "Doctors don't manage projects" is a corollary of "doctors don't do things with computers." Unfortunately, without direct control of resources (such as hiring, firing, and budgets), a person is an 'internal consultant', not a leader, despite any titles or representations to the contrary. This can be referred to, in a term coined by a friend, as a "Director of Nothing" position. This reduces effectiveness and certainly reduces job satisfaction and career-advancement opportunities.

Here’s another new job posting ad that speaks for itself. In one possible area of improvement, the posting does not try to hide the fact that it has no direct reports:

Description: Senior Medical Informatics Research Scientist

The organization recognizes that Informatics capabilities linked to Delivery System business processes:

• Enables enhanced medical cost management through timely identification of actionable drivers
• Improved quality of care for members
• Improved provider performance
• And improved organizational effectiveness through data driven business management.

In this role, YOU WILL:

• Provide vision, leadership and execution of health services research projects to help meet business objectives.
• Work in collaboration with the Director of Advanced Analytics.
• No direct reports but would have ability to collaborate with analysts on specific projects.
• Work with clients across different business units to address some of the most complex analyses facing the company.

A challenging role with a diverse set of projects varying from health economic modeling, provider assessment strategy (P4P), population segmentation for targeted health management programs (case mgmt, disease mgmt and preventive health), predictive modeling, and disease registries/models of disease progression. Specific projects will depend upon prior experience and skill set.

Of course, it could be argued that some informatics clinicians would find having “no direct reports” to be attractive.

However, I then ask – what is the background of the person who the “senior scientist” reports to, why is the job title “senior scientist,” and how is the “junior scientist” role structured?

Additionally, this position is likely in an insurance company. Those companies have a history of layoffs as in most big organizations. What is the position security here? What are the job advancement opportunities? (Perhaps “Super Senior Scientist”?)

Perhaps most importantly, what are the capabilities, if any, to develop analytics and algorithms fair to practitioners as well as payors without interference from above, and of the incumbent to challenge unscrupulous or unfair data manipulation that might favor the payor over the provider, and still remian employed?

On a related note with regard to hospitals and the new "Chief Medical Informatics Officer" title that seems to have appeared out of nowhere in recent years, it seems to me that hospitals have skirted the issues outlined above and kept health IT management authority "closely held" to the traditional players, i.e., IT and CIO/COO/CEO, and 'friendly' vendors.

It appears the old role of "Director of Informatics" has now been given a shiny "C"-level title - "CMIO"; however, it seems the thinking about the role's specifics has not really changed in a decade. In review of job descriptions and in actual interviews I've had recently, as well as via discussions in my professional society, it seems the role is still viewed as an "internal consultant" position (irrespective of what it's called), whose role is in large part to placate doctors into EMR use of which many are skeptical, not a true "C" level officer role with control of management and resources and a career path into higher levels of healthcare management .

In essence, the title "CMIO" itself may be a new designation for "Chief of Nothing", a title that costs healthcare organizations exactly - nothing - to hand out. It could be construed as a title that masks the lack of power-sharing by traditional healthcare executives with clinicians, especially informatics-credentialed ones.

I ask the hard questions, you decide.

-- SS