Controlled burn! Physician executives must be ready to handle job burnout, career stress

Job burnout for workers in any career can be frightening. It's truly debilitating to think that your job and career are worthless, that your future isn't bright. There are, however, some steps you can take to recognize, avoid or overcome the stress and anxiety that leads to job burnout.     

High expectations mirror high stakes for physician executives

Because the stakes in health care are high, physician executives are challenged to meet high expectations set by their CEOs and boards. These may be unrealistic--for example, demanding that physician executives possess expertise in finance or strategic planning. Job stresses for physician executives are specific to the role, but are not unlike those faced by other senior executives. It's a fact that professionals leave jobs for any number of reasons; sometimes, not through their own choice or fault. Thus, every time a physician executive leaves a job, it should not be characterized as "being fired," and not every job-leaving should be taken as a failure. Accept that you may make mistakes while doing the best job you can. Rely on your own value system and integrity to see you through.     

Equilibrium Wage‐Tenure Contracts

In this study we consider a labor market matching model where firms post wage‐tenure contracts and workers, both employed and unemployed, search for new job opportunities. Given workers are risk averse, we establish there is a unique equilibrium in the environment considered. Although firms in the market make different offers in equilibrium, all post a wage‐tenure contract that implies a worker's wage increases smoothly with tenure at the firm. As firms make different offers, there is job turnover, as employed workers move jobs as the opportunity arises. This implies the increase in a worker's wage can be due to job‐to‐job movements as well as wage‐tenure effects. Further, there is a nondegenerate equilibrium distribution of initial wage offers that is differentiable on its support except for a mass point at the lowest initial wage. We also show that relevant characteristics of the equilibrium can be written as explicit functions of preferences and the other market parameters.     

The Labour Market in Macedonia: A Labour Demand Analysis

Abstract. This paper examines the labour market in Macedonia, a country with the highest unemployment rate in Europe. I describe labour market institutions and policies during the transition. I also examine job creation and job destruction using firm‐level data and I estimate short‐term and long‐term elasticities of the labour demand. The analysis shows that there are regulatory barriers to the labour market flexibility. I can also conclude that the privatization of socially owned enterprises has failed to promote job creation. Nevertheless, labour market problems seem to stem from factors other than substantial sluggishness of firms in adjusting employment to variations in wages.     

Navigating the job search superhighway

The recent Cyberforum on "Navigating the Job Search Superhighway" gave 131 American College of Physician Executive members the opportunity to discuss the job search process, addressing questions and sharing what they've learned through their experiences in the medical management job market. Several comments that convey the essence of the discussion are listed, representing the various viewpoints of the participants. The words are from physician executives who have gone through the job search process and from some who have been involved in hiring decisions. The topics range from the value of experience to the importance of having a management degree to tips on networking to preparing for the interview. The final section on contract negotiation is a composite of comments on the subject during the Cyberforum.     

Equilibrium Labor Turnover,Firm Growth,and Unemployment

This paper considers equilibrium quit turnover in a frictional labor market with costly hiring by firms, where large firms employ many workers and face both aggregate and firm specific productivity shocks. There is exogenous firm turnover as new (small) startups enter the market over time, while some existing firms fail and exit. Individual firm growth rates are disperse and evolve stochastically. The paper highlights how dynamic monopsony, where firms trade off lower wages against higher (endogenous) employee quit rates, yields excessive job‐to‐job quits. Such quits directly crowd out the reemployment prospects of the unemployed. With finite firm productivity states, stochastic equilibrium is fully tractable and can be computed using standard numerical techniques.     

SEARCH INTENSITY,DIRECTED SEARCH,AND THE WAGE DISTRIBUTION

We propose a search equilibrium model in which homogeneous firms post wages along with a vacancy to attract job seekers while homogeneous unemployed workers invest in costly job seeking. The key innovation relies on the organization of the search market and the search behavior of the job seekers. The search market is continuously segmented by wage level, individuals can spread their search investment over the different submarkets, and search intensity has marginal decreasing returns in each submarket. We demonstrate the existence of a nondegenerate equilibrium wage distribution. The density of this wage distribution is increasing at low wages and decreasing at high wages. The distribution can be right‐tailed, and, under additional restrictions, is hump‐shaped. Our results are illustrated by an example generating a Beta wage distribution.     

