Shortly after I was appointed chair, my predecessor gave me a copy of Sir Ernest Shackelton's epic tale of survival, South: A Memoir of the Endurance Voyage. At the time, I considered this a reflection of Gary's wry sense of humor. Now, 4 years later, I have a greater appreciation for the deeper meaning of this gesture, for Shackleton's memoir is a heroic saga of survival and triumph against seemingly limitless threats and overwhelming obstacles. In considering how best to respond to Dr. Roberts' gracious invitation to contribute to this Academic Psychiatry collection, it seemed to me that Shackelton's expedition could serve as an appropriate analogy.
I have occasionally characterized the role of chair as leading a cast of crewmates—some committed to the mission, others dragooned into duty—across an ice flow (the image of herding cats doesn't work in this Antarctic setting). Ideally, elements of a daily calendar, like individual blocks of ice on a moving flow, are sufficiently linked to one another and integrated from day to day, allowing one to chart a course and make steady progress towards identified goals. Such progress can be illusory, however, because countervailing currents can shift the entire landscape beneath one's feet, sometimes unknowingly. Footing can be precarious too, particularly during times of change. Crevices can gape open unexpectedly, blocking progress, requiring changes in course, or in the worst case, dooming the enterprise. Focusing too closely on the foreground in an effort to avoid immediate surprises can result in a failure to maintain perspective on the horizon, resulting in expeditionary failure.
At this point, some readers are likely to be detecting a hint of desperation, rolling in like a cold, wet, disorienting fog. Fortunately, like the Endurance voyage, this story too has the potential for a successful conclusion. Hard work and good luck, if superimposed on the correct mission objectives, can carry the day. Effective leadership is essential, of course. Assembling a talented leadership team and, ideally, enjoying their company, increases the odds of spotting risks and crafting successful solutions and, importantly, balances the workload, not unlike distributing the weight of an expedition party traversing thin ice. Finally, optimism and an appreciation for adventure are highly adaptive attributes that are worth cultivating.
Within this conceptual framework, let me describe a recent workday, which began, as do most days during the school year, with family responsibilities. My wife is also an academic physician who works 6:30 AM to 3:00 P.M. in order to be home when our son returns from school. My contribution to the parenting effort is to get him prepared for school (e.g., fixing his breakfast, making his lunch, dropping him off at school). My workday usually begins with a quick survey of emerging e-mail before leaving home. I arrived at work on this day at 8:30 A.M., spending the next 30 minutes reading e-mail, returning phone calls, and preparing for the activities that followed.
At 9:00 AM, I joined our residency director to meet an assembled group of residency applicants. I spent 30 enjoyable minutes orienting them to the department and learning of their interests and aspirations.
At 9:30 A.M., I traveled downtown for a presentation before the Compliance Subcommittee of the UW Medicine Board, a group comprised of University of Washington (UW) Regents, community leaders, and the dean. This was the one-year anniversary of the formation of the Physician Education, Billing and Compliance (PEBC) Council on which I served as vice-chair. The PEBC Council was established to spearhead improved training in professional billing and to reengineer the charge capture, documentation, coding, and billing activities of the UW Physicians (UWP) practice plan, an outgrowth of an ongoing federal investigation of Medicare billing practices at UW. The PEBC Council represents a major effort to recruit physician leadership into the management of the practice plan. The S ubcommittee was understandably eager to learn of our progress and future plans.
Returning to campus, I ate lunch in my office while reading mail and answering e-mail. At noon, I had my weekly meeting with our department Administrator and reviewed a broad range of administrative and fiscal issues. This theme carried over to my 1:00 P.M. weekly meeting with our Manager of Clinical Service Systems. She updated me on maturing clinical initiatives (e.g., virtual front-desk access system, clinical template task force activities, and documentation training for the faculty).
From 2:00 P.M. to 3:00 P.M., I saw a patient being treated with psychotherapy and medications.
From 3:00 P.M. to 4:00 P.M., I returned phone calls and responded to e-mail.
The monthly meeting of the UWP Management Committee followed from 4:00 P.M. to 6:30 P.M. This executive group is responsible for the management of the academic clinical practice at the UW Medicine hospitals. We focused on preparing a recommendation for the membership on whether to accelerate implementation of a new computerized billing system and a practice-wide electronic medical record. I am a member of the task force analyzing the alternative strategies that were being deliberated and the recently appointed UWP President.
At 6:30 P.M., I returned home to enjoy dinner, followed by our evening romp with Tango (black Labrador), accompanied by my son.
At 8:30 P.M., after my son and wife began settling in for the night, I returned to the computer for a final check on my e-mail and one remaining task. Our chief of psychiatry was recently appointed associate dean and medical director of UW Medical Center (that's the good news). Consequently, I have assumed his former duties, pending the outcome a search to fill this vacancy. I had received an eight-page letter from an outpatient who was unhappy with his experience during an intake interview at the clinic. I spent an hour reviewing his medical record and writing a reply that I hope will adequately address his concerns.
Although other workdays might allow for a greater proportion of time focused on research activities, scholarly writing, or patient care, this workday was reasonably representative. As is apparent, much of my effort was devoted to ensuring that the business and clinical operations of the department and medical school were secure in order to allow our teaching and research missions to advance. I concluded this particular day with the satisfaction that none of our party was lost on route and with confidence that we are still on course. See t1.