Rural vs. City ER Leadership is Just the Right Challenge


For Michael McDougall, perfection found in leaving life in the big city

For Michael McDougall, it took leaving the big city to find the perfect work/life balance. While most of his life had been spent in large urban cities working in busy healthcare facilities, McDougall realized that there was more to life than work. Last spring, when the opportunity came to be closer to family and work in a smaller rural healthcare system, McDougall jumped at the opportunity. Little did he know that being the executive director for emergency services for Jackson General and Humboldt would let him continue to work in a big city-type facility while enjoying the laidback pace of life in a small town.

McDougall grew up in Cleveland, Ohio and earned a Bachelor of Nursing from the University of Toledo. Right out of college he joined the Air Force as a commissioned officer. "I had always wanted to be in the Air Force and they were looking for nurses, so about a year before graduating college I decided to join. It also provided me training in so many of the basic areas such as medical-surgical, pediatrics, psychiatry and emergency services because they wanted to be able to pull you into any area," said McDougall. "It was also where I got my first taste of management. I went in as an officer so I had people reporting to me and had to manage resources. My final job while enlisted was at an air staging facility in Japan that served as the main hub for the Pacific region. Patients from all branches were brought into our facility to be evaluated then sent out to a hospital for treatment. Then they would come back to us before they were sent to their respective base."

In 1999, McDougall, left active duty at the rank of captain and moved to Atlanta. He worked in emergency departments throughout Atlanta while pursuing his MBA from Troy State University. As he completed his master's degree, he realized he wanted more from his career than working as a staff nurse. Over the next five years, he transitioned from a staff nurse to nursing supervisor in nursing services then to managing an orthopedic unit.

From 2004-2007, McDougall was in Colorado where he was the manager of two very busy units - general surgery and a joint replacement unit. Wanting to be closer to family on the East Coast, he moved to Philadelphia to be the operations manager of an inner city pediatric level one trauma center.

When the opportunity to work for a dynamic CEO arose, McDougall returned to Colorado to be the CNO of a small rural hospital. "It was different than what I was used to in terms of busy," said McDougall. "A rural hospital can be quite busy because it can be the only one in region. Ironically, my experience in a big city really helped me so much since people are just as sick in a rural setting, so I was really prepared for what the job held."

When a call from the Big Apple came, McDougall left for New York City to take a job as manager of a busy inner-city ER. "With an average of 100,000 visits a year, we were very busy," he said. "I then took a directorship of a Level One Trauma Center in Manhattan. It was interesting due to the diverse population from fact that we were right across from Cornell University as well as a park that a lot of homeless people inhabited and there was a lot of crime."

While McDougall loved life in the big city, as he got older he found his priorities were beginning to change and felt the need to downgrade. With family in Memphis and Nashville and his mother from Helena, Arkansas, McDougall couldn't pass up the opportunity to work for a large rural healthcare system in May 2017.

"I wanted a small city with a major medical system and West Tennessee Healthcare provided me that," said McDougall. "What people fail to realize is that while this is a small county seat, it is the major medical provider for the surrounding area. The ER is extremely busy - much like what I was used to but I do not have the cost of living and commute that I had in a larger city. This is what attracted me to this job. I really enjoy living in a big city - just did not want that lifestyle. For the first time in a long time I have true job satisfaction."

McDougall's role has him overseeing, not only the ED of Jackson Madison County General Hospital, but also its satellite facility in Humboldt. The Humboldt Emergency facility is located in what was formerly Humboldt General Hospital. "As we examined the healthcare services in Gibson County, which included three full service hospitals within the same county, we strategically converted Humboldt General Hospital to the current Medical Center model which maintained the emergency services for the community of Humboldt," said Tina Prescott, chief nursing officer, Jackson Madison County General Hospital. "The upgraded 24/7 Emergency Department is staffed by the same physicians as our flagship hospital, Jackson- Madison County General Hospital. The center also offers radiology, lab, and physical therapy services for the community. The presence of emergency care in Humboldt is a huge benefit to the community."

The ten-bed facility sees about 10,000 visits annually, which is the volume McDougall would expect to see at an ED of that size. "Their key role is to provide basic ER care to Gibson County and parts of North Madison County," he said. "I think it plays the same role as many ER's do in terms of primary care. I have seen it in every place I have been, and it is not uncommon; people use the ER for all types of reasons. If this facility was not in place, the 800 patients they see each day would be added to the already busy flow in Jackson. The interesting thing is that while the two are different in terms of size and volume, they still see the same types of patients and treat everything from pediatric to geriatric patients."

McDougall says he is making the adjustment to life in a small city very quickly. "I enjoy living in Jackson. The commute is short and I don't miss traffic," he said. I'm here for the long haul. It has been a great change for me that has provided me great work/life balance."


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