Date: September 17, 2019

To: Todd Margolis, MD, PhD

From: Meagan Walter
RE: A proposal to promote from within but still save money and continue exceptional patient
care

Purpose
The purpose of this proposal is to bring awareness to the job duties allocated to staff and
difficulties within the office with tasks due to staff not having appropriate titles. We want to be
able to keep our patients and their families with our clinic but have lost some due to not being
able to have diagnostic tests done quickly and them back in to see the attending in a timely
manner.
Current Problem
One of the problems that we struggle with is when two of our attendings have a full load with
patients and exceed the time of work hours for the majority of staff, especially those that are not
Washington University employees. When normal BJC hours are over for their staff, we now
have no one to run any diagnostic testing that needs to be done ASAP. As a result, patients and
their families are having to make another trip up to the hospital for another appointment and fess
out of pocket. With having a staff member with the job title of “medical records clerk,” they are
allowed limited access to certain rooms and testing equipment that is ultimately needed to
provide excellent care to out-patients. This not only causes complications for our patients but
also our attendings. Since they are unable to have urgent tests ran for them at the time of the
scheduled appointment, it may now mean that the attendings are taking a week to review the
results and get back with the patient since they are in different locations and have surgery days.
This goes against the St. Louis Children’s Hospital motto of “doing what is right for kids.” Every
Wednesday and Thursday, it is guaranteed that I am still in the office helping out 1-2 hours after
office hours because the attendings are still seeing patients due to their scheduled being
overbooked and also because they are the only ones who can see the more serious cases. This is a
position I was nominated for by fellow staff members due to my past medical background, my
familiarity with the hospital and also the relationship I have formed with our attendings. I was
only supposed to be in the position temporarily but months have gone by and I am now in this
position that I love and it allows me to form relationships with our patients, but currently, it
comes with unfortunate limitations.
Proposed Solution
By promoting my title, you not only would be granting me access to the medical equipment
needed for our attendings and our patients but you would also be saving money by not having to
bring someone new in from outside. The trust has already been established between the
attendings, the chief of staff, other offices, and me. I have worked alongside our chief of staff
with in-office procedures and he trust me to have his patients’ charts formatted correctly for
appointments, procedures, and surgeries. Since I am now familiar with the flow of the office, can
initiate procedures on our patients, and am the only staff member at the main location that can
run the majority of the diagnostic equipment, promoting me would be more affordable than
having to hire a certified ophthalmic technician (COT). A COT working only on the days the
attendings are here, about 56 hours every two weeks, and that is not including after hours when
appointments go beyond their scheduled time, can cost you anywhere from $25,000 – $29,000,
along with having to provide them benefits. By promoting me to the title of clinical services
representative II (CSRII), it would allow me to better serve our patients and their families and it
would only be an additional $7,000 a year, a savings of at least $18,000.
Conclusion
I would love to be able to do more for our staff and our patients. Promoting me would allow me
to do that and to become more knowledgeable about the diagnostic equipment that we have so
readily available to use. Efficiency, flexibility, and compassion are some of the major
requirements needed for our patients and their families, especially for those who might be
receiving bad news or those who are just worried about an upcoming surgery. When your
patients are acknowledged on a personal level because you took the time to get to know about
them, that is what will keep bringing them back and how we can continue to expand our practice
and I know I am the person to help with this. I would be happy to discuss my ideas further with
you at your convenience and I look forward to hearing from you. Thank you for your time.

My strategic plan behind this was to help save because the School of Medicine prefers to hire
COT, which are hard to find and can be costly. Instead, if the school was to promote from within,
they can train an employee to work as an ophthalmic technician and they do not have to be
certified; therefore, it saves them money. Since this is primarily a surgery center and
appointments are often coordinated with other clinics in the hospital, building the relationship
not only with your own attendings but with the other clinics helps to make things run smoother.
The patients that the children’s eye center works with are occasionally adults but primarily
children and their parents, or guardians, or case workers. Having relationships with them and
making them comfortable and a priority is living up to the motto of St. Louis Children’s
Hospital, “we do what is right for kids.”