Evan Flatow, MD, chair of the Department of Orthopaedic Surgery and chief of shoulder surgery at Mount Sinai Hospital and Mount Sinai School of Medicine in New York, oversees a team of 17 full-time orthopedic surgeons and 20 private-practice surgeons in a department that was recently ranked in the top 25 hospital-based orthopedic programs in the nation by U.S. News & World Report.
Q: What is the most critical function of an orthopedic department leader in determining the department's success?Dr. Evan Flatow: I think the most important thing you do as a chairman is to recruit. At the end of the day, a lot of the rest is pushing papers around. Having the right people in the department is absolutely key. When I recruit people, I almost overdo it. I ask everyone I know to name five physicians in their field, and I go after the names that keep coming up. I research all I can about them and really do my homework. This is especially important when I'm recruiting in a field that's a new area for our department, such as when two years ago we hired a top orthopedic oncologist. When I hire surgeons, I want to be sure they are not only talented surgeons but also wonderful people. I also never hire on a clock. I'll leave a spot open for a couple of years or hire someone when we didn't think we needed one. It's more important to bring in wonderful and talented people.
Q: Once you identify the surgeons you want to recruit, how do you go about attracting them?
EF: One thing we do is to try to have a very good professional culture. I don't tolerate petty fighting or cliques. If I have two fighting surgeons, I'll threaten to fire both of them if they keep fighting. We have a very strong spirit of cooperation here. There is some level of gentlemanly competition between the surgeons in private practice, but overall there is a spirit of collegiality here. We support and promote all of our surgeons. We don't just hire and then see who makes it. We only recruit when there is business and OR time to support a new physician, which is attractive to recruits.
The full-time staff works in a medical school-based practice, and we have a very transparent administration. Money is very easy to follow and physicians can track their claims and how they're collecting. We also recently cleaned up billing by bringing in a billing consultant to improve our collections. A surgeon we recently hired tripled his collections in a year after moving from another medical center without any significant changes in his volume, and word gets around when that can happen.
Q: Top orthopedic departments often set themselves apart from others due to strong research programs. How can smaller hospitals remain competitive when they often lack significant funding for such efforts?
EF: Research doesn't have to take place at a medical school or medical center. Many great advances in orthopedics actually occurred at small community hospitals. What you need is an environment of curiosity and surgeons who are willing to thoughtfully keep track of cases and new ideas. Publication and presentations can be a powerful marketing tool for a department. What you really need is a little investment in clinical trial nurses or others to run studies, and that doesn't have to cost a lot.
Q: What advice would you give to other leaders of orthopedic departments?
EF: I have three rules for being chair. No. 1: Show up. So many important things happen that if you miss a meeting you can really miss the boat. Then, at those meetings work hard to promote your department and always try to defend your faculty if they are doing a great job, which mine usually are. No. 2: Use common sense. Sometimes presentations from consultants [hired by the hospital as part of improvement efforts] can seem other worldly. Always put clever management principles under the harsh light of common sense. For example, it doesn't make sense to try to get people to work harder without any incentive to do so. No. 3: Never forget why you became a doctor in the first place. In the end, all of the other things work out if you focus on that. If you get too caught up in the business and politics of running a department, you'll lose that core which tells us to always do the best for our patients.
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