Career paths for women physician executives.

The career path leading toward being a physician executive is similar for men and women, but there are some issues that have unique elements for women. Thus, any person interested in developing a medical management career can follow the advice in the following pages, but it is especially useful for women or for those who are coaching women in career development and management.

If you are thinking about your career and your future, it is important to take time to assess your present situation before you plunge into a new area.

Find out what you want.

Use a technique called "free writing." Write the answer to the following questions without worrying about spelling, punctuation, grammar, or anything else some English teacher told you to worry about.[1] Time yourself so that you spend two minutes on each one. You must start writing and not stop until the two minutes have passed if you want the exercise to be effective. Ideas will come to you if you keep writing; they will not if you just sit and think. If you can't think of the next thought, just write over and over, "I can't think of anything," and you will find that something pops into your head. After each question, I'm going to list some answers I have gotten in the past to help spur your thinking.

* Write one thing you like about your job.

I like seeing patients, especially those I can help and those that appreciate it. I like planning for the future of the organization--how we will better serve patients, how the medical school will better train physicians to work in a rural area by doing internships in rural areas. I like organizing a lot of detailed information.

* Write one thing that frustrates you about your job.

Patients who beg for drugs. The threat of being sued. Increased paperwork. Someone else telling me what tests I can and cannot do.

* What kinds of things are you putting your energy into now?

Getting an MBA, seeing patients, taking care of a new baby, searching for a job.

* What kinds of things are you struggling with?

I don't think my second marriage is going to make it. My sitter is moving back to the east. People in the office are complaining that I micromanage--I don't let go of anything. I didn't know I was like that, and I don't want to be like that.

* If you had a magic genie, what would you command it to do to solve a problem?

At first people may say--give me the right lottery numbers, but, as they write, they sometimes realize that what they want the magic genie to do they can do themselves.

* Who are the people who are important to you?

Spouse, children, parents, some patients. I have worked with people who did not mention spouse. That's a clue to me that big life changes are on the horizon for that person. It's just a matter of when it is going to happen.

* Name an image or a picture that describes your life right now.

My life is like a roller coaster--up one minute, down the next. My life is like banana pudding. It tastes good, but I'm drowning in it. My life is like a deep pit. I'm sinking in decisions that other people have made for me.

* What are your hopes and dreams?

To write a book. To win the lottery. To make a difference in the delivery of health care. To be CEO of my hospital.

* List some things you do to take care of yourself.

Walk three miles a day. Run. Play tennis. Listen to classical music. Get up an hour before my children do so I can have some time alone. Get to the office an hour before everyone else does. Close my door during lunch and take a nap.

* List the steppingstones of your life. Significant events that have led you to where you are today. After you have made the list, ask yourself these questions: Do you see any patterns? What looks like the next logical step?

One physician said he saw a pattern of leaving situations when they get difficult. He didn't want to do that again this time. He was having difficulty in his second marriage and second practice.

You feel most satisfied if life makes some sense to you. I was a high school English teacher, then a college English teacher, then a consultant doing writing workshops. I then added speaking and listening seminars to my repertoire, followed by career development. It seems a natural progression to me. What is your natural progression? Did you put aside some activities to make way for others? Do you want to go back and pick them up?

Take the time to write about these topics. Then, if you want to become a physician executive, what steps should you take?

Become a board-certified clinician who practices 3-5 years.

You do not have to practice full time, but it has to be in a setting where you are fully responsible for some patients. Nancy Ashbach, MD, MBA, says, "The clinical experience is critical5 years of it, but not necessarily full time. Urgent care facilities where you haven't had full responsibility for patients are not as good as 1/2 time for Kaiser or 1/2 time for a group.'[2]

Get management experience. Serve on committees and task forces. Let people see you doing management activities-- working with people and tackling problems. If you serve on the long-range planning committee, the utilization review and quality assurance committee, the credentialing committee, you can claim all of them as experience when you are ready to move more into management.

Get involved in the county medical society, the state medical society, the American Medical Association. Some HMOs and insurance companies hire people to do utilization review and quality assurance part time this is valuable experience.

You may have to take a management job that is not quite fight in order to get the necessary experience. Once you go into the management arena, you may have to move every 3-5 years. You need to think about whether you want to do that.

Three career paths of women physician executives are shown in the box on page 47. They are very similar to those of many male physician executives I have talked to. Women can wait and go into management in their 40s. Many men do that. Many women have more time because their children are older.

Get education.

