Mr Management

There’s a scene in one of my favourite TV shows of all time, The Wire, in which soon-to-be mayor Tommy Carcetti is talking to one of Baltimore’s past mayors about what to expect in the job.

Being a mayor, the older veteran explains to Carcetti, involves eating “bowls of sh*t”, one after another, day after day, year after year. It’s as good an explanation of a management position as I’ve heard so far.

It hurts my natural British humbleness to admit it, but I was a pretty good general practitioner – I listened to what the clients wanted, I thought about what their patients needed, I had a reasonable grasp of medicine, I enjoyed surgery, and I wasn’t afraid to admit when I was out of my depth. I was never much of a salesman, which always has been at least a part of the job, but I was honest and I cared, and clients liked it, and generally liked me too.

Charlie in charge

A few years ago, I was “promoted” to clinical director (CD) of the practice. I had been one of the senior vets for a while, but suddenly I was in charge – at least, as much in charge as a CD gets in these changing corporate times.

Making mistakes as a vet can be hard. If you make mistakes in a medical job you can cause harm, or even death, and that can be a heavy burden to carry (I’ve talked about this before) – but I quickly discovered, as CD, you don’t just have your own mistakes to deal with any more: you have everyone else’s too. While the burden for dealing with them is lighter, as you can see the mistakes for what they are, the time spent dealing with them seems to expand exponentially.

Similarly, I began to dread the moments when a member of staff would come into my consulting room and ask if they could have “a quick word” – a word that, almost invariably, was anything but quick. As I drove to work in the morning, I would do so with another phrase from The Wire bouncing around my head: “heavy is the head that wears the crown”.

You can’t please everyone

I was a good GP, but not a good manager. Just as I wanted to listen to clients and please them, I wanted to please all my members of staff and the clients, and the corporation that owned the practice. Obviously, that wasn’t possible, and I never learned a way to square that circle and sleep easily at night.

I am not a man generally well motivated by money – my life in general has been too easy and comfortable for that – but I found while my stress levels, already high as a GP, shot through the roof as a manager, my salary increased by the relatively modest £5,000/year supplement CDs are offered.

In the old-style arrangements of partnerships my salary might have doubled, with a share of the profits, too. In the middle of one of those long nights where I was trying to untangle another one of the seemingly insurmountable problems in my head, I thought about the extra money, and I knew, beyond a question, it simply wasn’t worth it.

Too little time

I made mistakes, of course, which just added to the stress. Like a lot of vet practices at the time, we were short staffed, and I tried to keep my management duties to one afternoon a week, spending the rest of my time on clinical work. In retrospect, this was hopelessly little time to deal with everything the new position threw at me.

I wasn’t, like many managers, good at delegating, and I tried to do too much myself. I had been left with a number of issues that had been brewing in the practice for years, yet I felt failure when I was unable to solve them instantly.

I had also worked alongside my wife for years, which we both found worked well. However, when I was suddenly her boss the dynamic changed, and I started to feel like I was failing her personally when she had difficult days.

Brief tenure

My time as a manager was brief and it could be argued I didn’t give it enough time. Perhaps I was expecting too much, to learn an entirely new job in a short space of time, that I was still trying to be a vet when the time for that had passed, but when I look back at the discussions with the VDS, and the phone calls to angry or upset clients and members of staff, and the “quick words”, and the stress I felt on my management afternoons when I knew how hard the vets were working. And when I think about all those bowls of sh*t lined up in my future, waiting for me to eat them; I know, deep in my heart, I did the right thing.

Management, one way or another, would have, in the literal sense of the word, killed me. There are many people better suited than me, with a better instinct for the work and a more positive outlook than mine, who are able to avoid dwelling on things in a way I couldn’t.

Sometimes, though, when I try to keep track of the dizzying changes happening in our profession – and I think about the supplement CDs are offered – I wonder if even those people who, unlike me, are born leaders, might sit back one quiet afternoon after one more phone call apologising for someone else’s mistake, and wonder if it really is worth it, after all.