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.

Fired Physician Executive Seeks Better Severance

* Dear Coach,

I've just been fired. We're going through a merger and they've offered me only three weeks severance after nearly four years on the job. Is there any way to get a better deal at this point?

Sacked in the South

* Dear Sacked,

Maybe. John Pufhal, PhD, a career counselor who specializes in such transitions says, "most companies are skillful enough these days to not violate the law when they fire a physician executive. On the other hand, it's often possible to negotiate a better severance package, even at this point, by following some simple advice." Consider the following:

* Don't respond right away. Just express surprise, even shock, at what's been offered.

* Take a few days to gather information. What does company policy say about severance for senior executives? What does your own contract say? Who hired you? What verbal promises did they make?

* Draft a written response. Be friendly and non-confrontational in your tone. List your accomplishments and express your disappointment at how this matter was handled relative to the promises you feel were made or implied.

* Include an brief alternative proposal for increasing your severance emphasizing fairness, the difficult job market you face and the interim needs of your family. Don't forget non-salary items like extended health care coverage, outplacement support and relocation assistance.

* Make no legal threats (unless you have very good legal grounds, in which case your attorney should do that, not you).

* Request a meeting to discuss the issues and find a better, fairer solution for you and your family.

Most importantly, recognize that you didn't do anything wrong here. Termination is one reality of modern executive life. An article I wrote in 2000, ("Congratulations...You're Fired," The Physician Executive. July-August, 2000, 26:4) points out that more than 40 percent of physician executives will eventually experience something like this, completely unrelated to their own performance.

Regardless of the outcome of your severance negotiation, your professional future as a physician executive will not be significantly affected by an event of this kind. Keep your chin up.

* Dear Coach,

My administrative assistant for many years has been an absolute gem. She handles my schedule flawlessly, deals with a bewildering array of requests, can always find the right document at the right time and offers me solid advice on everything from office politics to family harmony. That's the problem She's retiring in two months and I'm at my wit's end not knowing how to replace hen Is it possible I'm overly dependent on her or do other people have this problem too?

Help Wanted 

* Dear Wanted,

You're overly dependent on her, but you're not alone in this regard. The relationship between an administrative assistant and an executive is always a critical one. As a CEO coach, I've probably seen more professional disasters result from having the wrong administrative assistant than from having the wrong CFO, CIO and COO combined.

Take some time with your selection. One good technique is to ask your long-term assistant to participate actively in the recruitment of her replacement. Another is to plan for a lengthy baton pass. A two-or three-month transition period can be helpful to all of you.

On the other hand you don't want to get too fixed on any one person. Think more in terms of the specific functions you need and the style of relationship you'd like.

For example, what level of scheduling authority do you want an administrative assistant to have? If high, you'll need to spend considerable time working with your new hire to define nuances of that authority. Or what level of confidentiality do you expect to maintain in your office? Getting to specifics like these is the real key to a successful transition.

Using such approaches, a few years from now you'll still look back fondly on the years you spent with your old colleague, but you'll be much more comfortable realizing that you can work successfully with a variety of people.

* Dear Coach,

I recently applied for the CEO spot in our medical group (300+ docs) but one of my colleagues was chosen instead a guy I consider less qualified but probably a better politician and schmoozer. As a consolation prize, our new CEO offered me the COO spot which I accepted. Over the past year, our group's finances have gotten pretty bad (something I predicted during the search) and it's clear that we'll need to reduce costs by 10-12 percent to break even and avoid a significant reduction in physician incomes. This will require many unpopular cutbacks.

I've been appointed head of the "cost management" task force. The CEO has distanced himself from the task force, asking me to deliver progress reports directly to the board and to make final recommendations within the next couple of months. Is there any way to accomplish this and still keep my generally good relations with the docs and others?

Nervous in New England 

* Dear Nervous,

Probably not. You're being set up. Your colleague is indeed the better politician. Personally, I'd start job-hunting right now.

In the interim, you can use the tools available to you. Start by making sure that your task force members meet regularly with their constituents, including your practicing docs, nurses and mid-level managers. Increase the number of focus group meetings you personally attend with your key physician leaders and managers.

At every meeting, repeat the facts of the situation clearly without leaping to solutions or trying to sell your favorite answers. Invite everybody into the problem-solving and invite them to help your task force develop some reasonable solutions. The object is to make your eventual recommendations as much of a common conclusion as possible.

If finances allow it, hire a cost management consultant immediately. Ask the consultant specifically to stake out an extreme position, giving you some room to advocate less severe directions. A good cost management consultant will readily understand your dilemma and will be happy to oblige. A bad one won't.

Finally, maximize use of your new direct access to the board. As your task force begins to formulate possible directions, present a list of "options" to the board at an early meeting. Invite your board member directly into the thought process long before you make any final recommendations. Be sure to include the CEO, too. While he may express support to you in private, it'd be much better to get him to express that support in public. Rope him into the evolving solutions.

Overall you're in a tough spot. You're right to be nervous. The job-winner is wisely using you for cover. From his point of view, he's doing exactly the right thing. You need to be equally wise yourself. Do the specific things I've described. And while you're doing them freshen up your G.V. and increase your contacts with recruiters.

Brilliant work might just allow you to emerge unscathed here, but many unpredictable things occur in these situations and it's much better to be prepared.

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