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Seeing the big picture

Cate Swannell
Med J Aust
Published online: 2 February 2015

Medical administrators are low-profile but highly effective influencers on Australian health care systems. The Royal Australasian College of Medical Administrators is out to raise the profile of the profession and encourage young doctors to look at a fascinating alternative career path.

Dr Lee Gruner started down the specialist path and had an excellent managerial role model who sparked her interest — she thought it looked interesting and volunteered for administrative duties. But for most colleagues her generation it was, she says, a case of being “tapped on the shoulder”.

“People were recognised as having a talent for administration and were moved into those positions”, Dr Gruner tells the MJA. “Often it was the people who complained the most who were asked to come and try it for six months and ended up loving it.”

Dr Gruner is president and board chair of the Royal Australasian College of Medical Administrators (RACMA), a position she has held since 2012.

Apart from her RACMA duties, Dr Gruner is also principal of Leaders in Health Coaching, director of Quality Directions Australia, and consultant director medical services of GEO Care, and of the Djerriwarrh Health Service.

RACMA was born in 1967 and today has over 800 members across Australia, New Zealand and Hong Kong. These countries are the only ones to treat medical administration as a fully-fledged medical specialty. The UK has formed a Faculty of Medical Leadership and Management but it is not yet a recognized medical specialty; there is also some interest emerging in the United States via the American College of Physician Executives.

“The reason most people give for wanting to go into medical administration is they want to make a difference”, Dr Gruner says. “And they want to make a difference to larger populations than they can as providing direct clinical care.

“It gives them an opportunity to influence health care systems. You do get very good opportunities to influence policy.”

While not all medical administrators are doctors, to be Fellows of RACMA and to be considered a specialist medical administrator, they must be registered doctors and go through the fellowship program with the College.

The end result is a chance to work in a wide range of career paths in administration that may or may not involve a mix of clinical work as well.

Dr Karen Owen, chief executive of RACMA, says there is a staggering array of options for the administration-friendly doctor.

“About 60% of our Fellows are working in hospital settings”, Dr Owen tells the MJA.

“The other 40% are working in the military, departments of immigration, departments of health, advising ministers — even prime ministers — in insurance agencies, running huge pathology businesses, detention centres and corrections, strategic organisations, the Therapeutics Goods Administration, e-health and as management consultants.”

And with the medical administrator population ageing along with the rest of the country, there is a shortage of younger doctors coming through.

”We’ve asked our members what their plans are for retirement and career change and we’ve come up with a future shortfall. Added to this is our estimate of about 4500 medical management positions where we believe there could be a trained Fellow of our College, where there currently is not, so we would argue that there is a shortage”, Dr Owen says.

Dr Gruner says that understanding medical administration used to be a lot easier. When she began her medical career — in radiology — she reported directly to her medical manager.

“We didn’t have a [computed tomography] scanner in our unit and I would watch my boss arguing every day for resources like that, and to me it seemed to be an interesting career path”, she says.

“It used to be a lot easier because a professional medical manager was a lot more visible because there were many fewer layers between them and junior doctors. Now we have something in between called a hospital medical officer unit and often when you talk to younger doctors, that’s all they see.

“One of the ways we can promote [the profession] is for the senior administrative officer to go out and be visible among the junior doctors, so that they see that there’s a job there and they can see that it’s interesting.”

RACMA has a standard pathway to Fellowship, and two accelerated pathways.

The standard pathway requires completion of an undergraduate degree, current registration in Australia or New Zealand, a minimum of 3 years’ full-time clinical experience (PGY4) and a medical management position. Additionally, candidates must complete a master’s degree recognised by the College and pass the College exam.

The accelerated pathways are for clinical specialists already engaged in medical administration work at a senior level.

“Many of the doctors we get are not the young doctors”, says Dr Gruner. “They’re the doctors in their 40s or 50s [who have] been managing a unit or department and want to do a bit more of that management and less clinical work. So we have a large number of Fellows who are dual qualified.”

A pet project of RACMA is the World Federation of Medical Managers, initiated by the College in 2009.

“We decided we would search the world for like-minded organisations”, says Dr Owen. “We invited them to a special meeting in Hong Kong and it’s grown from there.

“We have representatives from organisations from around the world who come together once a year to discuss issues of medical leadership, clinical engagement, and strategy.

“There are very few organisations like RACMA around the world and a few are now starting to move in our direction.

“It’s been a great opportunity for us to benchmark and network.”

It’s been a turbulent time for health and medical policy since the election of the Abbott government federally in 2013.

“As medical managers we look at it from a helicopter point of view and see what systems are involved”, says Dr Gruner. “There are some things with the health systems that we don’t think will ever be fixed — for example, the multiplicity of funding between federal and state governments — but we’re realistic enough to know that we don’t think that’s ever going to change.

It’s a matter of priorities, she says.

“We don’t do enough for prevention in Australia. We do a lot for the acute and the ‘glamour’ things. Not enough on prevention and how much we could actually save if we worked down the preventive, non-glamourous end, rather than the high end.

Professional standards are also a high priority for RACMA.

“Because we work across all the specialties, we’re interested in standards for all people working in medicine — so we’re interested in the revalidation debate and what that means.”

The bottom line, Dr Gruner says is health care delivery that is patient focused and cost-effective.

Dr Gruner’s eyes light up when asked to explain her passion for medical administration.

“Look, it’s a fascinating career”, she says.

“You get to meet some really interesting people. You get the opportunity to influence a lot of things. We have people working in high levels of government with the chance to look at the whole health system and how we can do things differently.

“How often do you get the opportunity to do something like that? It can be very exciting and you can really see the results of your labours. It’s something that can be a very rewarding career.”

For more information about Fellowship and Associate Fellowship pathways, visit the RACMA website at www.racma.edu.au

The full interview with Dr Gruner and Dr Owen is available as a video at www.mja.com.au/multimedia, and as a podcast at www.mja.com.au/multimedia/podcasts, and from iTunes.

One person’s path to administration

Dr Leana Wen is the new health commissioner of Baltimore City in the United States.

In an interview with National Public Radio (NPR) she recently explained what enticed her from clinical practice into medical administration.

“My patient was a woman in her 40s who was being admitted because her lungs were filling with fluid, a complication of kidney failure. She had missed all three dialysis appointments that week”, Dr Wen told NPR.

“She told me that her son had been arrested, and he was the one who drove her back and forth from the dialysis clinic. She couldn’t pay her bills, and her electricity had been shut off.

“When I relayed her story to my supervisor, the attending physician, he cut me off. ‘It’s not your job to open Pandora’s box’, he said. ‘Don’t ask questions you don’t want to know the answers to.’

“I felt compelled to ask my patient about her life so that I could understand the social factors that play such a key role in health.

“So I began to inhabit two worlds. In one world, I became an [emergency] doctor who diagnoses diseases and treats health problems fast. In my other world, I became an activist … I worked on national and international policies that would encourage more equitable access to health care and life-saving pharmaceuticals.

“Now, I have the opportunity to bridge the worlds of frontline medical care and public policy.”

To read the full interview with Dr Wen, visit the NPR website at http://www.npr.org/blogs/health/2015/01/15/377286159/why-i-m-leaving-the-er-to-run-baltimores-health-department

  • Cate Swannell


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