Breaking through the caducean ceiling. (Climbing to the Top).

SO YOU'RE DRAWN TO the management side of medicine. You'd like to run a health care organization some day.

Does the caducean ceiling that appears to block physicians from the CEO's office make it impossible to reach your goal?

Not at all, say those in a position to offer advice. Here's how physicians need to groom themselves for the ultimate career breakthrough.

Pick your spots

There are certain organizations that typically select their leadership from the ranks of physician leaders.

Unlike the rest of the health care industry, the military invests significantly in training its physicians to be managers and leaders, says Frank Byrne, MD, president of the Parkview Health Foundation in Fort Wayne, Ind.

With rare exceptions, the deans of medical schools are physicians," says Frank Riddick, MD, FACPE, who was chief executive officer of the Ochsner Clinic in New Orleans and its foundation.

Traditional large teaching hospitals will tend to pick physician leaders. Doctors, of course, head the American Medical Association and the various specialty colleges. They are also often at the helm of medically oriented philanthropic foundations and federal agencies like the National Institutes of Health. Large group practices of physicians typically select an MD as director, as well.

Ochsner, like the Mayo, Cleveland and Lovelace clinics, the Group Health Cooperative of Puget Sound and some others, grew into a complex integrated health care delivery system. In these organizations, there is no caducean ceiling. The chief executive is almost universally a physician who has come up through the ranks, Riddick says. They are also organizations in which senior physician executives are usually able, and even encouraged, to maintain a modicum of clinical practice.

Elsewhere, unfortunately, warns Riddick, "vice president of medical affairs, although it can be a stepping stone depending on the system it's in, is typically about as high as you can go. Often when physicians are asked to take positions with hospitals, it's to bridge the Chinese wall between doctors and administrators. And the management of hospitals is a pretty strong union."

So finding the right venue is part of what you want to do, Riddick says.

Get management training

"Physicians by and large come to the table late," Byrne says, "although I think that trend is going to change over time. But the skill sets are so different between being a successful physician and a successful executive. A physician is outcome-oriented, whereas executives need to be process-oriented--adept at conflict resolution and communication. And physicians have virtually no financial training unless they go out and get it."

Which is exactly the first priority for the doctor who's a CEO aspirant.

"One of the most user-friendly options is the graduate program in medical management offered by the ACPE," suggests Byrne.

That's the road he chose to fulfill "my own goals, which were to stay employed, stay married and stay sane, while getting a legitimate master's degree." (His was conferred by Pittsburgh's Carnegie Mellon University.)

There are, of course, many other routes to academic credentialing in business. Their suitability is dependent on an individual's focus, ability to devote time to a program and mobility.

But make no mistake, experts say the fanciest diploma and $2.50 will get you a decaf latte at Starbucks.

"I think physicians who get management degrees are often somewhat surprised and disgusted that they're not immediately chosen for a VPMA job at a 600-bed hospital," Byrne says.

Get experience

"If you were a candidate for a CEO position," says Donald Hofreuter, MD, "you would have to show me operational experience--if not as a COO, then at least with responsibility for more than one department. And that wouldn't be enough. You'd also have to show me that you had the fortitude to make the tough calls while running a successful operation with good numbers, high staff morale and so on."

Simply boasting that you can herd cats--a staff of quarrelsome, independent-minded physicians--is not a valid ticket to the chief executive suite, Byrne says. "Most VPMAs don't have profit-and-loss responsibility."

Still, becoming involved in medical staff committees is a good way to dip your toes in the management waters. Serve as chairman of a committee or two. Then, especially in smaller facilities, take on part-time departmental administration. If that agrees with you, assume fulltime responsibility, Hofreuter says.

To be viable as CEO candidates, executive recruiter Carol Westfall says, physicians must demonstrate "any P&L experience where they could get their hands around a project and own it, take it from end to end. Especially anything that can be seen as a turnaround. Physicians need something like that for their resume because they have some catch-up to do."

Be square and be there

Getting to the top will be an arduous flight, with many unforeseen layovers, diversions and cancellations along the way. And the destination may not be as attractive as the brochures suggest. But once embarked, play it smart.

"Most physicians are not familiar with how to use headhunters," says consultant Leland Kaiser. "CEOs have developed experience with placement firms."

If hospital management is a strong union, it would seem to behoove the would-be senior manager to join the union. And yet only 410 physicians belong to ACHE. Byrne is one of them, both an ACPE board member and a regional regent for the ACHE. "It has helped me," he says, "with networking opportunities--meeting, understanding and interacting with other health care executives."

"Physicians have a lot to bring to the CEO suite," acknowledges ACHE president Thomas Dolan, "as long as they also bring the education and the experience."

In fact, demographics bode well for physicians who want to break through the caducean ceiling.

"It's really getting hard to fill these chief executive slots," Kaiser says. "I know of one organization that's been looking for six months and still doesn't have a good candidate. And there are a whole bunch of retirements coming up across the field. In the future, demand will be greater than supply--and that's going to work in the physician's favor."

David O. Weber is a frequent contributor to this journal and 2002 winner of the eighth annual award for trade journalism presented by the National Institute for Health Care Management Research and Education. He can be reached in Mendocino, Calif., at [e-mail].