Is he called the Chief of Staff? Or something else?
Depends. Chief of Medical Staff is a common term in my area.
Usually it’s a rotating position, and someone gets coerced into taking it for a 2 year term, before being allowed to lay it down.
Chief of Staff (also Chief of Medicine, Chief of Medical Research, Chief of Surgery, etc.) are administrative terms. Chief of Staff is the boss of all the doctors on staff at the hospital. Whether that makes him “lead doctor” is a matter of interpretation.
Not sure I’d call the Chief the “Boss of all the doctors”. It’s more like the President of the Student Council, or even the Hall Monitor, at some places.
In case of any confusion; I didn’t mean lead, as in the most knowledgeable.
What I mean is who is the head doctor on top of the org chart at a hospital…
Thanks for the reponses so far.
I am not sure if you know this or not but the top people at hospitals on the org chart aren’t doctors. They are hospital administrators who hold an advanced degree in hospital administration and/or something like an MBA. Some of those may have once been practicing doctors but they certainly don’t have to be. They are the ones that do most of the actual management of the hospital just like any large company has an officer structure and they don’t have to know all of the technical aspects that the people they supervise but they are supposed to know how to manage them. They build budgets, hire doctors and nurses, negotiate contracts etc. for everything you see in a hospital that a doctor is not responsible for. They also form hiring committees to hire new doctors themselves.
Hospitals are structured several ways, depending on their ownership model.
In many hospitals, all of the practicing physicians are voluntarily associated with the hospital. They choose that hospital as one of the ones where they would like to work, go through an application process, and obtain privileges to work there. Those types of physicians do not have any formal hospital-side hierarchy under which they function–that is, they don’t “report” to anybody. The medical care they do at the hospital has an oversight process that filters up through various levels and any issues will typically end up in a Medical Executive Committee, or similar, which normally has several representatives from the medical staff along with hospital lead administrators. One of those physicians will be designated as the Chief of the Medical Staff (or similar). This is usually an elected position (the main physicians do the voting) in this hospital model, and the Chief of the Medical Staff is usually also a practicing clinician. The Chief of the Medical Staff is not directly responsible for the care administered by the other doctors and he (she) does not have the power to fire or suspend except where specific regulations already in place exact that sanction. How much power the Chief of Medical Staff has is very dependent from place to place.
In other hospitals, some (or all) of the practicing physicians are direct employees contracted with the hospital or its governing corporation. Internally, these hospitals usually have similar committee and oversight structures, but there is a subtle difference: a practicing clincian can be directly fired so the concept of a “lead” doctor changes a little bit.
Every hospital also has an Administration side composed of direct employees. In recent times there has been a shift to include physicians as administrators as well. These are usually, but not always, physicians who do not currently take care of patients. The commonest administrative position is the Chief Medical Officer, or CMO. The CMO is part of the overall “C-suite” and typically is a direct report to the CEO (who occasionally is also a physician). So the CMO might be considered the “lead” doctor from an administrative viewpoint.
Many individual hospitals are part of a larger health system, so there may be an extensive layer of administration above the hospital itself, and of course there are usually other physicians represented in those layers.
Who is the “lead” doctor? In simple terms, most ordinary physician-related medical issues (Dr. Smith prescribed the wrong antibiotic) are going to filter up to the Chief of the Medical Staff. Most behavioural issues (Dr Smith thinks the nurse has to bring him her coffee) are going to filter up to the CMO for a final disposition. But both of those individuals work in tandem in a well-functioning hospital, so the distinctions are very blurred and very dependent on a particular hospital.
Having said all of that, the fundamental concept in American medicine is that the practitioner and the hospital are two separate things, and the care delivered by the clinician is essentially part of a contract between the individual patient and the individual clinician. We are, as doctors, our own boss, and herding us around has been likened to herding cats. Yes, there are ‘lead’ doctors out there, but historically we have not been good at following.