Over the past five years, I have found myself doing more and more work with medical directors. It turns out that as veterinary medicine has corporatized, the medical director role has soared in commonality and importance. As the practice owners who sold their businesses to consolidators retired, and as the stress of pandemic and post-pandemic practice settled in, the demand to develop and retain a new generation of medical leaders has grown steadily. As a result, I’ve gotten to work with medical directors individually and in groups all over the world to help make them and their practices more successful.
Working with these doctors, I have seen countless challenges, headaches and setbacks involving practice and corporate leadership. I’ve also seen fantastically lucky breaks, incredible feats of skill and savvy, and amazing accomplishments. I’ve gotten the pleasure of knowing some exceptional veterinarian leaders, and I’ve learned as much as I can from everyone involved.
Recently, an independent practice owner considered creating a medical director job in her hospital. She contacted me for advice, curious about the qualities that make someone successful in that position. “When you think about the most impressive medical directors you’ve seen,” she asked, “what do they have in common?”
Here’s what I told her.
1. The Best Medical Directors Truly Understand Their Jobs
A multisite veterinary group I consulted with asked me to interview one of the company’s newly appointed medical directors. She had been in the job for about a year and had a good reputation with her team, but the practice group’s leadership thought she wasn’t quite hitting the mark. They wanted to know how to support her better.
As I sat down with her, I began with a simple question: “Before we get started, do you have any questions for me?”
Her response surprised me: “Yes, what am I supposed to be doing here?”
It turned out that the practice where she worked had been acquired a couple of years prior. As part of the deal, the previous owner became the medical director, but he had no real responsibilities. When he retired, the veterinarian I was interviewing — the most senior associate — was promoted to replace him but received little guidance beyond “Make the practice more successful.”
This lack of clarity is a common challenge. Medical directors are often thrust into leadership positions without a clear understanding of their responsibilities or how to achieve success.
In some organizations, the medical director is expected to set the strategy for changing a practice’s medical standards from year to year. In other places, the strategy is set at the corporate level, and the medical directors focus on mentoring and developing veterinarians. In some organizations, medical directors are responsible for the daily management of the associate doctors; in others, they are discouraged from doing so. Finally, some spend 100% of their in-clinic time on appointments, while others dedicate 50% or more of their time off the floor, working on leadership and management tasks.
I’m not here to tell people what the job description should be (although I have an opinion). Still, I am saying I have never seen outstanding medical directors who didn’t have clarity about the objectives and how they were expected to pursue those goals.
2. The Best Medical Directors Build Trust
The first thing that good medical directors focus on is building trust. Medical teams do not need to agree with everything a leader wants to do. However, they must trust that the leader is acting ethically, telling the truth and pursuing a goal that matters to the people being led. If a team does not believe the medical director will do what she says she will do, they will approach every request from her as though it might dump them into a bad place at any moment.
3. The Best Medical Directors Know How to Handle Fighter Pilots
To appreciate what I mean about this point, you must understand what it’s like to manage doctors. One of the biggest mistakes I have seen corporate groups make when entering the veterinary space is to manage veterinarians like they are almost any other employee. These companies walk in with a medical cookbook and tell the veterinarians what they will do and what patient, revenue and diagnostic quotas they will hit. This approach does not end well.
From a management perspective, it’s best to think of veterinarians as fighter pilots — people with a lot of training and skill, a very healthy ego, and a low tolerance for being told their opinion doesn’t matter. I don’t mean for that description to sound offensive. I am a veterinarian who checks all three boxes. I also respond poorly to quotas and top-down mandates.
If you’re going to manage veterinarian fighter pilots, you need to treat them as individuals. The best medical directors know that and lean into discussing issues with associate veterinarians while focusing on what those doctors are passionate about or motivated by.
4. The Best Medical Directors Speak Two Languages
One of the most significant issues affecting health care providers in veterinary medicine since the pandemic has been a substantial redistribution of industry control from those with medical backgrounds to those with operations backgrounds. Historically, veterinary medicine has been guided by veterinarians who owned the practices and saw the patients. However, as corporatization transforms the industry, the clinic-level veterinarian has less and less power over where the profession goes.
It makes sense that as organizations get larger, we’ll see an increased focus on things like labor efficiency, staff and client scheduling, inventory management, and revenue. Given that these considerations exist across industries and that it is much easier to bring high-level leaders into veterinary medicine than to grow them internally (given the relatively short history of corporate practice groups), we can expect to see an increase in the percentage of decision-makers with operations backgrounds relative to those with medical backgrounds.
Also, through the process of merging veterinary practices into large groups, the number of administrative and management jobs has exploded. Once integrated into corporate culture, these administrators and managers generally do not speak the language of medicine. They talk about financial targets, risk management and net promoter scores.
Let me be clear here and say that operations and its language are not bad things. Well-tested approaches learned from other industries can make veterinary medicine better for pets, clients and veterinary professionals. The problem lies in how medicine people and operations people communicate.
Doctors and technicians who prioritize patient outcomes over everything else don’t typically respond well to an initiative they believe is simply about making more money or hitting an arbitrary target.
Operations language and thinking are required to run an effective business at high levels, but they do not motivate doctors and technicians who prioritize patient outcomes over everything else. Medical-focused veterinary professionals often react negatively to directives and initiatives communicated or justified by operations people.
That is why the best medical directors are fluent in two languages: medical and operations. They can talk to upper management about how a new endoscope will drive revenue and grow services. They can also talk to the veterinarians about how a new endoscope will improve patient outcomes and reduce recovery times. A good medical director gets a request from a practice team speaking medical language and communicates it up the chain in operations language, and vice versa.
