The Crimson Press Curriculum Center

First Page and the Assignment Questions:
In June, some nine months after having assumed the chairmanship of the Lenox Department of Ob/Gyn, David Rand, M.D. was reviewing the changes that had taken place since his arrival. Much had been accomplished. Yet he wondered if he had been too naive and optimistic about the amount and pace of change that was possible. He had developed short-, medium- and long-term priorities for the department and hoped he would be able to continue the change process.

INITIAL ACTIONS

Upon his arrival at Lenox, Dr. Rand had determined that the broad objectives of the department resided in four major arenas: 1) education of students, residents and fellows, 2) patient care, 3) administrative/financial, 4) research. He felt that the most pressing were addressing clinical and administrative/financial needs.

In preparing for his arrival Dr. Rand recruited and hired Betty Lowe as department administrator. He also appointed Carol Randall, who had been the secretary to the previous chairman, as office manager. Together with Ms. Lowe, Dr. Rand immediately reorganized the office, replacing equipment with state of the art computers, renovating space to provide comfortable and functional work places, and assigning secretaries to work for different faculty groups. Job descriptions for all secretaries were updated, individuals reviewed relative to the new responsibilities, and a program of goal setting, quarterly evaluation and merit increases initiated. Secretaries also were sent to word processing classes.

Ms. Lowe also began efforts to improve collections on practice billings, believing that the situation was so bad that almost any effort would bring positive results. Initial investigation revealed that collections were limited by the capabilities of the billing agency. Attachments to bills provided by the department were not forwarded to payers but were piled in boxes at the agency.

In beginning recruitment of new faculty, Dr. Rand began by focusing on Maternal and Fetal Medicine (MFM). He cited four reasons: 1) among subspecialties he had the greatest knowledge of potential faculty recruits in MFM; 2) community needs presented a window of opportunity for establishing Lenox as a center of excellence in the region; 3) an expanded section could provide exemplary care and generate clinical income both at Lenox and a number of affiliate institutions; 4) initial start-up investment in MFM recruitment is small as compared to other subspecialties; and 5) MFM should provide inroads for oncologic and reproductive endocrine referrals in the future. Four new attendings in MFM had been recruited during the academic year.

Ob/Gyn ultrasound activities within the hospital were developed by initiating the "Antenatal Evaluation Center" (AEC), a joint venture begun in September, just after Dr. Rand’s arrival, between the Department of Radiology division of ultrasound and the Department of Ob/Gyn divisions of MFM and ultrasound. As stated in the Ob/Gyn Department's annual report, "The current agreement is not an optimal one; under the current interpretation of the agreement, MFM is a 'guest' in the 'house' of Radiology. However, it is a 'start'."

William Walters, M.D. had been recruited as division chief of Reproductive Endocrinology. Dr. Rand noted, "In addition to outstanding academic credentials, Dr. Walters was recommended as being extremely personable and as having the leadership and communication skills needed to develop a new division." He had experience in establishing a successful In-Vitro/GIFT program and had established a reputation in pelviscopy. Dr. Walters began weekly meetings for full-time and volunteer members of the division, and developed plans for expansion of laser surgery capabilities. Start-up time for the In-Vitro/GIFT program was delayed until Spring next year, pending recruitment of a program director and two Ph.D.'s and selection of an optimal site.

Other new faculty recruited during the academic year included one full-time and two voluntary general Ob/Gyn specialists. A director for the division of gynecologic oncology was not found.