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.     

The importance of building alliances

This may come as a surprise to Gen-Xers, but on-the-job allies are a political necessity. Information and support from workplace alliances are vital to doing your job. Your peers, boss, subordinates, and even enemies, can and should be in your network of allies. How do you build alliances? It's accomplished by cultivating relationships based on mutual benefit and interest. Information and favors are traded on a quid pro quo basis. Your peers, subordinates, and boss have different needs but they share some goals with you. Goals are the common denominator. Consider the following ways to cultivate your network of allies: Be a reliable news source; offer feedback; be congenial; share expertise; consult; strive to be a role model; don't demand credit; don't wait for recognition; articulate your needs; share a hot idea; save face for someone; and connect people who can help each other.     

How to make the pitch for a part-time workload

Are you planning on moving from full-time to part-time hours? You'll need a game plan to negotiate what you want, including establishing a timeline and agreeing on productivity expectations. If you can agree on a reasonable timeframe that doesn't inconvenience anyone or endanger important results or relationships, you have a high probability of getting your boss' okay. If you and the boss can't agree on what you must produce, don't consider part-time work unless you thrive on combat. Once you negotiate your new schedule, consider the issue of managing co-worker resentment. Here are the best hints for keeping co-worker envy and resentment at a manageable level: Don't be secretive; keep a low profile; attend all office frolics; and ask for a trial period.     

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.     

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.     

How to cope with behavioral interviewing questions.

What should a potential employee do when asked behavioral or highly intrusive questions during the interview? Here are some suggestions to help you be prepared should the interviewer ask you personal or objectionable questions: (1) Take some time for introspection; (2) be prepared to draw the line; (3) complain; and (4) write it off. And remember: A show of determination and setting boundaries in an interview may advance your progress. Coolness under fire is an attractive personality trait.     

Fired? Here's an exit strategy

Who gets fired in a boom job market? People are fired more often for things they failed to do than for mistakes they made. The new rules of engagement are: There is no probationary period; resistance to technology is a quick ticket out; a lack of emotional commitment to the role you're hired to play is usually fatal; personality defects that keep others from producing are not tolerated. The most common reason for being fired, however, is lack of fit. Whether you're laid off or fired, don't ask for explanations. The fact is, the people with the power to get rid of you don't want you to stay. What matters is maximizing what they'll do for you on departure. To get the most favorable terms with the least financial and ego damage, here's a game plan: (1) Get a favorable reference--in writing--from your boss; (2) gather work samples and good performance appraisals you've received; (3) negotiate for as much severance pay as possible; (4) negotiate for outplacement assistance; (5) gather contact names from co-workers; and (6) leave in style.     

Is it change? Or is it noise?

How can you tell the difference between mere noise, and a profound change headed your way? Your gut instincts may not always be a reliable gauge. It takes a long time for most people to become an executive leader. If you are typical, you were raised and trained in a different era, with different expectations. You see things with different lenses. So what can you trust? You can trust first principles. Ask yourself what you know about the reasons that changes are happening in this environment. Then ask yourself about what is being proposed--how does it fit with the roots of the changes in health care and your organization? The three change filters presented here can help you to figure out if it's change or just noise. Ask yourself: (1) what are the changes occurring in the health care industry; (2) is your organization ready for change; and (3) how likely is it that your organization will easily adopt this particular change? These three filters together will help you decide what is a truly important change, how ready your organization is for change, and whether it will adapt to this change with ease or difficulty.     

Salary negotiations the smart way.

No one holds all the cards in a job interview, unless one party to the negotiations gives them to the other. To obtain the salary that you deserve, you have to do some homework to determine your market value and you have to stick to your guns during the bargaining. Taking less than you, and the prospective employer, know you're worth is a sure road to disaster.     

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.     

Are you obsolete?

Are you vulnerable, regardless of length of service at your organization and your unique skill sets? There are ways to test vulnerability and assemble some hard evidence that your management role makes a difference. You need to conduct a self-test for obsolescence. Ask yourself the following questions: Are your skills state-of-the-art? As a manager, how do you compare with others doing the same, or similar, job at competing organizations? Is your role essential? Where does your job fall into the big picture? Can you be replaced easily? If a thorough examination of your skills and your role convinces you that your contribution returns more to the organization than your salary, can you prove it? Consider these strategies: (1) Put together a portfolio, (2) ensure your boss' support, (3) advertise your successes, and (4) cultivate recruiters. The best reason to analyze your value to the organization is that if you are laid off, getting another comparable job--or a better one--will be far less of a hassle.     

Interviewing from the organization's perspective

Hiring medical professionals is an expensive process. It is important to conduct an effective interview to help you determine the qualifications of a candidate and to persuade the candidate to join your organization if that's what you decide you want.     

How could I have gotten it wrong?

Can you avoid ending up in a career-denting job: Are there potential pitfalls to recognize on the search for a rewarding position? Finding oneself in an impossible job, working for a boss who brings out your worst qualities and deepest insecurities, or joining an organization that is doomed are nightmare scenarios. How do these judgment errors happen? We asked physicians who've been there and, unfortunately, done just that. What they learned might help the rest of us skip the experience.     

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.     

Got curiosity?

The newest scientific models of decision-making suggest that the way we actually decide to do something is different from the story we put on it later. Organizations think that way, too. The real process of decision-making is hidden. Management is complex--and a key tool is curiosity. A critical question would be: "What experience are we creating?" When you get curious, separate what you notice from the story you tell yourself about it--even if the story is true. Look for the meaningful experience: your own, your employees', your customers', your physicians'. The essential act of management is to notice, to not look away.     

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 water is wide

Before you build your bridge to the future, stop and take time to lay a good foundation. Discover your own core beliefs and, perhaps more importantly, discover those of your employees.     

Welcome everything

The failure of management is largely a failure to bring our whole selves to it. What parts of your self do you bring to your work? Do you bring only the management mind, only logic, only the company guidelines? Or do you bring your passions, your values, your soul, your deepest self? Do you react? Or do you respond? Letting go of what you think you know can be the first step to a creative and powerful response. Many of the tools we use in management can actually remove us from the experience and make it harder to respond. Reacting closes down options. Responding opens up possibilities and nurtures trust. This is kindness transformed into a business imperative--responsiveness.     

Medicine, management, and me.

What is medical management? How do you learn about it? How do you get into it? Is there a future in it? Is medical management for you? Can you do it? What will it mean to your original plans for your life in medicine? Is it worth the sacrifice? Get comfortable. I have a story to tell you. It may help if you hear about medical management from a medical director who has preceded you. I doubt I can answer all your questions. I can, however, tell you about one physician's visions, expectations, decisions, experiences, and rewards from what can be loosely called "medical management." If you find something of help in your decision making in this account, my telling it is worthwhile.     

Watching the falling barometer

How can physician executives create a vision, a strategy, in the face of such overwhelming forces for change? The answer has two pieces. The first is the Weather Channel: scanning the future for warning, for opportunities, for new business possibilities. The second leads us to such questions as: What is your situation? Financially? In market terms? It leads us, as well, back to the question: For you and your institution, what is your reason for being in this business? In other words, what is your foundation? If you can become clear about who you are and what you are here for in the long run, and match that with some sense of the technologies and the political and financial pressures headed your way, then you can begin to create a vision of a future that works for you. In the coming years, we will begin to create entire new ways of doing health care, new roles for hospitals, new types of medicine--and the time to begin the creation is now. If you wait until the hurricane hits, it will be too late.