Hired, fired, and not retired: an interview with a physician executive who has run the career gauntlet. (You're Fired!).

Q: THIS ISSUE'S OVERARCHING theme is "You're Fired!" You have not only been hired and fired, but you have hired and fired others, and you have not retired. You've run the gauntlet, and you've landed on your feet.

Hudson: I have been hired, fired, and had changes in GEOs, which puts you in limbo because you don't know if you will retain your job or will be let go.

Q: Being fired is not a fatal event. Often it is a valuable learning experience and, in retrospect, it looks like it might have been a good thing.

Hudson: Absolutely. In fact, being fired causes you to take stock of what's important to you. It can be a blessing in disguise.

Q: What's happened to you through the numerous mergers and consolidations?

Hudson: I was working for MetLife and we heard that there was a big deal in the wind. We wondered who we would be buying because we were so huge. Ha ha. The merger with Traveler's was the first time I had been through it, and the first time most of the people on the Met side had been through anything similar. The people on the Traveler's side had been through downsizing and were much more experienced.

With a merger, you have two of everything and usually you only need one. So how did they pick? There are, of course, politics that decide who wins and who loses. It was interesting to see how people reacted, and I saw it again when United bought us a year later. Then, as a consultant, I worked with a company that I predicted would be purchased if they didn't change the way they were doing things. Sure enough that's what happened. Over a six-month period I saw that fallout, saw the people go someplace else, saw people experience a change of CEO and then they were let go. The only thing you can count on, and here comes a tired cliche, is change itself.

Q: The health care industry is undergoing a turbulent transition. HMOs are consolidating and merging and profitability is down. Hospitals' profit margins are at 4.3 percent, an all time low. PPMGs have crashed and disappeared with the wind. It's a period of restructuring, and job losses are inevitable, aren't they?

Hudson: Yes. And the definition of the medical professional and what he or she has done and is capable of doing and can bring to any organization is changing. Physicians are trained to be problem solvers but our approach differs from the way businesses solve problems. Physicians are intelligent, smart, and can think on their feet. We are no strangers to risk management. Many companies need someone with those skill sets.

Physicians who have left practice and gone with managed care have had to learn business and finance, and it helps when you are looking at risk management from a million different perspectives. If the company is about to go into a new endeavor, assessing the risk objectively is important. Some businesspeople only want to see the best side of a problem. In medicine you have to face the downside--in the worst case, the patient dies. Physicians can look at those hard problems in a very objective sense, and they bring some good skill sets to the table,

Q: In your experiences of hiring and firing, have you been able to step back and have a more balanced perspective, to divorce yourself from your ego and to see things from the other person's point of view?

Hudson: You learn as you go. The first thing you face after being fired is fear, and you react by thinking, "Oh my God, what will I do now with no job?" But, yet, you have enough reserves and you look around and say, "Do I want to continue to be a part of this organization or not"? "If not, what am I going to do?" When you join a new organization, the best advice I can give is to keep your head down and do your job. It's easy to turn a negative light on yourself by defending the old way you did things or fighting the new things and knowing that the management team is going to have a different approach. Listen well and ask, "What is it that they want?" and "What can I bring to the table?" Don't be shy. Raise your hand and let them know that you can fit into these new ways. I have been on the side of the firing too. The people that you wind up firing generally are the ones you lose patience with pretty quick because all they do is complain that "This is not the way it was." They're not going to be team members going forward. People who can change, listen, and use their old skill sets or who can develop new ones will be successful.

Q: What did you look for in the many medical directors you have hired?

Hudson: I paid attention to someone who was willing to change and who was a good listener. Physicians have been accused of not having skills in either one of those areas. I wanted physicians who would fit on the team and get in there and work. If the physician resisted change and had his or her own agenda, had everything figured out and was already set, I knew that I wouldn't have time to sell a new way.

Q: Is one of the problems that physicians tend to ask themselves, "What can the organization do for me," rather than "What can I contribute to the organization?"

Hudson: That's a good way to put it. One of the reasons we went into medicine was to be our own boss, and we're all independent thinkers in the first place. But medicine is a team sport now. If you play well with others, you get more points.

