Don't be an accidental physician executive.

Most physicians completed medical training with the expectation that they would, indeed, practice medicine. The new, combined MD/MBA programs are unlikely to produce credible physician executives for at least a generation or so, because there remains an expectation that one must "pay dues" as a clinician before moving into management roles. These rites of passage expectations are important and will not disappear overnight.

But, having paid their clinician dues, many physicians (perhaps you?) today find themselves--whether through mere happenstance, because of intellectual curiosity, or a change of interests--in a leadership role. And you like it. Your taste of the management life has been satisfying and you want more.

You are, in fact, at the career crossroads, a time when you must leave luck and accidents behind and begin crafting your career with intention and careful thought. It's pre-med all over again, but this time, it's premed-itation.

That means, before you go leafing through The Physician Executive or the New England Journal of Medicine's Positions sections, you'll need to conduct a thorough career evaluation of where you are and where you want to go.

Filling out your skills portfolio

If I'm losing you already by making that sound too challenging, consider this: Your competitors (the non-physician executives) probably already have 15 to 20 years of management experience. With the ink still wet on their MHAs or MBAs, these folks embarked on their methodical career program approach. They acquired--in each job they held--the administrative skills that would help to move them from internships to assistant director and director jobs through to assistant vice presidents and even higher.

And physician executives have to play catch-up, if they are interested in crafting fulfilling and exciting careers. Remembering the 15-year competitive spread, you'll realize that you have real time pressures to consider. You have to become better, faster.

The time is right

There are more career tracks in more types of organizations available to you as a physician executive than ever before. There is also considerable turbulence, creating unexpected opportunities. The times have never been better for aggressive, energetic physician executives who want to move up and out. Options you can consider include:

* Hospitals--director-level roles, chairs of departments, VPMA 

* Academic Institutions--the same titles as in hospitals, as well as faculty practice and dean positions

* Managed Care--medical director roles in HMOs, IPAs, PPOs

* Group Practice--department chairs, medical director of satellite facilities, CEO or director of a group

In addition, physicians are sought for R&D positions with pharmaceutical companies or for medical director roles in insurance companies, as well as for QA/UR positions in general business. There is almost no limit to where you can go. I believe the real trick is knowing where to go in the first place. Remember, as health care organizations generally are diversifying and entering numerous business lines, they expect candidates to have a variety of experiences in a multiplicity of settings. And that brings us back to the concept of crafting a career, making a plan and then carrying it forward.

What to leave in, what to leave out...

Crafting your career requires, at the outset, an assessment of your strengths and weaknesses. This will not be as excruciating as you might suppose.

Be aware that you are almost surely a good physician, because that gives you credibility with your peers. In fact, my experience says that you are probably an above-average physician. Your colleagues have confidence in your clinical ability and therefore assume you are a capable manager. It may not be logical, but that is how it works. Also, as a physician, you already are a highly motivated self-starter with strong integrity and values. Those are pluses in any career field.

But you have to look at the gaps as well. Think about the kind of position you want to achieve in three or five years. You probably do not have all of the skills needed. You may need more knowledge of business principles, more experience in managing operations, more skills in interpersonal communications, or you may have to expand your set of managed care tools. Whatever your gaps, you'll need a plan to fill them. Here are some suggestions to help you go about that:

* Look at the job content for any position that appeals to you. What would you actually do in that job? One great way to find out is to call someone who holds that position (perhaps in another city or state, if you are concerned about competition issues) and ask them to lunch. Quiz them, asking for details on how they really spend their time. What do they do in a day? A week? A month? Ask them to identify the key skills they see as important for their work. (Later, when you've picked up the check and thanked them, you can decide whether you would want to do that work--or if you would be bored out of your mind. You don't need to let them know the latter.)

* Look at where you currently are, and try to see yourself in a career context. If you have only hospital experience, is it likely you'll be able to move readily into a managed care organization? Probably not. Instead, try to move around, even if it means volunteering for extra committees or new projects that are outside your usual sphere.

* Any CEO will tell you that physician executives need more finance and operations experience. So ask for it. Seek it out. Demand it, if need be. But expand your range and fill out your skills portfolio.

* Be sure to aim for jobs that you are not entirely qualified to do. If you are completely able to cover a job, you will probably be bored in a short time. Keep it interesting by keeping some learning as a factor.

Charting a course for yourself

The reality is that physician executives, because of the real lag that is built into their career plans, do not have the luxury of time in which to plan and then act. Physicians who enter administration usually do so in their late 30s or early 40s--and that means they have to stretch themselves hard to move to the next level in a timely fashion.

Crafting a career satisfies two needs--you make a personal plan that is right for you, and you have an enriching career as a result. By seizing the reins, by taking control so that you are no longer an "accidental executive," you can have a career that truly fits you and your capabilities to the fullest. And that will be satisfaction, indeed.

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.