Vice President of Medical Affairs--moving on up to CEO?

Increasingly, physician executives are reaching the conclusion that if they choose, they may be viable candidates for CEO positions. While this opinion has merit, it must be tempered by marketplace realities. A fundamental issue for VPMAs aspiring to become CEOs is that they have little formalized training or education for CEO roles. Also, they may lack team-building skills--a critical success factor. Physician executives who seek out professional development opportunities that enhance both their interpersonal/management and "business" skills--accounting, finance, and planning--are more likely to be attractive candidates and succeed once they are in the position. Another consideration is that the CEO position usually has a precursor role--the COO. This position is the training ground for the CEO. Physician executives aspiring to be CEO will want to consider the following suggestions: (1) Make your intentions known; (2) groom your successor; (3) request a title change; (4) get your master's degree; (5) pursue professional development opportunities; (6) consider leaving the organization; and (7) talk with your family.     

Influence by learning how people process information

To have a successful career in management, you have to pay more attention to refining your communication skills than you ever thought was necessary. In a survey of 100 physician executives, 94 percent felt training was needed in communication skills if you are thinking about becoming a physician executive. When recruiters talk to us about the basic requirements for physician executives, one of the things they say the person needs to have is excellent communication skills. Most people have good communication skills, but what can move you into the category of excellent is paying careful attention to how the person you are talking to processes information. You can only do this if you listen before you do much talking. What do I mean by processing information? When we get up in the morning, the world is out there separate from us. We have to take in information about that world and make decisions all day long. We don't all do this in the same way. In this article, I am going to discuss four ways to process information.     

Hired, fired, and not retired: an interview with a physician executive who has run the career gauntlet. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Robert J. Hudson, MD, on April 24, 2000 to discuss his experiences as a physician executive who has made the career transition from practicing physician to managed care executive to biotech entrepreneur. Along the way, he's hired and fired others, and been fired himself. Painful as it is, many physician executives' career realities include being fired. Organizations, after all, are living organizations--they grow, wither, and molt. And as they molt, organizations shed and regrow new skin. What do physician executives do when they've been fired? They go through their own cycle and retreat, reflect, and re-emerge, often reinventing themselves as they go. An essential part of this process is looking within to plumb likes and dislikes, strengths and weaknesses, nightmares and dreams, and positive and negative experiences. For most executives, out of these experiences has come a circle of friends and a Rolodex. Start by reaching out to the circle, by going through your Rolodex, and you can broadcast the news of your rebirth.     

Thriving in change

The turbulent state of health care and the rapid changes that show no sign of abating point to many career-related challenges for physician executives. How can you predict the impact of these changes on your career? What measures can be taken to prevent any negative impact of change? And how can you prevail when dealt a negative blow like job loss? The signs that foreshadow the unraveling of a physician executive's career are described. The warning signs are: Not keeping up with change, losing your influence; getting negative feedback; turning your "concerns" into complaints; the economy working against you; and being blindsided because we think leaders operate logically. Being proactive puts more control in your hands and leaves less to chance. You can prevent being blindsided if you: develop your people skills; get comfortable and involved with e-business; stay abreast of health care trends; pick up the pace; and develop "You, Inc." There is a final component to prevailing over adverse circumstances--find your work-related passion and apply it to your career.     

The physician executive "arrives"--a new generation prepares for the future

The recent rise in the number of physician executives in the health care industry vividly demonstrates that a genuinely new generation of physician executives is seeking to combine the sensitivity of their clinical skills with the business acumen that today's health care organizations need to prosper and grow. But physicians who are preparing themselves to be selected one day as chief executive officers by hospitals, integrated systems, and managed care organizations should understand that the CEO role is radically different from that of the CEO of a physician practice. The corporate CEO role requires the management of managers and responsiveness to the organization's board. Those who imagine that the corporate CEO role bears any resemblance to the autonomous, independent existence of the practitioner are certain to have a rough time.     

Professionalism is judged by appearances ... like it or not

Exploring the larger subject of executive professionalism should include the whole range of behavior issues that affect others' perceptions of you. In this competitive environment, with limited time to manage relationships, physician executives must take control of all aspects affecting their credibility and communications. This is not to suggest that you become the stereotyped, air-brushed news anchor, all style and little substance, but that you create a total package, one in which the "inside" and the "outside" of your presentation are complementary. Focus your attention on how well you have developed these factors as a physician executive: Appearance; demeanor; professionalism; and integrity. To create a "total package," it is helpful to consider the following recommendations: Write "commercials" for yourself and your organization; use every interaction as a selling opportunity; make every context a platform; don't hide from criticism--seek it out; and use every opportunity that comes your way to listen.     

The right paperwork for the right audiences

Physician executives need to exercise considerable discretion, care, and judgment when they write about their professional accomplishments in the form of a résumé or curriculum vitae (CV). This paperwork is intensely personal. It must be a true reflection of you, your achievements and goals. Others read it to learn more about you. Those you fail to convince, you're likely to lose--along with your chance to meet and charm them in a personal interview. A physician executive's thoughtfully prepared résumé and CV can result in him or her being offered terrific opportunities for career growth. The paperwork is a self-constructed gateway through which you can properly approach hiring organizations--and how it reads is totally under your control. Some suggestions to consider in developing your résumé or CV are: be succinct; don't overstate; use both documents; do your homework; and be ready for the next steps.     

Diagnosis of a stalled career

What should physician executives do to prepare for a career move? This is not a list of items to improve technical skills and knowledge, but information on how to accurately and clearly present your experience and gain credibility. A few of the basic career preparations that physician executives must make include: (1) Get your paperwork in order, both a resume and a curriculum vitae; (2) seek feedback and critical input; (3) refresh or establish your interviewing skills; and (4) focus on your communications techniques. Physicians executives cannot rest on their deserved laurels as strong practitioners when aspiring to a senior management role. It is critical to emphasize other skills--decisiveness, communication, and management experience in a range of health care organizations.     

