Career profile: hospital & medical management

Q&A with Dr Graham Rich, giving an overview of a career in medical management

Q: What does a career in hospital management potentially offer?

A: It offers variety, complexity and the ability to make a difference to how care is provided.

For example, here in Bristol I’ve been involved with the Medical Director in pushing for a new facility for endoscopy. This has helped us move from an 18 month waiting list to no waiting list.

I’ve also introduced lean thinking to simplify processes. For instance, the team in the Oncology Centre used to have three different chemotherapy pathways. Now they’ve designed one pathway. So now everyone knows how chemotherapy should operate. It’s simpler, it’s quicker, it means blood test and notes are more likely to be there than before, it is easier for nurses to cross cover etc.

These are examples of how management techniques can have a direct impact on patient care. As a Chief Executive you can encourage these types of development, making sure there is funding for the team and encouraging staff engagement.

Q: How does it compare with being a doctor?

A: Well, you have to think about the whole organization and its patients rather than just one patient at a time. It involves a lot of listening, problem solving and team work, so in some ways the job requires several skills that are required of doctors.

Q: What led you to move from medicine to hospital management?

A: The first step into management for me was based on wanting to have a bigger impact than I could have as an individual clinician. I realised I was spending a lot of my spare time when I wasn’t working trying to do things like improve the organisation I was working for or the care I was providing, or improve the care provided by the next set of junior doctors. For instance, I was writing induction guides for new doctors before they were commonplace. So I realized I was motivated to do this kind of thing and decided to do it full time.

It has been a long and fun-filled journey via business school, the Department of Health, health policy in the USA, management consultancy, health authority and a Chief Executive job at a Primary Care Trust.

Q: If a junior doctor wants to make a switch to a career in hospital management, what are the best times to consider this?

A: It is possible at any point if the junior doctor definitely wants to make the switch to general management, but don’t leave it too long as medics tend to earn more than managers when they start to get senior. No-one likes to take a pay cut to pursue their chosen career.

If you are within 18 months of getting your CCST, or trained as a GP, I would recommend finishing the training as it is great for credibility when working with clinicians, and it gives you a plan B if it all goes horribly wrong.
Immediately post medical degree, the Graduate Management Training Scheme for the NHS is an excellent structured start. Mid career, consider the Gateway to Leadership Programme. If you have a black or minority ethnic background, the Breaking Through Programme may be useful.

Q: What career structure is then open to them?

A: There are several levels of general management from service manager all the way to Chief Executive. A more traditional route is to become a consultant, then specialty lead, then Head of Division or Associate Medical Director, then Medical Director, then Chief Executive.

Q: Are there opportunities across the UK?

A: There are opportunities across the UK and internationally. Hospital managers from the UK can get jobs running hospitals in places such as the Middle East or in New Zealand. The New Zealand system is very similar, so it is relatively easy to make the transition. There are possibilities in other countries but the Middle East and New Zealand are the most likely. Another option is to go there for a short while and then come back to the UK.

Q: How difficult is it to get into hospital management, as a doctor?

A: Few decide to do it, but if you are determined and listen to advice from the Medical Director, Chief Executive and others, the transition should be fairly easy.

Q: What will recruiters be looking for?

A: Good people skills are essential. Recruiters will also be looking for leadership, problem solving, numerical and writing skills. You also need resilience and a strong sense of purpose to make a difference for patient care.

Q: Do the same sort of points about career structure and entry requirements apply for a career in public health or primary care management?

A: A career in public health is fairly well set out through the public health training schemes and the career pathway is well trodden. It gives you a good grounding in a lot of the elements that are important for general management numerical skills: system understanding, etc. Primary care management is still an evolving area, and I watch with interest as Practice Based Commissioning consortia start to get going and are catalysing the formation of all sorts of interesting collaborations and organizations, spanning primary and traditional ambulatory secondary care.

Q: A majority of recently qualified doctors are female. How family friendly is hospital management?

A: I have to say that hospital managers work some of the longest hours in the hospitals. However, there are the usual opportunities for part time work, job sharing and flexible hours.

Q: How do salaries, pensions, and hours of work compare?

A: The pension arrangements are the same. Salaries probably do not keep pace with medical salaries until Chief Executive level. Even then medical directors often earn more than the Chief Executive as the ACCEA award scheme can add a considerable sum to the base salary. Unfortunately, doctors in full-time management are precluded from applying for an ACCEA award – a situation that does not make sense. Lord Darzi and David Nicholson are starting to sing the praises of clinician leaders and clinicians in management, so I hope the ACCEA award criteria are changed to encourage more to go into general management.

Q: Overall, what would you say are the pros and cons of hospital management as a career?

Pros: it’s a huge amount of fun because you have so much variety. You get to hear about all the weird and wacky stuff that happens in a busy hospital. There is plenty of opportunity to make patient care more efficient, more safe and less hassle for staff. You can have a bigger impact on patient care than if you are an individual clinician.

Cons: sometimes you have to work long hours. Doctors in management are excluded from ACCEA awards. You may need to move house to get a more senior job, as there may not be any openings locally and a broad base of experience is valued.

All in all, though, I love my job.

Q: If a doctor wanted to find out more about a career in hospital management are there any obvious starting points?

A: I would suggest sitting down with the Chief Executive of the organisation you’re working in. Most Chief Executives will be happy to consider a one off discussion with anyone considering a move from medicine to management. Last year I spoke to a Cardio Thoracic SpR who had realised there was less demand for cardiac surgeons and the country has trained too many, so was considering management and we had a discussion about how to do that. The other option is to talk to the Medical Director.

Another thing to do is, while doing your training, take the opportunity to shadow some managers. It is probably useful to do this even if you’re not considering a career in hospital management, as it helps to understand what managers do on a day to day basis.

The Health Service Journal carries adverts for a wide range of NHS management opportunities.

Dr Graham Rich was the Project Director and previously Chief Executive, University Hospitals Bristol NHS Foundation Trust

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