Computer incompetents in the cross-hairs.

Human Resources managers are distressingly aware that more than half the middle and senior managers (40- and 50-year-olds) in their organizations are technologically incompetent. Having spent millions on technology, most corporate CEOs, many of whom can't use a computer either, are drawing a bead on middle managers who are passively resisting the computer revolution. Physician executives are no exception. Given the current shortage of physician managers with good track records and people skills, can middle managers skirt technology issues until retirement if they dance slowly enough? It's doubtful. Organizations are using new tactics to bar technically challenged managers from their ranks: They will only interview candidates with mastery of specific software and they're posting job opportunities on their web sites. Those who still believe they can ride out the computer revolution may want to rethink that strategy.     

Shared planning: a new foundation for quality criteria.

The Chinese word for crisis has two characters. One for danger and one for opportunity. A crisis is a time for awakening to new perspectives and for asking different questions. The widely touted "liability crisis" in the health care field provides just such a time for new approaches. Perhaps there is a way to establish market mechanisms for decision making that gives expression to the desires and values of consumers while respecting the abilities and preferences of physicians. Quality might then be the result of natural selection or, more accurately, of market demand. Such a system would acknowledge that quality in medicine is not for defining. It's for having. Quality should be obtained in bargaining for services, not in mandates of professional regulation.     

Delegation can make (or break) your career

Delegation is not a soft skill. Physician executives who do not delegate well and strategically cannot expect to achieve the top jobs now or in the future. It's not enough to have great communications skills to convey your vision. You won't achieve that vision alone; you must have a great team to bring that vision to fruition. However, you can't delegate your first and most important step--self-assessment. To maximize your strengths and minimize your weaknesses, you'll need a clear view of what makes you tick. Then start thinking about your executive role in these terms: Conceptualize work mandates as projects; choose people who are better than you for your team; and try to work yourself out of a job. By learning to delegate, physician executives can make their own careers (as well as those on their team) richer and more fulfilled.     

THE POLITICAL ECONOMY OF FLEXICURITY

We document the presence of a trade‐off in the labor market between the protection of jobs and the support offered to unemployed people. Different countries’ locations along this trade‐off represent stable political‐economic equilibria. We develop a model in which individuals determine the mix of job protection and support for the unemployed in a political environment. Agents are heterogeneous along two dimensions: employment status (insiders and outsiders) and skills (low and high). Unlike previous work on the political economy of labor market institutions, we emphasize the role of job protection and unemployment benefits in the wage‐setting process. A key implication of the model is that flexicurity configurations with low levels of job protection and high levels of support to the unemployed should emerge in the presence of a highly educated workforce. Panel regressions of countries’ locations along this institutional trade‐off are consistent with the implications of our model.     

An Equilibrium Theory of Learning,Search, and Wages

We examine the labor market effects of incomplete information about the workers' own job‐finding process. Search outcomes convey valuable information, and learning from search generates endogenous heterogeneity in workers' beliefs about their job‐finding probability. We characterize this process and analyze its interactions with job creation and wage determination. Our theory sheds new light on how unemployment can affect workers' labor market outcomes and wage determination, providing a rational explanation for discouragement as the consequence of negative search outcomes. In particular, longer unemployment durations are likely to be followed by lower reemployment wages because a worker's beliefs about his job‐finding process deteriorate with unemployment duration. Moreover, our analysis provides a set of useful results on dynamic programming with optimal learning.     

DOES THE ILO DEFINITION CAPTURE ALL UNEMPLOYMENT?

The labour market status of many nonworking persons is at the boundary between unemployment and inactivity. Like the unemployed, they seek and are available for work; unlike them, their last search action was not recent enough to meet the International Labour Office definition of unemployment. In this paper we examine by nonparametric tests how the transition probabilities of these out‐of‐the‐labour‐force job seekers differ from those of the unemployed as well as the other nonparticipants. First, using data from the European Community Household Panel, we show that in most EU countries these job seekers constitute a distinct labour market state. Second, we rely on information available only in the Italian Labour Force Survey to derive a measure of search intensity that we use to break down the out‐of‐the‐labour‐force job seekers. On the basis of their transition probabilities, the most active are indistinguishable from the unemployed. (JEL: J64, J22, R23)     

