Boldly going where no one has gone before. (Career Rx:).

You know that sometimes, even when you're traveling on familiar roads, you take the map out just to check that you're going the right way. Maybe they built a new mall, or maybe the old red barn that was your guide has fallen down. Whatever the reason, you look at the record to be sure.

That's essentially what I did about a year ago, when I began to sense there were real shifts occurring in what had previously been a relatively uncomplicated area--titles for physician executives. I wasn't prepared for the extent of the change when I looked at the 'map,' that Is, recent search assignments.

Here's what I found: In 1995, 7 percent of the physician executive search engagements of Witt/Kieffer, Ford, Hadelman & Lloyd were for new titles; in 1996, the number rose to 42 percent. But this year-to-date, in my portfolio, the number has grown to a whopping 80 percent. I confess, even given the by-now predictable complexity and turbulence of these times, I was amazed. In effect, we all might as well throw the maps out--we're in uncharted territory.

What do the clients want?

The client organizations--systems, networks, IPAs, managed care companies, and many more--are not looking for "maintenance" people for their senior positions. They are reconfiguring existing positions, or creating new ones to meet new needs, and want to identify and recruit the best qualified people for their physician executive roles. They want individuals for high-risk positions with unique skill sets and bright, new ideas.

It's an exciting time, if you're up for it. But these are some key points to keep in mind, if you want to boldly go where no one has gone before:

1. A longer, larger learning curve is required for these new positions. Everyone wants to hit the ground running, but you may find that your first job is to define your job.

2. No one knows the way. There is both good news and bad news here, and your ability to tolerate ambiguity will be tested mightily.

3. The situation presents more opportunity than ever before. That excites some people and alarms others, Which type are you?

4. More than ever, the risk/benefit ratio needs to be analyzed carefully. Too often, organizations have allowed problems to cause disastrous deterioration and think an MD/Messiah can come in and just "fix" everything. If you're that MD, and you succeed, you're on top of the world. But if the job is too much, are you ready to risk failure?

Is success possible?

On that last point, it's important to look clearly at whether it is even possible to succeed. For example, there are jobs being configured today for physician executives that involve clinical quality improvement--but without any real authority to make the hard calls. If you have the title, but you're not empowered, what can you actually accomplish? Maybe not much.

That's not to say that good situations don't exist. I know, for example, of a recently hired Director of Clinical Effectiveness who is empowered to act with authority while reporting directly to a supportive, enthusiastic Chief Medical Officer.

New titles, new work

Here are just a few of the new titles from my current search engagements. See if you can quickly define their day-to-day job activities:

* Vice President, Network Development

* Vice President, Clinical Quality Improvement

* Director, Clinical Informatics 

The first two may not have stumped you, but the last one is truly cutting-edge--a senior-level executive whose job, essentially, is to explain the Information System to physicians, to bring them on board and up to speed.

One of the first questions I am asked by individuals that I interview for these and other "out there" roles, is: "Is this a dead-end sort of job, or is there potential for true advancement?' My advice is that it's up to them to avoid being pigeonholed by maintaining a big picture attitude and demeanor. If they are able to deliver on their goals, these new roles should be excellent rungs on the senior executive ladder.

Due diligence 

None of the factors/questions that follow are in and of themselves a good reason to turn down an opportunity. Nobody can make those choices but you. But I would suggest that you keep these issues in mind if you are planning to "boldly go into new and largely undefined roles:

* Ask if this is a new title to get the lay of the land. If a search firm is assisting an organization, you know the position is being configured with consultation that should result in more realistic expectations than if the organization is going it alone.

* Be careful. Look at where the job is in the organization. and to whom it reports. Most importantly, determine if it is conceived as an adversarial role, often a thankless task.

* Consider what you bring and what you would bring away. Every job can teach you something, but some wear you down while they do it. Will the job use your talents to the utmost? Will it leave you stronger?

* Does it have 'teeth'? By teeth, of course, we mean muscle. Would you actually be in charge of something? Is there a reasonable balance of authority and responsibility?

* Is it doable? Fair question, especially if it is a new role that no one has attempted in this organization previously. One way to find out--ask your interviewers how they think it can be done. Especially, ask the individual to whom you will report. If you can't get a good answer on this, you should look before you leap.

* Who are the key people already on the scene? You can tell a lot about an organization by the people in its key relationships. I know of one young physician executive who had to learn the hard way. After a while he realized he had misgauged his direct report. He ultimately realized that he was brought in to be a hatchet man, not a Messiah. He was used up in the process, a bitter experience that he vows he will never repeat.

* Is It well-funded? Remember Charlton Heston trying to make bricks without straw in The Ten Commandments? Hot, hard work. Make sure the financial capital that is needed is available to your work.

* Is this boat afloat? Weigh up the stability of the situation carefully. Look particularly for longevity among senior people. If nobody has been there more than two years or so, and it's not a start-up company, consider that a red (or at least a yellow) flag has just been raised.

What are we looking tar?

As noted, each skill set required for each new role is unique to a certain organization at a specific time in its history. Organizations want to find people who can do what has never been done before--for them, at least, if not anywhere in the universe. How does that translate into experiences that you might want to acquire?

Most organizations today are looking for individuals with some networking experience, but analogous experience (such as in a multi-site medical group or active involvement in formation of IPAs) is often a good alternative. In addition, true line experience in one or more organizations is a solid credential. Knowledge of where managed health care dollars begin and end is a necessity. As always, executive style and presence are expected.

The fact is, there is no single place where one can go to find the individuals for these new roles. And as hard as we are working to find them, it is still also true that they find us as well. If you have an eclectic health care management background with unusual interests and skills, you owe it to yourself to make sure that reputable executive search firms know about you. Eclectic is in.

Mary Frances Lyons, MD, is an Executive Search Consultant with Witt/Kieffer, Ford, Hadelman & Lloyd in St. Louis. She can be reached at 8000 Maryland Avenue, Suite 1080, St. Louis, Missouri, 63105 or by calling 314/862-1370. Please fax career development questions that you would like addressed in this column to Dr. Lyons at 314/727-5662.