Q: It's tough going from an individual sport to a team sport. How do you make that adjustment?

Hudson: I've learned two things. The first is that in medicine we are searching for the truth most of the time, but in business the truth doesn't matter as much as the perception of it. If someone believes something, it's truth to them, That is how you have to respond. The other is to learn to listen and then to approach the person, trying to understand where they are coming from. That's sometimes not the way physicians do things. We do the right thing, but you can be right and not be successful. You haven't involved people and made it worth their while to be on your team or to espouse what you think needs to be done.

Sometimes you realize that what you thought should be done when you started the project is not the best way to get it accomplished after you have really listened to all the people involved. They bring a lot of different perspectives. Physicians tend not to ask for help or ask someone else's opinion. They will call on a specialist only if they need to. I guess that comes from our training. We have this secret- we don't want everyone to know that we don't know everything. We turn the light on the fact that we don't know everything when we ask others what they think. What comes out of those conversations is a better way of approaching the problem than either individual would have arrived at.

Q: Sometimes medical directors and other physician executives lose their job or are fired because of personal reasons. Other times it's a failure of the organization. How do doctors judge whether the organization they are considering joining will succeed?

Hudson: In an interview, too much of the time you're trying to sell yourself rather than asking how stable the environment is. Financial stability is one thing, but it's important to ask about the leadership and the organization's philosophy. If that doesn't match, even if you think it will succeed, I don't know if you will be happy. Can you share the philosophy? Are you going to be selling shoes that you really don't think are good shoes? We all sell whether we think we do or not.

Q: Don't physicians also have to get over the old way of thinking, namely that you are going to start a practice or be in a job until you retire or die? This new environment is too volatile. Most business executives have five or six changes in their career.

Hudson: That's why it's so important to keep contacts up-to-date, to touch base with people that you have had in your past life at least a couple times a year. I sit down in the Spring and Fall and I go through my Rolodex calling people to say hi and to catch up. Not only do you learn what is going on in the industry, but it's important to keep those communication lines open with friends and colleagues.

At one of the American College of Physician Executives meetings, a woman who taught an early Physician in Management (PIM) course talked about the chip theory. Everybody gives chips and everybody receives chips and everybody is an accountant. If you want to run smoothly through this world, you should keep everybody in chip surplus.

Q: One of the big opportunities for physicians is in the biotechnology, pharmaceutical, or e-health fields. How do you find that environment different than the managed care industry?

Hudson: Going to the commercial side sometimes is a big jump. Biotechnologists generally have been entrepreneurial types, and some have practiced, but most have been scientists. I am in a small company and the exciting thing is how rapidly you can move-you have an idea in the morning, and it is reality in the afternoon. In big Pharma or some of the managed care organizations, your idea may take six months or a year to be acted upon or may never even be heard. That's frustrating. In a small company, you know where your idea stands pretty quickly--you walk down the hall and sit down and talk to someone and it either gels or it doesn't.

Q: Does it help to have an entrepreneurial risk-taking bent?

Hudson: Risk-taking and the willingness to change go together. It's absolutely necessary in a small company. You have to have that creative juice. People that are more left brained tend to be less creative and less willing to change.

Q: Have you met any fired physician executives who returned to clinical medicine?

Hudson: I have let go of several who didn't have the communication or business skills, but they were wonderful physicians. It's the Peter Principle--sometimes people get into a job where they are really not suited and go back to where they were suited. They are probably happier, as is everyone around them, and they are more productive.

Q: Peter Drucker said sometimes the best thing you can do if you are the boss and have elevated somebody above their level of competence is to sit down with them and say, "I have made a terrible mistake. I put you in a position that you couldn't handle, and it is my mistake and not yours. Why don't you return to where you are happy?"

Hudson: Sometimes bosses are wise enough to do that and sometimes they are not. Sometimes people get canned and it is a mistake. Other times the boss thinks you have the skills to fit in one area, which you maybe do, and once it gets started there is a political or personal thing that doesn't quite work. Yet, there is somewhere else in the organization that does and the bigger the organization, the more opportunity you have to look around and say 'I think I can do that."