Ist Marktorientierung ansteckend? Der Transfer der Marktorientierung über Hierarchieebenen – Eine empirische Mehrebenenuntersuchung

It is generally accepted that market orientation as a well-established marketing phenomenon influences the performance of companies. However, work investigating how market oriented behaviours of customer-contact employees can be influenced is conspicuous by its absence. This article is the first empirical multilevel study in this area, which simultaneously examines intralevel-effects (effects within the level of customer-contact employees, e.g. length of work experience, job satisfaction) as well as crosslevel-effects (effects which come from superordinate managers). Based on a large-scale three-level study, the results show that the transfer of top-managers’ market orientation via sales managers down to customer-contact employees is definitely not an automatism. In fact this market orientation cascade particularly succeeds, if the market orientation of superordinate managers comes along with intense charismatic leadership. All in all, the entire impact of crosslevel-variables on the market orientation of customer-contact employees is at least as comprehensive as the influence of intralevel variables.     

Falling from the top: the fired physician executive

Today's health care market is volatile, and the job of a physician executive is becoming more risky. Recognizing signs of trouble and taking immediate action is essential. Ten early warning signs that you could be fired are: (1) Net profits dip unexpectedly; (2) investment income can't cover operating losses; (3) bond rating is downgraded; (4) revenues are not rising as fast as costs; (5) senior executives leave the team; (6) wage increases don't improve nursing vacancy rate; (7) unions begin whisper campaign; (8) medical staff elect an SOB; (9) hospital is slapped with a costly lawsuit; and (10) recruiters call to check on your status. Physician executives are quickly learning what it takes to overcome tough challenges and prevent premature job termination: Communication; no-surprise performance; continuous monitoring of key indicators; openness and plain talk; and no-more-business-as-usual attitude. What can you do to make your job loss as painless as possible? (1) Negotiate a contract upfront; (2) don't lose your temper; (3) ask for your wish list quickly; (4) be reluctant to sue your former employer; (5) tell your family as soon as possible; (6) take only a brief vacation; (7) consider a temporary assignment; (8) be prepared to be re-employed by your former employer; and (9) keep a positive attitude.     

Informal Referrals,Employment, and Wages: Seeking Causal Relationships

Employers and job seekers rely extensively on informal referrals to fill vacancies or to find a job. The widespread use of job contacts has been largely associated with labor outcomes, such as finding a job or even affecting wages. This paper explores whether the use of informal referrals on the job search process affects labor market outcomes of Colombian urban workers. Results indicate that informal referrals are slightly more successful than other job search strategies in term of job seeker's placement. However, referred workers earn in average less than their non‐referred counterparts. Yet, this is only true in formal‐sector positions.     

The Pace of Job Creation and Destruction,Cyclical Shocks and Employment Dynamics

This paper investigates (un)employment dynamics in response to labour demand shocks using a small empirical flow model for the labour market in The Netherlands. The model explicitly takes account of the propagation of shocks through the various duration classes of unemployment and allows for duration dependence in the state of unemployment. A sensitivity analysis shows that 1. congestion in the matching process due to the increase in the pace of job creation and destruction may have substantial effects on (un)employment dynamics; 2. the effects depend very much on the initial pace of labour market dynamics and they are larger when the initial pace is low; 3. the labour market may be out of its equilibrium for quite a long time after a shock occurs; 4. fluctuations in the pace of job creation and destruction only lead to unemployment persistence in the model when the escape probability from long term unemployment is zero; otherwise, the economy returns to its original equilibrium, albeit with long adjustment lags in the case that the initial pace of structural change and/or the escape probability for long term unemployed is low.     

PRICE DISPERSION WITH DIRECTED SEARCH

We present a model that generates empirically plausible price distributions in directed search equilibrium. There are many identical buyers and many identical capacity‐constrained sellers who post prices. These prices can be renegotiated to some degree and the outcome depends on the number of buyers who want to purchase the good. In equilibrium all sellers post the same price, demand is randomly distributed, and there is sale price dispersion. Prices and distributions depend on market tightness and on the properties of renegotiation outcomes. In a labor market context, the model generates a strong empirical prediction. If workers can renegotiate the posted wage, then the model predicts a positively skewed and realistic‐looking density function of realized wages when the mean number of job‐seekers per vacancy is large. (JEL: C780, D390, D490, E390)