Maybe back in the day—at least as we like to recall it—a medical director could keep issues of cost at arm’s length.
Not anymore, says Eneida O. Roldan, MD. “The reimbursement environment is now focused on how we practice medicine—increasing efficiency, quality, and safety and reducing medical errors,” says Roldan, who is now the CEO of FIU HealthCare Network, the entity that manages the clinical faculty at Florida International University’s Herbert Wertham College of Medicine in Miami. “The days are over when a medical director could look strictly at treatment while another administrator reviewed its financial impact. Now the two must be integrated.”
Roldan, 59, knows whereof she speaks after some battles while holding several top-level jobs in the Miami area over the past decade.
Her career path to “physician leadership” began in the 1980s, after a residency and fellowship in pathology and pediatric pathology at the University of Miami School of Medicine. That specialty, she says, gave her an early appreciation of the efficiency and standardization that have now become musts in health care delivery. “There was an ingrained efficiency in my training, because we were trained not only in the diagnostics of tissue and surgery, but also in how to run the lab efficiently,” she says.
Roldan branched out from pathology and earned credentials in bariatric medicine. In 1992 she became the founder and medical director of Miami’s Center for Bariatric Management. “I had my own clinics,” she says. “That’s when you start hitting reality. You ask: ‘How do I manage the business side of this?’”
For many in her generation of medical directors, she says, that question triggered lots of learning on the job. For Roldan—as for increasing numbers of medical directors today—those lessons were eventually supplemented by a return to school. In 2002, she earned an MPH at the University of South Florida and a year later, her MBA in the Physician Executive Program at the University of Tennessee. She then took on some very tough assignments. She was president and CEO of Pan American Hospital, later named Metropolitan Hospital of Miami, during the period when it emerged from bankruptcy.
At the 1,700-bed Jackson Health System in Miami, she wore the chief administrative officer’s hat along with that of CMO. She reported to officers above her in the system, as well as having to work with the hospital’s physicians. There were some hard-won achievements. Neither officers nor the doctors were on board at first when Roldan, noticing bottlenecks in the coronary care unit and the intensive care unit, proposed the establishment of a palliative care unit. But her cause ultimately prevailed, and within six months the new unit had rung up $7 million in savings and avoided costs—while providing, she says, “a better quality for the patient.” But Roldan lasted just two years in the top job at Jackson. Within the first 30 days as president and CEO, she was faced with a disastrous budget deficit. She was given credit for facing up to the shortfall and making hard decisions that dug the Jackson system a good ways out of its financial hole. But her long-term plans for the system met with stiff opposition and politics got in the way, she says. When she resigned in 2010, one news account quoted an anonymous source as saying she was tired of being a punching bag.
From her medical director years she recalls being caught in the middle sometimes. For example, an effort to cut costs through reducing variability in materials acquisition ran afoul of “physician preference” items that doctors were used to ordering. But she wasn’t always the cost-cutting cop; there were occasions when she needed to defend doctors—and realism—against unreasonable expectations from higher management.
“Sometimes,” says Roldan, “you know that a specific change has to be made gradually for better buy-in and sustainability, but the top wants it right away because they’re just looking at numbers.”
Roldan concedes that the role of the medical director—like those higher up the ladder—isn’t for everyone. She’s known fellow medical directors who have chosen to retire early or to start business ventures because of their dissatisfaction with the job. But she also believes—and tells her students at Florida International—that a key requisite for being a physician (any physician, let alone one who presumes to lead others) is “a passion for lifelong learning.” That’s one quality that surely comes in handy for being a “change agent” amid the seismic pressures in health care today.