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The Exec: 'The Broader Based You Are, the Better'

Analysis  |  By Christopher Cheney  
   April 19, 2023

The new chief medical officer of Morristown Medical Center developed a well-rounded level of experience in pulmonology and critical care.

To succeed in physician leadership roles, clinicians should have a diverse background in patient care, says Stanley Fiel, MD, CMO of Morristown Medical Center, the flagship hospital of Atlantic Health System.

Fiel was named CMO of Morristown Medical Center in March. He had served as interim CMO since May 2022. Fiel previously served as chairman of the Department of Medicine at the medical center for two decades. He is also a professor of medicine at Thomas Jefferson University's Sidney Kimmel Medical College. Before working at Morristown Medical Center, his physician leadership roles included serving as chief of the Division of Pulmonary and Critical Care Medicine at Drexel University College of Medicine.

HealthLeaders recently talked with Fiel about a range of issues, including the challenges of being a CMO, balancing clinical work and leadership roles with research efforts, and addressing pediatric respiratory disease surges in recent months. The following transcript of that conversation has been edited lightly for clarity and brevity.

HealthLeaders: You have a clinical background in pulmonology. How has this clinical background helped you serve in physician leadership roles?

Stanley Fiel: I am an internist by training. Before I left Philadelphia, I was running the fellowship program at Drexel University and the ICUs. Working in an ICU with multi-organ failure and a multi-disciplinary approach, pulmonary doctors are very good generalists. I am not denigrating any other subspecialty by any stretch, but pulmonary and critical care allowed me to see the whole body. I dealt with patients with neurological impairments, kidney failure, cardiac failure, and post-surgical problems, so I had a very broad-based background in many areas of medicine.

The more one understands about the trials and tribulations of each of the specialties and what individual patients are going through, it is helpful in physician leadership. The broader based you are, the better. And I still see patients—I am still clinically active. That is an important part of having the respect of your fellow clinicians.

HL: What are the primary challenges of serving as CMO of Morristown Medical Center?

Fiel: For me, this is the first time I have been a CMO. I have been in medicine a long time—I finished my training at the University of Pennsylvania in 1980. So, I have been a pulmonary critical care doctor for decades, and I have been in leadership at academic medical centers. I have a good sense of how to deal with difficult decisions.

Moving into this role, it is a big role when you are responsible for all of the medical staff and all of the clinical activities to be sure that all of the physicians are operating appropriately for their license and for their credentials. The goal for Atlantic Health System and Morristown Medical Center is to create a healthier community, and we want to be at the forefront of quality.

It is important for me to be the standard-bearer for quality, involved with strategy, and how to make ends meet in the business of the future. I was the chair of medicine for the past 19 years, but now I am responsible for all of the medical activity. The challenges for me are in the areas where I lack experience—I have not been in an operating room for a long time. I have not been in the obstetrics suite. So, I am going down to different areas with my scrubs on once a week and seeing what gives down there. I am getting a new appreciation for the different disciplines that are now reporting up to me.

One of the challenges is dealing with some physicians who are difficult—not acting within the bounds of what we expect and not following guidelines or rules. The CMO has a vice principal role.

We don't have problems every day, but in a large organization with lots of physicians interacting under the pressures of work, there are issues that relate to their credentials and problems that go awry in the hospital. When individuals fall out of bounds, there are collaborative conversations, and they can be escalated up to improvement processes. If there is a problem with not meeting a standard we have established, there is a discussion around that, and we talk about ways to improve. A plan is created with the individual and the chair of their department, so we come to an agreement on whether they need some remediation or disciplinary action. The worst outcome is a physician can lose their privileges at our hospital, which is few and far between.

HL: How do you plan to rise to your challenges?

Fiel: Basically, I am not new to these challenges, I just need to learn more about some areas. I also have great colleagues to work with. There is a strong team approach to care at Morristown Medical Center. The nursing service and the infrastructure are wonderful, so it has given me the opportunity to learn a lot from the multi-disciplinary teams that are already in place. Given the situation, it has been easier for me to meet the challenges for some areas that I am not as familiar with.

