Bouncing back. (Career Rx).

Health care barometers show that these are turbulent times for leaders in our industry. Reports indicate the annual turnover rate for health care CEOs is nearly one in five. Witt/Kieffer's In-depth interviews with a select group of health care executives show that 40 percent expect shorter tenures in the next 10 years. Sometimes job stress contributes to the executive's departure. But in other cases, the problem centers on the volatility and instability of the health care entity Itself in a turbulent climate, not the physician executive who leads It.

As an executive search consultant, I advise hundreds of physician executives each year, the vast majority of whom are in some stage of transition professionally. Lately, I've noticed a number of bright, young physician executives who surface after having taken their first (and even second) senior-level position within a PHO or physician management joint venture. This is where many of the new management opportunities have been housed as the configuration of health care delivery has evolved. But, unfortunately, within a year or two, the entity folds--through no fault of the physician executive.

Perhaps the organization relied on a new or untested model, or maybe It failed to reduce costs, gain additional managed care contracts, enhance reimbursements, or create crucial partnerships. In some cases, the venture may have had insufficient capital or perhaps the board failed to predict marketplace shifts accurately. Whatever the reason, the physician executive is out of a job and in search of a new career opportunity. It's clear to me that the outcome is not related to the prowess of the physician executive, but rather to commitment and other essentials that are the underpinnings of enduring ventures.

If you have taken a similar career sidetrack--or maybe more than one--realize that you are still marketable. You have skills, traits, and knowledge that are transferable to many new opportunities in health care. When you sat down to plan your physician executive career (and I say this knowing that in many instances, the positions found you rather than you finding them) you planned to have stability, to be able to show results, to demonstrate leadership, to create new infrastructures, and to report professional success. This less than "successful' outcome looks like nothing else you've tackled in your experience, and you are used to getting an "A." This, by contrast, feels like at least a "D," if not an "F."

Fortunately, many leaders today in health care and executive search are familiar with your plight, given that they all have their own version of initiatives that did not fly. They will not judge you unfairly because they understand all too well the complex pressures of today's health care environment, filled with risk, cost constraints, and unrealistic profit targets.

Bouncing back from an unfortunate career move

But if you're bouncing back from an unfortunate career move, these steps may keep you focused on your search for new health care opportunities:

* Recognize that you are not alone. You'd be surprised by the number of credible executives who accept new positions, uproot their families, and then realize they made a less than sound career decision. They picked themselves up and found better career opportunities. So can you.

* Realize that the entity failed, not you. Take a step back from the situation and attempt to gain perspective. Sit down and make a list of your strengths, marketable skills, past successes, and goals for the future. Such an exercise can demonstrate that you have much to offer a new employer.

* Discuss the farmer position in a positive light. What did you learn from the experience? If you gained valuable management skills, be certain to focus on those positives, especially when discussing your experience with potential employers. And, importantly, you learn significantly more from the "failures" you've encountered than from the successes.

* Don't give in to cynicism or self-pity. Adopting a cynical attitude will only hurt your chances for a new position. Employers don't hire cynics because they don't want that attitude spread throughout the organization. Having seen that from both sides. I've had more than one client decide that a potential candidate is too far over on the cynicism side of the philosophy curve to go further. Conversely. I interviewed one executive who acknowledged he had learned much from his past missteps. His sense of humor and honesty were appealing, and, ultimately. irresistible. It was obvious that his past experience seasoned him. He landed on his feet once again.

* Don't let it happen to you again (if at all possible). Continual change within health care will occur for some time to come--and so will the potential for future career "missteps" (though by now I hope you are beginning to see them as learning opportunities). Be ready for the unexpected. Rely on your experience to point you to the opportunities that look promising. not risky. If your paperwork is beginning to take on an air of instability, make sure that your next decision is made with some thought given to potential longevity. If you are a risk-taker, you may not need that. The most important consideration is positioning yourself so that, at the conclusion of the experience, you have measurable, live accomplishments to report, you have evolved professionally, and you are the best judge of the potential trade-offs there.

* Play an active role in structuring your next position. Perform due diligence to help ensure you'll win a job that will lead to career success. Work with your next employer to structure the roles and responsibilities of your new position. Know what the trustees will expect of you, and create a document that defines what you plan to deliver. Negotiate a strong severance package.

* Work with executive search consultants who specialize in health care. You will, no doubt, find it helpful to work with an objective consultant who understands your situation. Health care executive search consultants can steer you toward new opportunities that are right for you. Equally important. they will provide you with insights about organizations and staff to aid you in your decision-making. You also can rely on them for assistance in rejuvenating your career. They can provide you with marketing ideas, resume development, interviewing skills, negotiation strategies, and more.

Focus on your strengths. boost your self-esteem, network every day, take action, and never doubt the importance of your personal integrity. Remember, too, that your new career move is always within reach-- whether you make the decision to go looking or others make that decision for you.

Mary Frances Lyons, MD, is a Senior Consultant at Witt/Kieffer, Ford, Hadelman & Lloyd in St. Louis. She can be reached by calling 314/862-1370, via fax at 314/727-5662, or via email at [e-mail]. Please fax or email questions that you would like addressed in this column to Dr. Lyons.