Balancing certitude and ambiguity.

You know what they say: Just because you're paranoid doesn't mean someone isn't watching you. If you have been feeling a bit uncertain about the state of health care and about your own career outlook, you probably have a good handle on things. These are uncertain times, and you must balance out the ambiguous feelings and doubts to keep your perspective.

You've been preparing for your executive role for years, and now you're moving your family halfway across the country to take on your first administrative position. How can you know if you are doing the right thing? The answer is, you can't...you can only make the decision, and ensure your success by meeting or exceeding your new employer's expectations.

If you have sensed (or experienced) this great tumult in the physician executive area, there are also data to support your disquieted perceptions. I recently analyzed our firm's search assignments over the past two calendar years and found a substantial increase (by a factor of six!) in new physician executive positions. That means the chances are great that you may be the first physician executive in a newly-created position. When you are the first, with no real precedent, it's difficult to know if you are doing "the right thing." And as uncomfortable as that may seem, it appears that you will have to learn to live with that ambiguity.

What is happening is that a group of intrinsically risk-adverse people--physician executives--find themselves working in a volatile and risky environment. This is a new dynamic in health care. All bets are off. In a world without guarantees, there is uncertainty everywhere--big questions surround every decision and every entity. Even the "safest" situation has become a potential minefield as organizations restructure, redefine, and downsize. Heaping quantities of character are called for in this exciting, and also frightening, new order.

As an extreme example, I know a physician executive who was hired as Vice President of Medical Affairs at a large hospital facility a couple of years ago. He was due to start there on a Monday, but he stopped in on the Friday before to check on a detail--only to be told that a deal had transpired, the organization had been restructured, and his job would be eliminated! Business moves fast, and this deal had been confidential until it had been concluded. He was offered an attractive payout by the organization; if he chose, he could take the money and run, and that was a reasonable option. But they also presented him with an interesting alternative course of action: He could stay on and join them in a new, and as yet undefined, executive role, while learning a set of skills to fit the evolving situation.

Fortunately, this physician executive was not the type to be derailed by a charge in course. Although he could have been caught in the headlights like the proverbial deer, wondering what was happening as he was being mowed down, he rolled with the punches, accepted the challenge, and took on the new role. In the past two years, he says, he has experienced an exhilarating life as a key executive in his newly-formed corporate entity. In sports terms, you could say he was blindsided, but took the opportunity to move forward. Fortunately, most new developments will be less cosmic.

Two types of "surprises"

Balancing certitude and ambiguity is a constant challenge. And even when you think you are prepared, things can happen. Two types of career-related "surprises" can confront a physician executive; a true surprise is one that could not have been foreseen, as in the previous example. Closely-held deals, in which investors may not be alerted by casual talk for fear that stock prices may be depressed or spiked upward, require absolute confidentiality. Up to the last minute, a deal can fall apart, and the participants are likely to feel that the fewer people who know, the better. There is no embarrassment for someone who is caught in the middle of this sort of "surprise." But even in that case, one should expect the unexpected.

The other sort of "surprise" is a self-imposed one--the situation in which all of the signs are ignored by burying one's head in the sand, as though change is an issue that can be wished away. Not so, as too many have learned when the dust has cleared on them and their damaged careers. This ostrich mentality has no place any longer, if it was ever a viable strategy.

The grace period is almost over

In the past, physician executives had fewer opportunities to become skillful in working adaptively with change, since the traditional health care organizations in which they toiled were especially notable for their stability and inertia. And you just don't develop speed when the pace is slow.

But that pace has definitely picked up in recent years, and is only expected to accelerate in the future. We are now in a hard-charging, fast-paced time, requiring energy and purpose. The grace period for status-quo physician executives is almost over; expectations continue to escalate. Change is a reality and it must be faced.

Responding to change

The response to change of a reasonable individual is to protect him or herself by understanding, anticipating, and accepting. These are some basic adaptive behaviors that can be used:

Be clear about your professional goals and plans. Think through what you need to be satisfied in your career, and make a plan to accomplish those goals.

Conduct "due diligence," the phrase used by lawyers to indicate that every effort has been made to explore options and potential outcomes; in other words, do your homework.

Have a contingency plan; develop a broad view of life that admits the possibility of changing course or going in a different direction.

Prepare for the worst, hope for the best. Deals can fall through and plans can change, so be ready for a change of course while you maintain your career on its track.

Some specific things you can do in the latter category:

1. Constantly review your skill set to remain current. It's essential to have experience in a wide range of settings and environments, both in traditional acute care and managed care. Make your job expand to enhance your skills, especially the transferable ones.

2. Keep your eyes open for new opportunities, and explore the ones that look interesting. You don't need to go on interviews if you're happy in your job, but talk to executive search consultants from time to time. They know what is happening in the marketplace.

3. Become adept at networking, partly to remain "in the mix" and partly as a means of keeping up-to-date on the big picture. Let people tell you what it was like to work through and survive a merger or reorganization, for example. It's useful information that you might someday need yourself.

4. Acquire and work with a career mentor, as soon as possible. Don't wait. As Chicago politicians always said in relation to voting: "Early and often." One of the key findings of our recent national survey of successful physician executives is the prevalence of the mentor (usually, another physician executive), who provides career guidance, experienced counsel, and support.

5. Stay calm. You can handle this. Most physician executives are great part-time schmoozologists who can deal with whatever life hands them.

The case of the proactive physician executive

One of the activities that consumes a lot of my days is networking--sometimes this means being a listening post and career counselor for physician executives. They call me with career questions and concerns and ask my advice on a wide range of issues. It's a great way to stay in touch with people, and it offers me a window on the daily working world of the physician executive.

One MD in particular has used me as a sounding board, especially to bounce off ideas about her new CEO. There had been no overt talk of changes in her situation, but she was sensing that the chemistry between her and the CEO might not be good, and wondering whether the CEO might view her as an unwanted legacy from the previous regime.

After exhaustively reviewing her options, she weighed her perceptions and decided that, in fact, she was not "in trouble;" she remains in her 30b as a productive executive team member. But the point is, she was not willing to close her eyes to the possibility of change and simply wait for some awful blade to fall, and she did not want to let her new CEO take all of the initiative.

Instead, becoming proactive and assertive, she took control of her career destiny by framing questions for the CEO: "Am I the right person for this job? Would you prefer that someone else was in this job? What contribution can I make that will advance the organization along the lines that you envision?" It certainly took some courage for her to act, but taking control does provide its own rewards. As she said, later, "At least I was shaping my destiny and not just waiting for it to happen."

Sounds like a plan to me. When you take control, you can make sure that the career decisions you take are the right ones.

Mary Frances Lyons, MD, is an Executive Search Consultant with Witt/Kieffer, Ford, Hadelman & Lloyd in St. Louis, Missouri. She may be reached at 8000 Maryland Avenue, Suite 1080, St. louts, Missouri, 314/862-1370, fax [phone]. Please fax career development questions that you would like to have addressed in this column to Dr. Lyons.