Eric J. Epstein, MD, served as medical director for the department of medicine faculty group practice, followed by vice chair for clinical affairs, before being named interim chair in October 2023. Read about Dr. Epstein’s journey from becoming a self-taught expert in practice administration to a physician leader, as well as how he came by his signature look.
![Eric Epstein, M.D.]()
Eric J. Epstein, M.D.
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If you see a gap, become the bridge: When I graduated from fellowship 20 years ago, I was offered the opportunity to practice in a new multispecialty ambulatory site for the department of medicine in Westchester, on Central Avenue in Scarsdale. I was given an ID badge and a white coat and told to make sure I circled all the charges on the billing sheet before I left for the day. Basically I was told to go out and see patients. I didn't know anything about documentation or coding or billing, and I certainly didn't know who was around to help solve problems when I felt they needed to be escalated.
We had no operations manager in the Westchester practice, and I and the other physicians there had no real understanding of the art or science of practice administration. I realized very quickly that it would behoove the group for somebody to learn about these critical items, which are essential to a successful ambulatory practice. I started doing coursework and traveling to see my colleagues in private practice to learn what they were doing, bring that back to Montefiore, and translate it into an academic faculty practice.
I also went to Florida to take a coding course so I could understand the world of documentation and coding. I was one of just a few physicians there, everyone else was studying to become a coding specialist. I brought back a language that allowed me to bridge the divide between the administrative team in charge of coding, documentation, and revenue cycle, and the clinicians who were seeing the patients and then entering the codes. I developed a style that seemed to cross the language barrier for this one particular part of physician practice, and it gave me the confidence to expand my knowledge and my desire to improve operations to other areas within ambulatory subspecialty practice.
Helping people hit the ground running: Fast forward 20 years. Based on my own onboarding experience, or lack thereof, and from work that developed with our clinical advisory committee, now everyone that goes through our faculty practice onboarding meets with their division administrator, practice manager, vice chair of clinical affairs, and the clinical director of operations. They get a thorough introduction to our workflows, templates, access center, MyChart messaging system, practice team, departmental policy reviews, ID badges, parking, how to get payroll access—pretty much anything you would need is available before you say hello to your first patient. We have a whole team helping new faculty and providers be successful right from the get-go, and in fact, before the get-go even arrives.
Stay open to new directions, and have fun: My interest in administrative projects led to me being asked to become medical director of what was at that time the still nascent faculty practice for the department, which in turn led to the role of vice chair for clinical affairs. But none of it was intentional. I didn't wake up one day saying, “This is what I want to do.” I recognized we could be providing patient-centered care a lot better and that, if we were successful, our associates would come to work happier, processes would be more streamlined, and the clinical teams would enjoy practicing medicine and engaging with patients. I brought a physician's perspective to these areas, with a mindset that physicians could and should play a role in designing an ambulatory practice. That is still my goal: to bring physicians’ voices into operations and make the art, science and practice of medicine work more effectively, which ultimately benefits patients. It’s very satisfying, and even fun, to improve a process that makes everyone’s lives better.
It’s very satisfying, and even fun, to improve a process that makes everyone’s lives better.
Dr. Eric J. Epstein, interim chair, department of medicine
Process makes perfect: One example of a process improvement with broad impact that we’ve developed is a system within our Epic scheduling workflow to get patients with specific conditions to the correct physician. Our faculty practice is made up mainly of subspecialists, some of whom are very focused on one facet of medicine, and we struggled for a while to ensure patients were scheduled with the right specialist for their condition. As an example, if a patient wants to see an infectious disease travel specialist, we (and they) don't want them to wind up at our transplant infectious disease clinic instead. The system we designed to ensure scheduling accuracy is called decision tree logic and it’s now the basis for all MyChart scheduling across much of the medical center. It’s an extremely powerful tool that we have continued to refine so that our error rate is now extremely low, which is why other departments across the Montefiore system have adopted it.
For a strong team, embrace differences: I look for people on the medicine leadership team who are open to the idea that we won’t agree on everything. I believe a certain amount of conflict is healthy and shouldn't be pushed away. One of my mantras is that if you can't bring up a problem, then that's a problem. If I don’t hear about it, how can we make things better? I don’t want to be the kind of leader where people don’t bring challenging ideas or problems to solve because they think they know what I want to hear. When someone pushes you to see something differently and you have a productive back-and-forth, you learn a lot more, and it also creates a sense of trust. I am always looking to learn from the team, and with a department as large and diverse as ours, it’s a must. That is the reason I started the clinical advisory committee, which has one subspecialist from every division within the faculty practice, along with our operations director, nurse manager, practice managers and divisional administrators. We need to find ways to row in the same direction in spite of practical difference in how we practice. We do that by working with each other, not around each other.
A signature look is born: For five weeks in late summer, I live and breathe our Einstein medical student endocrine systems course, which I have directed since the start of my career here. The lecture hall for the endocrinology course is kept at about 52 degrees. It’s August, so I wasn't going to wear a jacket to work, but I needed something to stop myself from shivering, and so I started to wear these fleece vests. About 10 years ago, I went to do a review session for the students, and half of them were wearing identical vests. It took me about 15 minutes to catch on. Then one of them said, “We're invested in endocrinology,” and that was when I started wearing them regularly.
Posted on: Thursday, June 27, 2024