The Physician in Management seminars of the American College of Physician Executives are excellent. Attend the College's National Institute, which has even more concentrated areas of study. Be on the alert for informal educational opportunities from other national professional organizations and from local colleges and universities. Get a master's degree if you have the time and financial resources. Remember this, however. A master's degree will help you do a management job, but it will not guarantee that you can get a management job the way the MD guaranteed that you could go some place and practice medicine. You will still need experience to get a management job.

Find a mentor.

Roger Schenke, ACPE Executive Vice President, advises, "Find yourself a mentor--male or female. Someone who has experience, who will help you think. Look for someone who is an effective person. If you admire the person and think you would like to be more like him or her, try to get on a committee that the person is on or in an education program that the person is in. Get in the same room, get to know the person. It will be natural for the conversation to be around management issues. Then ask: 'How does someone get involved in management in this organization?' 'How did you get to where you are?' 'Has this management change been good for you?' What education did you get?' If that person sees you begin to do management activities, he or she becomes like your mother or father. They feel like a parent by helping to get you started."3

Mentoring takes less time than many people think. The person does not have to be in your organization or even your town. You can call the mentor and say, "Can you listen to me for a while? 20-30 minutes."

Mentoring does not have to be regular. I have heard people try to set up formal situations--a contract where I'll help you with your weakness and you help me with mine. Once in a while that might work, but a formal commitment to a specific amount of time can scare people off. They may give you that much time because they get interested in you, but they don't want to promise it.

In some companies, mentor situations exist where some* one comes to your place to see how you do things. It's almost like an internship, but these situations are rare.

Carefully maneuver within the male network. Don't continue a mentoring relationship if sexual stuff gets in the way.

Kate Rand Lloyd, editor-at-large of Working Woman magazine, was asked the question, "Why don't women support other women?" She replied, "In no society do the powerless ever support the powerless."[4] When women first began to gain power, some were protective and wanted to keep it for themselves. "Most women in powerful corporate positions today are ever mindful of their responsibility to help pull other women to the top."

Lee Kaiser says, "...we are all mentors for the people who have not moved as far on the path as we have, and at the same time we are dependent on mentors who are further along on the journey to help us take the next step....You may never be able to help the people who help you. Your service is to those who are coming along behind you."[5]

Slow down a little for motherhood.

Women can have most of what they want, but not all of it at the same time. Some parental figure has to be with children, spend enough time with them, listen to them. If you have a husband who can listen well, does not always tell your children what to do immediately, and does not pass judgment quickly, you don't have to be there as much.

You can be a good clinician, a good physician executive, a good mother, but not all at once. Maybe it will all work for a time, but then your sitter moves back east, and you are thrown a curve. You probably will have to cut back on something when your children are born until they are school age. Then you will notice you can add more. You can add still more when they are teenagers, because you don't have to dress them anymore and they are not home as much.

When my children were 14 and 16, I took consulting jobs back to back that kept me away two weeks. I was new in the business, and I didn't want to turn anything down. But the mop-up work was too much when I got home. The school work had gone to pot for one, and the social life had gone to pot for the other, and they had wanted me there to help with it. I vowed not to do that again for a while. Now that my daughter is in college, I can go more because my son and husband get along well, and he doesn't need me as much emotionally as she did.

In Backlash, the author claims society is trying to push women back into places they used to be in. There may be some truth to that, but, as New York Times columnist Anna Quindlen says, "Society doesn't project on us these contradictory feelings we have after we go back to work after having a baby. When a mother picks up her youngest child from preschool and the child says, 'Mama, I missed you so much,' that is not pressure from society; that is pressure from the reality of raising children."[6]

When my children were 2 and 5, I thought, "I can't do this motherhood thing any more. It's just too much for me. I'm not cut out for it. What can I do to make it go away."I went to a counselor to complain about my headstrong 5 year old. As you might guess, the problem was with me more than with the five year old.

Here is what she said to do. Spend 1/2 -1 hour with her every day doing what she wants to do. If you play a game and she wants to cheat, let her. If you start to color and she wants to finish your picture, let her. Don't do a project where you know you will lose your cool. (For us, that was baking cookies. I always thought mothers and daughters should do that, but I always ended up screaming when flour hit the ceiling.) As long as she did not throw a tantrum, I stayed with her and let her make up the rules.

If you can work all day and find that half hour to give each child at night, I think they will do ok. If you are moving in a direction that takes you away from home too many nights when your children are young, somebody is going to suffer--the kids, your health, your marriage, something.

Improve interpersonal communication skills.

