Negotiate the salary you want

How can physician executives negotiate the salary and terms that they want for a new position? The idea of negotiation raises the anxiety level of all but a few people, those who thrive on the thrill of competitive bargaining. Most physicians do not relish the process and view it as a type of conflict. But without knowing what you want to accomplish and preparing to ask for it, you may well leave the meeting frustrated and unhappy with the offer. Determine what you want before you get into an important negotiation. You will get clear on what you want much quicker and you will remember the points better when you talk to the other person.     

Medical staff handling of concerns with physicians' performance

Medical staff organizations and their leaders are frequently confronted with concerns about physician knowledge, performance, or behavior. Dealing with these concerns is a serious and time-consuming task. Poorly handled issues may result in serious legal consequences. In highly structured organizations, authority for responsibilities, income, and employment rests with individuals who must manage these problems, but medical staff structures do not always lend themselves to dealing with these issues. Introduction of quality improvement processes into medicine has been received as a panacea for physician problems. Certainly the majority of physicians understand quality improvement and work toward common goals to improve patient care. Unfortunately, a small minority remain problem physicians. Steps that can be taken to deal with problem physicians, particularly for issues of quality management, are described in this article.     

The purpose of a job interview is a job offer

Perhaps empathy has been overdone in recent years. Most of us would admit to some cynicism or disbelief when we hear the words, "I know how you feel." Having said that, however, I actually do know how you feel. If I can't identify exactly where you are coming from, I do know where you are likely to be going and how bumpy the ride is likely to be. I'm a physician and a physician executive. I am also an executive search consultant who is daily in the field interviewing physicians who may or may not be the right individuals for a client's situation. If I don't exactly feel your pain, at least I know its sources. I know how difficult it is to make the move from challenging clinical work to an administrative role in health care. While, as a group, physicians are multiskilled and multitalented, it's an unfortunate fact that some of the skills and talents that made you an excellent physician may be blocking you from succeeding in an executive capacity. My hope is that, through an occasional entry in this column, I can share my experiences and relate the remarkable wisdom of the impressive physician executives whom I meet every day. The first issue I'm opening up for discussion is employment interviewing: Why the interview is so important, what the interviewing process is, and how you can become more adept in this critical skill area.     

Don't be an accidental physician executive

How can physicians begin crafting a career with intention and careful thought? Before you go leafing through The Physician Executive or the New England Journal of Medicine's Positions sections, you'll need to conduct a thorough career evaluation of where you are and where you want to go. There are more career tracks in more types of organizations available to you as a physician executive than ever before. There is also considerable turbulence, creating unexpected opportunities. The times have never been better for aggressive, energetic physician executives who want to move up and out.     

Hold or fold?

This article examines some of the problems of the health care organizations we serve and that support us. While external problems can besiege an organization, the fundamental building block for success is to develop physician buy-in and a well-functioning team. The author describes how his IPA failed because the physicians in his organization didn't bond sufficiently, and for a sustained period, to carry out business operations. What are the warning signals that might help you decide whether to stay or move on? An IPA must have: (1) A clearly articulated vision of what success will look like, one that is accepted by its members; (2) effective leadership; (3) clear evidence of adaptability and flexibility; (4) financial stability; and (5) good data available to physicians. There can be other evidence of trouble you need to watch for. In some areas, hospitals and health plans are hostile to physician initiatives. Don't rely on politically motivated decisions--they are too easily changed. If you plan to be a leader for your physician organization, focus on creating or revising the internal architecture of the group.     

Physician organizations. Part 1: A report from the trenches of a start-up PO

How has Community Health Partners, a physician organization based in Kansas City, turned the corner as it rolls into the second year of operation? The biggest indicator is that CHP hammered out the city's first professional risk contracts and the PO has grown from 23 to more than 50 physician member/owners. Looking back, there are at least 10 reasons why CHP made it this far. These are not reasons you learn about in medical school or an MBA program. There is no one-size-fits-all template for building POs. No fixed organizational chart. No neon signs pointing to the best capital partner. Part I explores five reasons for success, such as having a strong board and physician leadership, as well as educating participating physicians about capitation and affiliating with any hospital or payer that really knows how to partner with physicians. Part 2 will focus on five more lessons learned from the trenches of a start up PO.     

Physician anger--Part 1. Changing perception: an interview with Charles E. Dwyer, PhD. Interview by Richard L. Reece.

On January 21, Richard Reece, MD, interviewed Charles E. Dwyer, PhD, to talk about solutions for changing the perceptions of today's beleaguered physicians. He discusses the state of affairs of physician executives in this turbulent industry and how they need to move beyond their thinking about organizations and their current responses to change. The key, Dwyer emphasizes, is influencing people to do what you want them to do. "If you want somebody to do something other than what they are doing now, then you must bring them to perceive that what you want them to do is better than what they are doing now in terms of what is important to them." He also explores how physicians can change their responses to the health care environment: "You can actually decide how you are going to respond conceptually, emotionally, and behaviorally to anything that happens in your life." Part 2 of this interview will appear in the upcoming May/June issue and will provide hands-on strategies for dealing with physician anger, fear, and resentment.     

Organizational politics: did you hear?

