Fly the coop: escaping the physician executive pigeonhole.

Evidence suggests that physician executives--and those who hire them--may be missing out on new opportunities, positive experiences and potential growth because of unspoken stereotypes. We're not talking about racial, gender or age issues. We're talking about pigeonholing physician executives.

A recent poll conducted by Cejka Search in partnership with the American College of Physician Executives (ACPE) reveals significant challenges for physician executives who seek to transition among health care sectors--for example, moving from a management position in a hospital to a health benefits organization or from a health benefits organization to a group practice, for example.

Yet, it is also true that health care organizations and physician executives who overcome the pigeonhole phenomenon discover that leadership qualities, market knowledge and skills acquired in a particular sector can be transferred to a new sector and environment.

According to the survey, 65 percent of physician executives who responded transitioned from one type of health care organization to another at least once. The majority of respondents said their first-time transitions were to hospital/health systems (26%) or health benefit organizations (20%).

For many, the pigeonhole phenomenon is frustrating. While data clearly show that physician executives are able to transition from one health care sector to another, nearly 40 percent of these physician executives experienced obstacles.

"Even though I have a lot of administrative experience (including my current position as chief quality officer), I have been unable to get the relevant experience for positions with health plans," one survey respondent said. "I feel that there is a barrier that is hindering my transition, but I am not really sure what it is. I can't seem to 'get in the door.'"

Other obstacles uncovered by the survey include:

* Skepticism that physicians have abilities beyond the pure clinical realm

* Major cultural differences among the health care sectors

* Perception of military physician executives lacking real-world experience

* Belief that skill sets are not transferable

* Lack of business background

* Not-for-profit versus for-profit mindset 

* Difficulty gaining respect at the executive leadership table

Four prominent physician executives provided valuable insights about making career transitions from one health care sector into another:

James Tucci, MD, a neurologist, is chief medical officer of St. John Health System in Michigan. Tucci began as a staff physician for a large clinic and then transitioned through regional and national health benefits organizations. He later moved to a large integrated delivery system and then made another successful transition to being the chief medical officer (CMO) of an eight-hospital health system.

Tucci believes that the stereotypes some physician executives confront stem from a common theme: technical skills versus business skills, and how the combination works in various health care settings.

"Physicians and administrators are acculturated differently when it comes to the basis of their authority and a sense of time," Tucci said. "Physicians are judged by technical skills and that is where their authority comes from. In the administrative world, technical skills are not paramount. Those who are politically adept derive their authority from those skills."

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Tucci said the sense of timing cultivated in medical training could also make it difficult for physicians to translate their adaptability into new arenas. "They may appear as impatient, dissonant, too direct; it is their sense that everything should be fixed or solved immediately."

Todd Locke, MD, is an internist who moved from private practice to a Medicare health maintenance organization and later to an independent practice association. He recently left his job as CMO of a provider-sponsored health plan to concentrate on finding an opportunity in the Eastern or the Southeastern U.S. Locke said he is running into some of the "managed care" stereotyping that occurs, and he is prepared to challenge that line of thinking.

Dan Kopp, MD, is vice president of medical affairs at Northeast Health in New York. He served for 20 years as a family practitioner in the military and was able to transition to CMO of an academic medical center. Later, he became the VPMA of a two-hospital system.

Kopp knows the challenges involved in overcoming stereotypes associated with very specific career environments, such as serving in a physician leadership role within the military versus a civilian environment.

Allen Woolf, MD, a pediatrician, is senior vice president, national medical executive of health advocacy and specialty medical management of CIGNA and chief medical officer of Intracorp. In this role, Woolf is responsible for hiring many physician executives, and looks for two major components when hiring them:

1. Direct competencies

2. Industry relevance

"First, I consider competencies that I believe can be gained in any sector: leadership, organization, project management communication skills," Woolf said. "However, the second major component--relevant experience and content knowledge--can put a physician executive from a different sector at a disadvantage. We are often looking for someone to bring a certain level of knowledge of the industry."

Strategies for escape

The good news is that these physicians represent a breed of health care executive who have creatively and successfully escaped the pigeonhole. They offer their suggestions about how physician executives can use skills and strategies that are transferable and marketable to break out of the pigeonhole.

"Yes, I have felt pigeonholed before," Tucci acknowledged. "The only thing you can do is to begin to take some responsibilities for areas you are not responsible for. Be willing to get engaged."

Tucci realized the impact he could make on decision areas outside of his expertise. Employed by a large hospital system--and looking to move into operations--Tucci began to work with the head of finance on assessing how clinical decisions impact the bottom line. The two began developing reports together. Within six months, Tucci was given responsibility for inpatient operations. This kind of outreach helps physician executives become recognized as having competencies outside of the clinical realm.

According to Kopp, a physician executive must demonstrate excellent leadership skills, which are often developed from an early age. He attributes his own leadership skills to his parents' expectation of him to set a good example, participating in sports and receiving top leadership training at the United States Military Academy at West Point.

