By Robert Welti, M.D., Senior Vice President of Operations A standard medical director agreement lists a daunting array of functions to be fulfilled by the practitioner taking on this critical position. Participation in facility committees, continuing medical education for the staff, and implementation of quality assurance programs are but a few of the usual “cut and dry” responsibilities that will help fill the medical director’s timecard. However, jumping from the hospital setting to the free standing physician-owned ambulatory surgery center takes the responsibilities of the medical director to a whole new level of involvement. No longer will there be multiple levels of hospital administrative bureaucracy to deal with the marketing of services, physician peer review, preparation for accreditation surveys, cost containment and surgeon satisfaction. Now, effective leadership will require that the medical director, along with the administrator and director of nursing (DON), step up and share total “ownership” for patient satisfaction, surgeon satisfaction and overall ASC performance. In effect, the medical director can become the “master of ceremonies.” As “master of ceremonies,” the medical director has the capacity to help shape the culture of the facility, both in front of and behind the red line marking the entry to the operating rooms. Although demands of a personal medical practice may require periodic absence, in the ideal world, the medical director would be on site every day with his or her finger “on the pulse” of the center. The medical director can be a champion of performance and quality enhancement; a relentless facilitator of improved turnover times and overall center efficiency without sacrificing patient safety. With every surgeon’s cell phone number in hand, the medical director can work with the nursing director to assure effective, personalized doctor to doctor communication regarding unforeseen scheduling changes, patient problems, and transmission of any information that might make the surgeon’s day go more smoothly. Interacting with the administrator, DON, patients and other surgeons necessitates that the medical director be a “people” person. Flexibility, listening skills and a desire to achieve goals thru cooperation rather than autocratic imposition, will help the medical director to avoid the “turf” battles that can so easily disrupt the tightly knit society of the ASC. For the physician making the transition from a hospital medical director to a physician-owned ASC medical director, an adjustment may be required to fully realize that the surgeon is now as important a client as the patient. Unless the safety of a patient is in question, the answer to a surgeon request is seldom “No”. Instead, the answer should be along the lines of “let’s see if we can make it happen.” An effective medical director is also a great asset as a surgeon recruiter. While working at other facilities, the medical director’s antennae should be on full alert to identify and follow-up with potential additions to the ASC partnership. Physicians transferring from hospital based practices to a leadership position in a free-standing ASC rarely have extensive knowledge of the business side of outpatient surgery practice, especially with respect to supply and labor costs. Becoming an effective Medical Director will require an understanding of case-costing and facility reimbursement methodologies. With this new knowledge, the medical director can take an active role in controlling pharmacy costs and working with surgeons to identify cost saving strategies. Should a medical director be an anesthesiologist or a surgeon? There is no hard and fast rule and the choice might depend on factors such as the size of the ASC, number of physicians on staff and the ability of a surgeon to devote time away from his/her practice and be on site. There are obviously many successful ASCs with surgeon medical directors. However, who will review charts preoperatively and make medical care decisions that can avoid costly last minute cancellations? Which physician will stay in the center until the last patient is discharged? Which physician will be able to allocate enough “on-site” time to fully understand and shape the dynamics of the ASC? These are but a few examples of where an anesthesiologist with a small ownership position might make an ideal master of ceremonies. Whether surgeon or anesthesiologist, the medical director of a facility is ideally positioned to take the ASC to new levels of excellence.