Ask the coach: physician executive experts answer your medical leadership and management questions.

* Presidential Politicking

We've had a terrific president of our 120-physician group the past nine years, but he's getting near the end of his term and starting to act like he doesn't plan to renew his contract. We have no formal succession plan. I'm an elected board member and the medical director for quality. I'd really like to move up in management but I'm not sure how to position myself either as a candidate for president or at least for some advancement if somebody else Is chosen. There are four other likely internal candidates, all of them with track records comparable to my own. Got any ideas?

Pondering the Presidency

* Dear Pondering,

Yes. The main thing to remember is that one out of five are not great odds and that doesn't even include outside candidates. So keep all your options open and don't burn any bridges. Here are a few specific actions.

First, talk to your esteemed president. Tell him you're enjoying management, are thinking about your future and would appreciate some guidance. What does he see for you in the years ahead? What might be some possibilities for your advancement? How can you prepare yourself for continued success?

I'm betting that such an open approach will allow your president to discuss his own plans a little more, as well as share some of his thoughts about succession and the future composition of the management team. A valued outgoing president often has a considerable influence on his board's choice of successor and a better understanding of his views will greatly help you make some better decisions of your own.

Second, do a little networking with your peers, the other physician leaders on your team. What are they thinking? Some doubtless see themselves as successors, others may not or perhaps they're just uncertain like you. Getting a dearer understanding of their views and those of your boss will help you better understand the odds and decide your' best course of action in the months ahead.

One thing's for sure, very few medical group boards will choose a new president without clear evidence of their abilities to lead physicians and manage money. Quality is a wonderful background in general but often insufficient by itself for CEO preparation

In preparing yourself for a senior executive career in the future, make sure your experience begins to include leadership and money management. If someone else is chosen CEO this time around, what opportunities might open up that include more financial or personnel responsibilities for you? Might you be a good candidate for chief operating officer, group medical director or head of a major line unit such as surgery or primary care?

I have a feeling that if you ponder this situation more carefully and evaluate your options thoroughly, a number of excellent career alternatives will emerge.

* Out to Lunch

I'm the chief of staff for a mid-sized hospital in the Midwest and I'm concerned about my chief of surgery, a 45-year-old woman with a bright future in management whom I see as my probable successor Last week, while out for lunch at an out-of-the-way bistro, my wife and I noticed this physician's husband at a nearby booth having lunch with a much younger woman. When we walked up to say hello he was obviously uncomfortable, averting his eyes and forgetting to even introduce us to his lunch partner. My wife thinks I should report this scene immediately to my colleague. Fm not so sure. We're having our usual quarterly review together in a couple of weeks. What should I say?

A Suspicious Scene

Dear Suspicious,

Based on what you've told me? Nothing. You have no clear information whatsoever. For all you know this spouse was just having a difficult interview with a problem employee or lunch with an estranged niece. You don't have anything meaningful to say.

The only way such an experience might be relevant to you and your chief of surgery is if there are problems in your hospital or if the 4 chief herself asks for your advice. If the chief has been performing poorly, for example, or seems distracted at work, you might inquire if there's anything keeping her from performing her duties.

I suppose, in the face of significant workplace problems, a lunch scene like the one you described might lower your threshold to asking this kind of open-ended question. By themselves, however, marital relations are dangerous and often inappropriate subjects for review with an otherwise effective colleague.

Your bistro suspicions are much more likely to be valuable at home watching the latest episode of CSI than in your professional workplace.

Truthful Tales

When should you lie? I'm the VPMA of a 250-bed hospital owned by national firm. Our hospital is apparently 'in play" as I, and other members of the senior management team, have recently been asked to meet with several pro spective purchasers.

The owners' favorite buyer appears to be a venture capital group with frighteningly little experience in health care and somewhat uncertain sources of future capital.

Following a recent meeting with our whole team, two of the purchaser's representatives asked me out to lunch and inquired about our capital needs over the next five years. I gave them quite an earful. Our needs are really significant, involving decrepit buildings, antiquated information systems and many badly needed pieces of clinical and imaging equipment.

The following morning the you-know-what hit the fan! My boss, the CEO, read me the riot act about my "sneaky" behavior and my undermining of the potential sale. I've often heard you and other leadership experts say that personal integrity is the bedrock of real leadership. All! did was tell the truth. Was! wrong?

Miffed in the Midwest

* Dear Miffed,

Yes and no. No, you weren't wrong to tell the "truth," at least as you perceive it. Deceptions eventually catch up with mid-level managers, usually at exactly the wrong time. In his recent book, Leading Quietly (An unorthodox guide to doing the right thing), Joseph Badaracco makes this point most eloquently.

What you did wrong was do it in private, exuberantly, over a lunch table with people who have an obvious bias rather than in front of your boss and the owners' representatives where expressing such views is appropriate, even essential, to a successful outcome for your organization.

If those are your views of the probable future needs, the place to start is during Both your annual capital budgeting process. Create a clear paper trail, including both a clinical and economic justification for each investment. Repeat your thoughts to your boss, to your owners, to your teammates and in appropriate group sessions with potential buyers when the subject comes up.

There's no need to get hysterical about it. I'm sure there are both pros and cons to your positions. Express your own views in settings where others' views can be heard as well. Sometimes the paper trail is useful in summarizing such discussions for potential buyers.

Both your patients and your colleagues deserve effective representation of their potential needs for future clinical assets, by someone well trained to understand them like you. The place to do such representing is not in a dark corner over soggy lasagna, but in more appropriate forums in the bright light of day.

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 executives. Questions for his future columns are encouraged and should be sent directly to [e-mail].

* 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.