I have not met a medical director who didn’t understand the culture and language of medicine. On the other hand, I’ve met plenty of people who have never learned the culture and language of business and operations, and that shortcoming holds them back.
5. The Best Medical Directors Understand the Difference Between Initiatives and Purpose
Modern veterinary practice is becoming more and more about sprints. Sprints are frantic pushes in one specific area to bring about quick practice or revenue growth. Then, they are deprioritized to push something different. The benefit of having two or three hard pushes in various areas — for example, dentistry, senior wellness, pain management and parasiticides —is that everyone on the team gets clear direction about what is crucial and the resources (including training) to get there.
The downside is how such initiatives can make teams feel. Change is hard in general, so frequently switching focus brings friction. Also, there is frustration in the feeling that, as soon as the team starts to figure things out, the target changes and all the hard work on the previous target is forgotten. Finally, given that some veterinary professionals don’t care about targets and only want to serve the patients and clients in front of them, such initiatives can feel like one money grab after another.
The best medical directors frame initiatives in a way that makes sense for their teams. Each sprint is an initiative that must serve the team’s greater purpose. Teams must not feel they are being ordered to sell dentistry this quarter and parasiticides next quarter. They need to feel they are being asked to do what is best for pets all year long and to pursue that unchanging purpose by supporting a dental initiative now and a parasiticide push in the coming months.
That difference might seem subtle, but believe me when I say framing initiatives is a critical skill for medical directors told again and again to change the behaviors of the health care teams they lead. Initiatives change. Purpose must not.
6. The Best Medical Directors Manage Upward and Laterally
I’ll keep this one short and sweet: The best medical directors focus as much on building and maintaining strong, collaborative relationships with their bosses and practice managers as they do with the teams reporting to them. If a medical director wants her team’s trust and wants her team to see value in her, she better be able to influence both up the chain and the clinic’s management side. That doesn’t happen without well-built and maintained relationships.
7. The Best Medical Directors Have Good Boundaries
The best medical directors understand that, regardless of what upper management tells them, their success will not be gained or lost today, this quarter or even this year. It will happen over decades. That’s why the best medical directors set plans and boundaries to keep their jobs sustainable.
Sure, jumping in to fix a problem is the fastest way to resolve an issue, but what does that accomplish in the long term? It trains the medical team to bring problems to the medical director for a solution. The same is true about being instantly available by phone or text message. In the short term, jumping into the fray makes sense. In the long term, however, being at the beck and call of an entire hospital is a recipe for personal ruin.
Good medical directors are available — but not too available. They set a pace they can maintain, they know how to recharge themselves, and they are comfortable letting a problem go unsolved for 20 additional minutes so that someone else learns to handle it.
Does this mean medical directors accept that they cannot and will never make everyone happy? Yes. Yes, it does.
8. The Best Medical Directors Remember Why They Took the Job
When your days are full of doctors complaining about medical issues, pet owners complaining about customer service issues, practice managers complaining about logistical issues, and upper management complaining about organizational issues, it’s easy to lose sight of why anyone would want your job.
Veterinarians become medical directors for various reasons, including:
- To attain more control of the clinic environment.
- To achieve better medical outcomes for patients.
- To have a bigger impact than an associate veterinarian role allows.
- To mentor and develop doctors.
Regardless of what comes down the pike, the best medical directors remember why they took the job.
We Need More Great Medical Directors
As veterinary medicine evolves, the need for clinicians who can lead others and advocate effectively for medical standards and patient care is increasingly vital. To this point, “medical director” has often been little more than a title given to the most senior doctors (or the highest producers) to pad their ego and keep them in the clinic. For veterinary medicine to have a bright future and to be an industry that those of us who prioritize patient care want to stay in, we need a lot more of the best medical directors.
If you are an associate veterinarian and think you can develop the necessary skills over the next few years (or would like to try), I hope you’ll consider taking on a medical director job. Our profession doesn’t just need medical directors. It needs GOOD medical directors to make our practices the places worth working in.
THEY’RE IN DEMAND
The American Veterinary Medical Association’s Career Center lists dozens of practices looking to hire a medical director. The compensation varies widely. At the upper end, one hospital recently offered an annual salary of $185,000 to $250,000, production and growth-based bonuses, a sign-on payment of up to $50,000, and the chance to become a part owner. Another practice touted a base salary of up to $250,000 (“with 25% production!”), a four-week sabbatical every five years and a buy-in opportunity.
HUMAN MEDICINE’S EQUIVALENT
According to a study published in Health Services Insights, the relationship between the medical director and physicians is crucial and “must be based on trust, respect and professionalism rather than displaced authority and/or excessive conviviality.” Read “The Function of a Medical Director in Healthcare Institutions: A Master or a Servant” at bit.ly/4fz0qaz.
STORY ARCHIVE
Veterinarian and award-winning columnist Dr. Andy Roark has contributed to Today’s Veterinary Business since 2017. Among his articles are these:
- “The Trouble With Pattern Recognition,” go.navc.com/patterns-TVB
- “Measuring Sticks,” go.navc.com/self-worth-TVB
- “Sometimes, We Hike in the Rain,” go.navc.com/struggles-TVB
BE A BETTER LEADER
Dr. Andy Roark has partnered with VetFolio to release the Uncharted Leadership Essentials Certificate. The program provides training appropriate for anyone who leads or manages others. The topics covered include setting a team’s vision and values, building trust, achieving team buy-in, delivering feedback, understanding communication styles, setting priorities, delegating effectively and managing time. Learn more at bit.ly/Uncharted-VetFolio.