After spending 3 years in private practice, Dr. Alexander became the Medical Director of Lakeshore Mental Health Institute, which at the time, had 800 patients. He was responsible for the clinical care oversight of the whole facility, served on the Executive Committee and as a primary liaison with the office of the Commissioner. He has served or chaired on a myriad of hospital committees at Lakeshore, as well as at several general hospitals, and in the Covenant Health System.

Dr. Alexander has chaired or participated on multiple committees, including the following: Hospital Executive Committee, Joint Commission Conference Committee, Executive Clinical Management Team, Physicians' Peer Review Committee, Mortality Review Committee, Treatment Review Committee, Pharmacy and Therapeutics Committee, Medical Records Committee, Quality Improvement Committee, Staffing Standards Committee, and Physician Wellness Committee.

Dr. Alexander has met with a Past President of the University of Tennessee, been flown on the UT jet with the Vice-Chancellor and Superintendent to meet with the Commissioner of Mental Health and Developmental Disabilities of the State of Tennessee, in order to complete the process Dr. Alexander started, of forming a Psychiatric Residency Program. He has worked with multiple CEOs, physician leadership, nursing leadership and a multitude of physicians

Dr. Alexander’s training and experience has made him an expert in group dynamics, which includes small groups to multi-level hospital units. Whether it be the functioning of a hospital unit, staff-patient relationships, staff-family relationships, or relationships with doctors, nurses, and every unit in a hospital, including the ICU and Emergency Department.

During his time as Medical Director, Dr. Alexander served as a direct supervisor of 17 physicians, did yearly performance reviews, recruited new physicians, facilitated Internal Medicine Residents coming from UT to work night call at Lakeshore, has been involved in numerous cases related to supposed or real maladaptive physician behavior, and put together plans of recovery for an assortment of different physician problems. He also served as the Chair of the Physician Wellness Committee at Fort Sanders Regional for over a decade.

Dr. Alexander has been involved in physician contracts, administrative contracts, as well as disciplinary actions with patients, employees, and police. He has had a private practice since 1988, and thus has negotiated numerous contracts with facilities, practitioners, and employees. He has also negotiated disputes between patients and staff and between patients and police.

During his 12 years as Medical Director, Dr. Alexander was the primary clinician responsible for all of the clinical functioning at the hospital. He was involved in planning for surveys, was directly involved in surveys, as well as follow up to surveys. This included JCAHO, Medicare, Medicaid, Tenncare, the State of Tennessee, and any other surveying organizations.