"Wherever you gain your leadership skills, hone them and use them to your advantage," Kopp advised. "Listen, learn and grow. Build relationships every day. To be a good physician executive in any sector, you should demonstrate that you are clinically mature, have good people skills and that you are a leader."

Locke once hired four medical directors. He hired two with health plan experience and two directly out of clinical practice.

"It is helpful to have industry experience," Locke said. "But, it is just as valuable to bring in those with clinical knowledge and an excellent standing in the community so they have the confidence and the status to talk to other physicians."

The relationships with the community physicians that the clinical practitioners carried into their new roles provided the health benefits organization with greater respect from the community providers.

This was echoed by another ACPE survey respondent who stated, "The academic medical center recruited me for the distinct relationship skills I had gained in the hospital/health system, specifically to deal with the faculty practice plan and hospital relationships."

Advanced degrees, operational experience

Formal business training is another factor identified as a critical element for success in an administrative position. According to Tucci, obtaining a post-graduate degree is a must. "You need a piece of paper and formal business training. Take advantage of business curricula that allow you to apply what you are learning. Volunteer to be on groups and teams that have nothing to do with clinical work. Be willing to be mobile and go where the work is. Build a resume of experience in non-clinical functions."

The wisdom of this advice is supported by findings in the Hospital CEO Leadership Survey, which was conducted jointly by Cejka Search and Solucient[R] to gain insights into executive leadership characteristics.

The survey revealed the importance of operations experience among all hospitals surveyed. Furthermore, a higher percentage of the top leadership team members among Solucient's 100 Top Hospitals "best of breed" have advanced degrees. More about this survey can be found at www.cejkasearch.com/ ceosurvey.

Organizational benefits

As part of an overall recruitment strategy, health care organizations that hire physician executives from another health care sector can expect significant benefits.

Kopp believes there is value in having a 360-degree view of the entire health care industry. "With Northeast Hospital, my vision is very much in alignment with theirs, but my experience in various health care sectors helped me contribute a more robust perspective. Not only can you share your view, but you can add value to that vision."

It is commonplace in business to recruit people from different industries in order to pioneer ideas that could have significant crossover impact. Tucci subscribes to this practice.

"Within my current work for a not-for-profit organization, I often hire candidates from the for-profit sector to gain 'new eyes.' When someone is coming from a for-profit organization, I know they are focused on goals and outcomes and are used to a result-oriented culture. There are times when I also look for physicians executives who are continuing to practice, because we benefit from the patient-facing perspective and a better understanding of what happens in the trenches."

Recruiting a physician executive from a different health care sector can provide a valuable viewpoint. Woolf hired physician executives without a great deal of administrative experience who are from the provider niche to work in the health benefits sector. "This has been valuable in understanding how our programs can better fit the needs of our network physicians and our members," Woolf said.

Woolf also has recruited from the academic sector to find a physician executive to lead clinically oriented programs, such as CIGNA's transplant and oncology programs. "Competencies determine someone's future. Strength in the desired competencies for the position can overcome a lack of sector experience."

Candidates for physician executive positions must articulate how their experience will positively impact the desired position. They should view the position from the hiring manager's eyes and demonstrate the benefits they will bring to the organization.

Successful transitions are attainable--with the right strategy to gain the necessary skills, education and leadership experience needed for the position.

Lois Dister is vice president, practice leader of Cejka Search. She manages the firm's executive search division that focuses on the recruitment and placement of health care executives for hospitals, health care systems, group practices and health benefits organizations.

RELATED ARTICLE: 5 Steps to a Successful Transition

Physician executives seeking to transition to a new health care sector must first do their homework. With a clear understanding of--and commitment to--what the new role entails, the following steps may lead to a successful transition:

1. Find a mentor.

Establish a formal relationship with another physician executive who can guide you and help identify the skills you can leverage--or must acquire--for the desired position.

2. Gain a complete understanding of the impact of the transition.

Do your research and know exactly what is expected of the desired role. Understand why this transition will be good for you in terms of your long-term career growth.

3. Understand your skills.

It is unwise to assume the hiring manager will dissect your resume to gain a thorough understanding of your transferable skills. Examine the key skill sets necessary for the role you are seeking. Build examples of how you have been successful in similar situations using these specific competencies.

4. Don't underestimate cultural differences.

The ACPE survey demonstrated that a significant cultural difference was the most common obstacle physician executives faced during transitions. As one ACPE respondent noted, "Cultures of organizations are very different--there are different priorities, people work at a different pace, it takes some adjustment." Commit to learning the culture of an organization ahead of time. Determine if you can work within the parameters of that new culture, and if so, be open to change.

5. Prove your credibility.

Past performance doesn't equal automatic credibility. In expressing the need to prove credibility, an ACPE respondent said, "The decision makers will readily accept the subject matter expertise that a physician executive possesses. However, they are much less likely to accept the business and analytical skills that the physician executive may possess."