Putting "teeth" in your résumé

How can physician executives get the kind of management experience they need to move to the next level? Is the MBA the end all or can significant management experience and top assignments impress recruiters and CEOs? Here are some important questions to ask yourself about each job you have held as you prepare to move forward in your career: How did I improve the organization? How did I contribute to greater efficiency? How did I affect productivity? How did my work increase the bottom line? Thinking about these questions can help you put teeth in your résumé and get you where you want to go. When you can answer those questions from your own experience, you will have created a powerful career track record that is likely to impress the next CEO whose staff you want to join.     

The successful physician negotiator

Whether you realize it or not, you are in the middle of a negotiation every time you are asked to do something. Negotiation skills are important for physician executives, both in their professional and personal lives. The Successful Physician Negotiator: How to Get What You Deserve provides useful examples of how to negotiate and helps you get in the proper mindset to get it done effectively. While the book explores the concept of cooperative negotiation, which is important if you want to have a long-term relationship with a person, it's also important to have other tactics. You need to understand your opponent by gathering information about his or her values and work situation. You can gather information when talking to your opponent, but you also need to do some "behind the scenes" preparation before the encounter begins. Other recommendations include: don't negotiate in your office, use time to your advantage, be able to keep silent when necessary, have options, be able to say no and walk away, keep your cool, and take notes.     

Getting started as a physician executive

In clinical practice, technical skills often outweigh interpersonal and leadership skills as success factors--you can be a great doctor and a so-so person. But the reverse seems to be true in the physician executive role; it is precisely the intangible leadership skills that contribute to and determine potential success. And they can be tough to master, especially when you focus on them for the first time, partway through an already-successful career. Practicing leadership is like practicing medicine. It's not just a matter of learning some new things--if it were only that, physicians are known to be excellent learners. Nor is it just a matter of determination or application--this is not a battle that sweat and effort alone can win. Most physicians will want to "try on" the executive role before making strategic moves in that direction. But be clear about what you want to get out of any project or activity before you jump in. If you're seeking a management degree, the best approach is to tie together developing your technical and interpersonal skills, as well as the formal credentials.     

You have the job you wanted--now what?

We've had calls from physicians who finally have the medical management job they always wanted and then a month later they wondered why they wanted it. I asked seven physician executives to come together as a group and talk to me about this issue. I also asked them what skills they needed most when they first got the job and, as time passed, which skills continued to be most useful. I have not used their names because they were open enough to talk about some very sensitive issues.     

How to survive a new CEO

A new CEO means everyone in the organization is now a new hire--an unknown entity that must prove he or she can and will enthusiastically, tirelessly support the CEO's agenda. Those who want to stay on the payroll must avoid a business-as-usual attitude and demonstrate that they share the CEO's dedication to change. If you're in a staff job, it's important to show you're essential to the new regime, quickly and convincingly. Some important steps to consider as you plan for the transition include: Do your home-work; anticipate the CEO's needs; be supportive and nonpolitical; be realistic with your direct reports; and appear poised to leave willingly and quietly--and you may not have to.     

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.     

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.     

Negotiation: the CMO's indispensable skill

Negotiation is the most important tool that a chief medical officer, or any physician leader, can possess. Here are some tips and insights on ways to improve your negotiation skills.     

The art and science of starting a new job.

To be successful in a new job out-of-town, physician executives need to develop a plan for a smooth transition into the organization. A checklist to prepare yourself for the new position should include: Updating your research; (2) staying in close contact with your new boss; (3) visiting the office; (4) hiring your own support person; (5) planning the first week; (6) telling the troops how to manage you; (7) making early decisions; and (8) meeting your peers. The focus should be on the job and connecting with your new boss, medical staff, and coworkers--and not exclusively on the environment of your home-to-be.     

Common denominators of success

There is no mystery to the success stories described in this column. In addition to a lot of hard work, a few basic principles have been applied to widely differing scenarios. These common denominators provide the philosophies and dynamics that can lead to your breakthroughs in quality health care delivery: (1) Trust--among the physicians and then between them and management and the board of directors; (2) positive physician culture and attitudes; (3) effective physician leadership; (4) patient care focus; (5) strong team orientation; and (6) true accountability by all stakeholders. Your job is to help your physicians feel they are major stakeholders in your health care delivery system and be their voice in clinical and financial decision-making at the highest level.     

Leading an organization through change. Interview by Barbara J. Linney

Robert Jamplis, MD, FACPE, has been President and CEO of the Palo Alto Medical Foundation for the past 30 years. During those years, he has led his group through many of the changes that are just occurring in other medical group practices--movement away from long hospital stays and toward large integrated health care systems. In an interview conducted late in 1994, the author asked Dr. Jamplis to describe the major changes that have taken place in his organization during his tenure and the leadership skills he used to make them happen. His comments are summarized in the following report.     

Bouncing back

If you have taken a career sidetrack, realize that you are still marketable. You have skills, traits, and knowledge that are transferable to many new opportunities. Fortunately, many leaders today in health care and executive search are familiar with your plight, given that they all have their own version of initiatives that did not fly. They will not judge you unfairly because they understand all too well the complex pressures of today's health care environment, filled with risk, cost constraints, and unrealistic profit targets. If you're bouncing back from an unfortunate career move, these steps may keep you focused on your search for new opportunities: (1) recognize that you are not alone, (2) realize that the entity failed, not you, (3) discuss the former position in a positive light, (4) don't give in to cynicism or self-pity, (5) don't let it happen to you again, and (6) play an active role in structuring your next position.