How do you define organizational politics? The underground system of communication, the grapevine, what's really going on in the organization, rumors, knowing who really has the power? However you define it, all sources agree you'd better not ignore it. According to one physician executive: "Organizational politics is how things really get done, who really has the power, how decisions get made. Things are not always what they appear to be on the organizational chart." Presented here are some thoughts about organizational politics from physician executives and their stories of when it helped or hurt their careers or prevented them from accomplishing something in their organizations.     

Confronting the disruptive physician

Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.     

Why it matters

Physicians everywhere are facing changes in the ways they are paid, and in their relationships with their patients. In the United States, an increasing number of physicians are being confronted with the choice to join their practice to a physician service organization (PSO) or some other capitated financial structure in which they collectively put themselves at financial risk for the health of their patients. In all these decisions, the biggest handicap is fear. Some physicians let fear keep them from changing. Others let fear drive them too quickly into change that turns out to be unwise. The fear of change-the fear of the unknown, of things that, deep down, under the professional veneer, we wonder whether we can handle-is quite real. It is immediate and nearly constant. How can you drive out the fear? There is no simple answer. The complex answer starts with daily practice, with taking the practice deeper, taking it wall-to-wall. Here are some ideas for dealing with the fear of change, from owning up to your true feelings, to acknowledging failure, to breaking the change down into its smallest components.     

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.     

Health care is sales

Health care is all about sales--everyone today in the competitive arena of health care is a salesperson. Your selling days began when you applied to medical school. Your product was yourself, and you worked hard to sell it. That was only the beginning. In your daily work as physician executives, you are selling yourself and your ideas-your ideas about relationships, management structures, partnership issues, merger questions, etc. It's a complicated world, and the concepts are often abstract and difficult. But it is your job to communicate with others to get things done. It is the most important part of your job. It is selling, in fact, at a sophisticated level. How do you communicate and sell yourself and your ideas effectively? Here, some ideas on how to listen and communicate.     

Skills needed by physician CEOs. Interview by Barbara J. Linney

How do you transition from physician executive to physician CEO? Three physician CEOs were interviewed to explore the skills they needed to land in the top position. They share their views on what it takes to be a successful CEO. They describe the skills that they needed when they moved into the CEO role and how they acquired them. Some of the qualities it takes to be a CEO include the ability to: Articulate your values; use your people skills; describe a vision; solve problems; listen; walk around; and use analytical skills.     

How to fire a physician

How does one fire a physician? In a word, carefully! Most of the legal protections for other employees apply just as well to physicians. And physicians have access to an expanded realm of protections because of the nature of their profession and because of its role in the health care delivery system. The ordinary employee cannot raise antitrust; the fired physician may very well raise just that issue. And yet the need to terminate a physician will sometimes, even though rarely, occur. How can the organization be certain that it has treated the physician fairly, has documented any and all offenses in a defensible fashion, and has generally followed accepted practices in all aspects of dealing with the physician? The author provides some guidelines for dealing with the problem or the incompetent physician.     

Boldly going where no one has gone before

With all the changes occurring in the U.S. health care system come new opportunities for physician executives willing to boldly go where no one has gone before. These positions are being newly created and thus are somewhat undefined and uncharted. Health care organizations want individuals for high-risk positions with unique skill sets and bright, new ideas. Organizations want to find people who can do what has never been done before-for them, at least, if not anywhere in the universe. How does that translate into experiences that you might want to acquire? Most organizations today are looking for individuals with some networking experience, but analogous experience (such as in a multi-site medical group or active involvement in formation of IPAs) is often a good alternative. In addition, true line experience in one or more organizations is a solid credential. Knowledge of where managed health care dollars begin and end is a necessity. As always, executive style and presence are expected.     

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.     

What to do next

Why do we work? While there may be some obvious, practical answers to this question, like needing to make money to survive, there are other reasons that people work. These include working: to have stimulation and excitement--to meet new challenges and have variety in your life; for love and affection--to be with colleagues, clients, customers and to provide security and protection for family and friends; and to leave a thumbprint on the world and change individuals, systems, and institutions. For quality life, it is necessary not only to work but to enjoy your work. For physicians considering careers in medical management, the key to success is being truly excited about management activities. If you are heading towards management, you need to view some of the tasks as fun or you probably won't stay with it very long.     

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.     

Touching what is, touching what might be

How do you master change? You have to master the paradox of changing while staying grounded. To make use of the power living inside any new thing that comes your way, you first have to touch it--not tentatively but profoundly--at the same time that you maintain a firm connection with that which is deepest and most fundamental within you. Here, some ideas on how to create "touch points," the ability to look at a problem or impending change from many different angles, thus broadening your understanding and possible response. A key tactic in creating a variety of touch points is quite simple: Ask a lot of questions. Ask especially the questions that have difficult answers, or for which you suspect there is no answer.     

Life after retirement. Interview by Barbara J. Linney

Are you thinking about retirement? Here are interviews with four physician executives who have made the transition. Some are recently retired, while others have been retired for many years. The good news is that all of them are productive and exploring interests and hobbies that their careers had taken precedence over. All of them were asked the following: (1) How have you felt about retirement? (2) What are some interesting things you've done? (3) What advice would you give to others who are planning for it?