One CEO has said this: "My present position as CEO depends on constant attention to the development of interpersonal skills, including patience, tolerance for delays, comfort with ambiguity, and learning to negotiate win/win situations. Never before were listening and communication skills more important."[7]

Take courses, read books, practice whatever you think your weaknesses are. I thought I could speak and listen well, but I knew I avoided necessary confrontation with some male figures, particularly those who reminded me of my father. It was not necessary for me to become someone who screamed and confronted everyone on everything I didn't like. It was necessary for me to calmly and clearly say what I wanted in some situations without retreating, brooding, and never saying what I thought and felt.

Resume.

Put together a short powerful resume, as opposed to the long CV that most people have. You not only tell where you showed up for work and when but also what you accomplished while you were there.

Example:

Medical Director

Healthplan of Baltimore

Baltimore, Maryland 

Recruited and hired 20 physicians for the medical staff of this group model HMO. Developed four new satellite centers, implemented an innovative HMO/hospital capitation arrangement, and reduced length of stay from 350 to 300 days per 1,000, which has resulted in a first-time operational surplus for the plan.

Networking.

Get to know more people than you know now. Most people get a job because they knew someone who knew someone that led to the position. People have to know who you are and what you can do in order to recommend you for a job. They need to see you tackling problems and working with people. I've known a few people that didn't have all the experience that the company wished that they had, but someone knew them and thought they had the qualities it would take to do the job.

How do you network? Increase your visibility--make speeches, write articles, serve on committees. Make phone calls, attend meetings and talk to people while you are there, send letters, send thank you notes, call people again, read journals for advertised positions, contact search firms. It's more work than most people want to do, but few people get to skip it.

Check Your Interviewing Skills.

Find out how you interview by watching yourself on videotape. If you have a friend who will pretend to interview you--good. If not, talk to yourself in front of the camera. Do you sound confident but not arrogant or argumentative? Do you sit up straight, walk holding yourself up-- not slouched over, looking meek. Do you have a firm handshake, but not one that breaks knuckles? Do your clothes fit well, look businesslike and conservative, tailored with nothing lowcut at the neck and no extremely short skirts?

I've been talking about a career path as if it might be a straight path that leads you in one direction, but don't have linear tunnel vision. Constantly scan the horizon for opportunities. I started working on a PhD in English because I wanted to be a tenured professor in a college. I had been teaching English in colleges in North Carolina and Florida for four years. When I finished the course work for the doctorate, an opportunity to do consulting landed in my lap. I took it and have been heading in that direction ever since. Now I would not want to go back to the original dream.

References

1. Some of these questions have been adapted from:Nelson, L. "Learning from Within: Ira Progoff and the Power of Personal Writing." Media and Methods, Sept. 1978, p. 112.

2. Ashbach, N. Personal communication.

3. Schenke, R. Personal communication.

4. Marquez, M. Orlando Sentinel, March 13, 1992.

5. Kaiser, L. Lifework Planning. Brighton, Colo.: Brighton Books, 1989, p. 7.

6. Pogash, C. "Backlash." Working Woman 17(4):64-7,104, April 1992.

7. Henry, R. "The Road to System CEO." In Roads to Medical Management. Tampa, Fla.: American College of Physician Executives, 1988, p. 39.

Representative Career Paths for Women Physician Executives

Nancy Ashbach, MD, MBA

* Went to medical school when she was 31, having raised her young children.

* Was a clinician for 10 years (1979-89).

* Became managing partner of a group.

* Served as chief of department several times.

* Got an MBA.

* Became medical director for managed care organization in 1989.

* Became executive director of managed care organization in 1991.

Kathleen Musser, MD

* Started her own surgery practice in 1976, which involved starting a small business with no business training.

* Involved in local medical politics.

* Got involved in managed care.

* Served on committees (nutritional support committee, tissue committee, state trauma committee, credentials committee).

* Instructed in residency teaching program.

* Moved into managed care as surgeon in 1984.

* Became chief of staff at specialty center.

* Became acting medical director in 1988.

* Became medical director.

* Became executive director/medical director.

Sim Tan, MD, FACPE 

* Clinician in HMO (1979-1984).

* Volunteered to be administrative support to the medical director. These were unpaid extra duties on top of clinical practice. She saw it as a way to find out how to do something she was interested in.

* Head of pediatric department.

* Head of clinic.

* Part-time utilization review medical director.

* Full-time utilization review medical director in 1983.

* Dropped clinical practice.

* Full-time medical director in 1984.

* Managed care consultant.

Barbara J. Linney, MA, is Director of Career Development, American College of Physicain Executives, Tampa, Fla.