15 Lessons learned: a journey from pediatrics to corporate America. (Careers: Special Report).

IN THIS ARTICLE...

Trace one physician's career path and share his insights as he went from a doctor working at an inner-city pediatric clinic to global medical director for General Electric.

As I sit here recounting my career, I am very thankful. While it has included both disappointments and rewards, I have learned many lessons.

Most recently, I celebrate being selected as a Distinguished Fellow of the American College of Physician Executives. All and all, I realize what a great adventure I have had in the pursuit of my passion: health care improvement.

Lesson 1--Your career is most rewarding when it allows you to pursue your passion.

My junior year of medical school was most difficult because I lost my father to the ravages of diabetes and less-than-optimal health care. His complex medical needs led to drug-to-drug and drug-to-disease complications that contributed to his death. The same care that kept him going ultimately caused his death.

Lesson 2--Intelligent and reasonably sophisticated patients can still receive sub-optimal care.

His final gift to me was to appreciate what it means to lose a loved one and how difficult it is to live on without them. This made me a much better doctor. I went through these stages without a doctor's helping hand. Although my professors were supportive. I vowed to help others.

Lesson 3--Even with the best of care, patients die. Denial, anger, bargaining, depression and resolution require time and guidance.

I was always fond of children, so I pursued a first-class residency in pediatrics matching at Children's Hospital of Los Angeles. I returned to my hometown of Philadelphia after the three years of residency, certain that I could treat any pediatric illness. Having come from the inner city, I wanted an opportunity to give back.

My medical school offered me a chance to run an ambulatory pediatric clinic in the North Philadelphia ghetto, so I took it. Supplemented with income from a private practice in the more affluent Northeast, I was able to generate $65,000--more money than my father ever made as public school teacher.

This was perhaps one of the most rewarding periods of my life. Being told that my passion for excellence was infectious and that my hard work was something to emulate by my residents and students was a great incentive to perform well for them and for my patients.

Lesson 4--Teaching residents and medical students is an honor.

Experimenting with many efforts to get black and Hispanic teenage mothers to be compliant, I learned early lessons in medical management. Using local church leaders and a same-day-every-month check up schedule for the first year of life, I was able to demonstrate an 85 percent compliance rate with appointments and a marked reduction in the admission rate in this most fragile population.

Lesson 5--Even the most challenging populations can respond to medical management efforts.

I might still be there today if it were not for the Reagan administration. Less than two years into my tenure and with our first son to be born shortly, I was notified by my medical school, Hahnemann Medical College, that funding for my clinic was being eliminated and I had six weeks to find a new job.

While this was a great disappointment at the time, I learned that you can make lemonade out of lemons.

Lesson 6--Losing your job may be good news.

I landed a position in a practice with two patriarchs of pediatrics in a middle-class area in the western suburbs of Philadelphia. Soon afterwards, we computerized our office. It was the early 1980s.

The computer was half a room in size and could not do what your wristwatch does today, but it was a start. Before long we knew data such as:

* Our most common reasons for admission to the hospital

* The diagnoses causing emergency room Visits

* Reasons for referring our children to specialists

But what changed my career was the utilization statistics it generated. Health plans were forming in the Philadelphia area and we had better pediatric utilization statistics than they did.

Lesson 7--It is always better for you to have the best data about your practice.

Our practice grew to eight doctors and 16,000 children. We were one of the two dominant practices in the county and the largest computerized pediatric office in the Philadelphia area. We were one of the largest practices serving the emerging managed care population.

Lesson 8--It is always better to be a dominant player in your marketplace.

I was asked to serve as a consultant for Travelers Insurance and then became a part-time medical director for Cigna. In fact, I was the first medical director for Cigna's Pennsylvania plan and built that health plan from scratch with the help of a wonderful administrative team.

Lesson 9--It is always better to actively participate in a changing health care environment.

While a part time medical director with Cigna, I joined the American Association of Medical Directors that later became the American College of Physician Executives. ACPE's Physician in Management Seminar and a course on quality convinced me that it was time to move into medical management full time.

After completing a decade in front-line pediatrics and building a premier practice, I took a 30 percent pay cut and accepted a position as a network medical director for US Healthcare.

While I had to say goodbye to the practice of 16,000, I was now indirectly treating a health plan membership of 500,000. After merging with Aetna, the population exceeded 17 million at one point.

Lesson 10--IF you feel like you have a mission in life, reach is important.

Initially, as a network medical director, I was to visit three or four practices a day sharing data and showing them how they were doing compared to peers.

I leveraged what I had learned in private practice and helped other doctors do a better job for their patients and our health plan members. I explained to my children that I no longer treated patients but helped other doctors treat their patients.

Lesson II--Most physicians are eager to reach benchmark performance with assistance and adequate resources.

My career within US Healthcare and Aetna allowed me to assume a myriad of leadership roles, always learning more and passionately pursuing health care improvement from many different angles.

I was always ready to take on a challenge and pursue opportunities to learn something new.

During my decade in managed care and the health insurance industry, I was fortunate to have held leadership positions in utilization management, disease management, quality management, national accounts, informatics and e-health.

Lesson 12--You get paid two ways in a job: the paycheck and what you are learning.

These experiences allowed me to teach numerous courses and make many national presentations. My interest was to share what I learned with others. With the encouragement of ACPE, I wrote and edited two books published by the College.

Lesson 13-It is not as difficult as you think to write an article or a book--consider writing one yourself after mastering a field of medical management. Without recording the knowledge, progress will be slower.

I also had the good fortune to participate at the national level in quality improvement through the National Committee for Quality Assurance and URAC. I served six years on NCQA's Standards Committee developing standards of accreditation for health plans, preferred provider organizations, disease management companies, behavioral health organizations and credentialing verification organizations.

In addition, I served on workgroups that generated HEDIS measures--still the nation's best effort at measuring health care. More recently, I served as a founding member and vice president of Health Internet Ethics.

It was an honor to help develop the ethical principles for e-health. Those principles were then adopted and converted to standards by URAC, leading to the accreditation of health Web sites. I presently serve on their national health Web site accreditation committee.

Lesson 14--To make a difference you need to apply your knowledge to efforts beyond your job.

Last year was another turning point. I was out of new leadership options in medical management at Aetna. It was time again to pursue a new opportunity.

To my great surprise, after 16 interviews, I find myself today as the global medical director of General Electric. In this role, I manage 238 on-site clinics in 29 countries and Puerto Rico.

This network delivers 1.5 million ambulatory visits. Its activities include preventive health, injury and illness treatment, medical compliance and surveillance of exposures, emergency preparedness, travel medicine and executive health. We are also committed to teaching the GE community to be better health care consumers. It may take me another decade to master this list of medical services.

Lesson 15--To understand health care, you need to appreciate the perspectives of all stakeholders.

Raymond Fabius, MD, CPE, FACPE, is global medical director of General Electric in Fairfield, Conn. He can be reached by phone at [phone] and by email at [e-mail].