HL: How have you addressed high patient volumes at Morristown Medical Center?

Fiel: This has been an issue that we have been dealing with for many years—there are more than 100,000 patients who come through our emergency department. Patients pass up emergency rooms in the surrounding area because of the high quality of care here, and the ED has been a challenge for us. There is a lot of teamwork. We learned a lot through COVID, so we have processes in place to handle patient volume.

We have dashboards for moving patients through the hospital. There is patient throughput and an approach to early discharges. We have leveraged a team approach and geographic rounding approach to patients so we can move patients through the hospital. Wherever the pressure points are, which includes the ED because we are so busy down there, we must get patients who are on the floors out. So, there is a process that is ongoing.

There is a challenge with nurses—we have lost nurses through the pandemic, and we are working on our staffing ratios to keep our quality care at the maximum. I must stress that we are taking a team approach to address the patient volumes that we have.

Stanley Fiel, MD, chief medical officer of Morristown Medical Center. Photo courtesy of Atlantic Health System.

HL: How have you addressed pediatric respiratory disease surges in recent months?

Fiel: These surges began before the winter, when we had RSV, flu, and COVID. The pediatricians were dealing primarily with the surge of RSV patients that occurred in October and November. We have the only pediatric intensive care unit for Atlantic Health System, and we had to deal with many patients.

With Morristown being our flagship and only pediatric hospital in the region, we were bulging at the seams. We had to take over some adult beds, which is the opposite of what we did during COVID, where we took over pediatric beds. As a result, we had to move some of our adult patients to other hospitals, so we could make room for the pediatric surge that we had. Our pediatric intensivists did an incredible job—they had to work back-to-back shifts and we had to worry about their resiliency. Their pediatric colleagues, who were the outpatient respiratory and pulmonary pediatricians, assisted the intensivists in the care of patients on the floors. It was a real team effort.

The other thing that happened that was incredible was that our adult nurses had to train up on the pediatric side because our intensive care nurses had to take care of kids. They had a crash course over 30 days.

HL: You have published more than 200 articles, abstracts, chapters, and monographs in the medical literature. How have you balanced your clinical work and leadership roles with your research efforts?

Fiel: When I finished training at the University of Pennsylvania, I got involved in a niche area in pulmonary medicine, which was adults with cystic fibrosis. That enabled me to have a special place through translational research on the burgeoning adult population. I was able to work nationally and internationally with individuals so that I could help bring forth new treatments and work with pharma as new drugs became available for this population.

I was able to work in the perfect time for a new area in adult care. I also worked collaboratively with some of the basic scientists and microbiologists to bring forth some of the new treatments. I had teams that I could work with to get grants, which enabled me to publish a lot and be known across the country and internationally.

It was a challenge, but I was able to balance things and compartmentalize. I was fortunate in the academic medical centers that I started in to have fellows and faculty who could work with me. With grant support, I developed a center where I had colleagues who could help me take care of patients. I brought that center to Morristown, and we became the largest CF center in New Jersey.

HL: You are a professor of medicine. What are the primary elements of being a good medical educator?

Fiel: Part of it is wanting to teach as well as enjoying students and residents. Part of the elements of being a good educator has to do with empathy, humility, listening, and being able to take those skills and pass them on to the future generation of physicians. That's a real privilege and a challenge. These are things that have been very important to me in my roles in academic medical centers.

At Morristown, we are in a unique situation in that we are not a pure academic medical center, and we are not a pure clinical hospital with no residencies. We have hundreds of residents in many areas of medicine. We have graduate education with fellowships. So, we are a training center, but we are not as steeped as a pure academic center such as Mount Sinai or University of Pennsylvania. It is a nice place to be, and the balance helps us deliver the quality of care that we do here.

Related: The Exec: Emergency Medicine Great Background for Physician Leadership

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

One of the challenges of serving as chief medical officer is remediating or disciplining physicians who do not stay within boundaries or follow guidelines.

Teamwork is essential to deal with high patient volumes at a hospital.

At Morristown Medical Center, the hospital had to convert some adult patient beds to pediatric beds to handle pediatric respiratory illness surges in recent months.


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