Ask the Coach: Physician executive experts answer your medical leadership and management questions.

Ask the Coach offers practical advice to answer your questions about medical leadership issues and physician executive concerns. ACPE faculty member Howard Kirz writes the column with help from experts both inside and outside the College. Questions for future columns are strongly encouraged and should be sent directly to Kirz at [e-mail]. All questions will be considered strictly confidential.

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I know this isn't a column for spouses, and you're not "Dear Abby", but I've got a concern about my physician executive husband and I'd appreciate your thoughts. I bet I'm not alone in this concern.

When my husband was a practicing internist, he ate sensibly, exercised regularly and we had a reasonable family life. Two years ago "Paul" became the full-time VPMA of our local hospital. Since then his health habits and our family life have gone to ........... well you know what I mean.

Paul's every waking moment seems taken up with one management problem or another. He stays up to all hours answering his e-mail and drafting his next day's memos. He wears a beeper to church, checks phone messages a couple of times a day when we're on vacation and seems constantly rushing off to one meeting or another.

When I ask about it, Paul says he just needs to learn better "time management" and once he does, this problem will surely go away. He's read a couple books on the subject and even taken a course on it. I love my husband very much and want him to be successful in his new job, but so far his job seems to be managing him. Is this normal for physician executives or are we missing something?

A Worried Wife

Dear WW,

Nope, you're not alone in this concern and it doesn't sound like you're missing anything either, but your husband definitely is.

Basically, like so many task-oriented professionals, your husband has failed to appreciate the real nature of management work. It's about influencing processes not racing around trying to complete a virtually infinite series of tasks.

In practicing medicine, our office visits end in 30 minutes, our hospitalized patients eventually get discharged and morning comes even after the longest night on call. But the practice of management is quite different. When is quality management actually over? When are health care costs completely managed? Who doesn't want their favorite VPMA to attend their very next morning meeting?

So, while time management skills can certainly help, ultimately new physician executives must come to grips with the nature of management work itself. The reality is that all management jobs are capable of filling all waking hours. To get his job under control, your husband needs to decide first what time he will devote to it, balancing this with his needs for a family life, maintaining his health and his other interests.

Once Paul awakens to this reality, learning time management techniques like "prioritization", "reverse delegation" and "touching paper once" can definitely get him become more efficient.

Until then however, all bets are off. Try showing him this column. If he wishes I'd be happy to respond to an e-mail from him. Otherwise, writing to "Dear Abby" might not be such a bad idea.

I just got a "Thank You" note from my boss, thanking me for my contributions to our recent strategic planning process (I led the physician input). That's the good news. The bad news is that the note was typed and obviously signed by his secretary.

I feel good about my involvement and I appreciate positive feedback now and then. But a pro-forma note signed by someone else seems really tacky to me. I know my boss is a busy guy but isn't this bad form for a leader, or am I just being overly sensitive?

Sensitive Sam

Dear Sam,

You're not being overly sensitive. It's bad form and "tacky" about sums it up. Appreciation is an important management tool and a very powerful emotion, both for the giver and the receiver. I'm sure you did a fine job, but your boss apparently doesn't get the importance of personal appreciation. The best thing to do with your recent experience is just learn from it.

Next time you send a note of appreciation to an employee yourself do it in your own handwriting, preferably on your own stationery or note card. This has no downsides and works wonders at helping create the kind of appreciative work-place we all desire.

An authority no less than management guru Tom Peters once characterized handwritten notes as "the secret weapon" of great management, pointing out that managers "wildly underestimate the power of the tiniest personal touch."

For more information on this important subject, pick up a copy of Business Notes by Florence Isaacs. Come to think of it why not buy your boss a copy, sign it personally and give it to him for his next birthday?

I'm a physician chief operating officer. In three months, I'll take over as CEO of our integrated system from my long-term boss and mentor who's retiring to teach and spend more time with his grandchildren.

My boss has been our CEO for 19 years and I'm grateful to him for his mentoring, his advocacy for me as a successor and his willingness to do whatever it takes to help me succeed.

That's the problem. A couple of months ago my outgoing mentor volunteered to become a board member for the next few years, something the board itself eagerly accepted. Everybody acknowledged it would meet some of his emotional needs after so many years and would be of great value to the board.

Last week, however, my mentor came to me wondering if he'd done the right thing. Will he be in my way? Will the board turn to him instead of me? Will this interfere with my growth or my authority as a CEO? And how will it feel to him to be an ordinary board member?

I really like this guy and value his skills and support but I'm wondering if there might be some better way to deal with this situation. Got any ideas?

A CEO-in-Waiting

Dear Waiting,

Congratulations. You've got good instincts. There are definitely better ways to deal with this situation and it sounds like you and your departing boss should consider some of them.

Ex-CEOs rarely become "ordinary" board members, board chairs sometimes, but never just another board member. The emotional needs of a valued ex-CEO are usually quite palpable and definitely need to be acknowledged, but your own needs for adequate running room and sufficient authority as a CEO are likewise very important.

First, sit down with your mentor and acknowledge that you share his concerns, about both his situation and your own. Commit to solving these problems together. One approach is to develop a special "emeritus" role for him, one that clearly acknowledges his contributions, allows him to be available to you and the board in some limited way, but without his actually taking a seat on the board.

Another possibility is to devise a consulting role in which he continues to advise you for a period of time but doesn't accept a board seat during that time. Techniques like these can meet the mutual objectives you've identified and help preserve your very important relationship.

CEO-in-Waiting, with instincts like these, I have a feeling you're gonna be a great physician CEO and a credit to us all. Have a wonderful run in your new job.

By Howard Kirz, MD, MBA, FACPE 

Howard Kirz, MD, MBA, FACPE, is a retired physician executive and past president of ACPE who provides executive coaching to health care boards and to a number of successful senior physician and health care executives. Questions for his future columns are encouraged and should be sent directly to [e-mail]