Don't be reluctant to raise your hand if you see an opportunity that you feel would stretch you and please you and help the organization and ask, "What would it take for me to get into that area? Or be considered for that area?" Everything has to be couched in terms of "How does it help the organization?"

Q: We talked about personal networking as an essential ingredient to finding the right fit. What about outplacement services? Have they been effective?

Hudson: Outplacement is helpful right after you have been let go. It lightens the psychological baggage that doesn't need to be there (but if you don't digest it, it can affect your success later). I had some outplacement firms in place when I let people go--it helped to cushion the blow and gave them some projects to do as they got used to the fact that they had been fired. A lot of the time it wasn't their fault. It was a change in direction or different needs.

If these firms are really good, they can help you find the types of skills needed to succeed. The exercises that they have you go through really get down to what do you want to be when you grow up. Sometimes you don't even think of it that way. Now you have an opportunity to do anything you want to do. Do you want to go back to medical school and teach or go back to practice? Or do you want to try something entirely different or set up your own business outside of medicine? I have seen all of those choices taken after some weeks of searching through their brains and hearts and finding out what they want to do.

It's scary going out on your own. At one point, I did some consulting-- that is what pretty much everyone does while they are deciding what they are going to do or looking for a job. I learned a lot doing that.

Q: What did you learn?

Hudson: I learned that I had a lot more knowledge than I thought I did. And that it's sometimes easier to go into a situation and problem solve and give recommendations and leave and not have to implement them. It gave me time to think about problems that I would like to be involved in solving. I considered setting up my own business and did due diligence on a consulting firm that would help physicians manage through the managed care piece and how you turn that into a positive. Part of that is practice management and part of that is consolidation and what's going on in business. Physicians are so independent that they don't want to do that.

After 18 months of consulting, I realized that I would rather be part of the doing and implementing, rather than just having the ideas. That's why I went to a small firm where you can come up with the idea and put the plan together and implement it.

Q: You have landed on your feet in a small vibrant technology company. Tell us about your new life.

Hudson: Life is what you make it. In a small company there are all sorts of strategies and exit happenings and the wise physician executive is always thinking ahead--what if this doesn't work out, what if someone buys this company, or what if somebody offers me something else? Playing out those scenarios helps you get used to the fact that change is going to happen and it doesn't come as quite a shock.

I have three businesses in my head if something happens where I am at now. It is working out, but things change. What am I going to do when I want to hang it up from a full time position to maybe a part time job? What niche would be there that I could enjoy and still be a go? With everyone living longer, I don't see myself retiring and fishing and playing golf all the time. I have worked 55 or 60 hours a week. Business people don't work that hard except at the top. In entrepreneurial companies you certainly do. It is not unusual for a physician to work that hard. I would like to cut it down to a 25-hour week in the next three or four years, and I have some ideas.

Q: Through your varied life and work experiences, you have learned flexibility and how to turn over other options in your mind?

Hudson: When I was 35, I said I would leave practice at 50 after 20 years. Many physicians don't think that way, but managed care came along and forced them to change. A lot of physicians are looking around and asking what are they going to do. They work so hard that they don't take the time out to look down the road and ask what they enjoy and other things they can do. Some of them say they will just retire. Prepare for those days and then it won't come as a shock.

Q: In other words, engage in some self-assessment and evaluation?

Hudson: Most physicians spend more time planning a vacation than they do planning what they are going to do when they quit practicing medicine or retire.

RELATED ARTICLE: About Robert J. Hudson. MD...

Robert J. Hudson, MD, has made a successful transition from practicing physician to managed care executive to biotechnology entrepreneur. Trained in pediatrics and infectious disease, he practiced medicine for 20 years. He then went on to work in the managed care industry as a medical director, culminating in a position as the Senior Vice President and Chief Medical Officer for Metra Health, which came from the MetLife Traveler's merger. He consulted for 18 months after United HealthCare bought Metra Health. For the past two and a half years he has been Medical Director and is now Vice President of Sales and Marketing for ZymeTX, a biohealth company in Oklahoma City that makes a rapid diagnostic test for influenza A and B. He can be reached by calling 405/271-1314 or via email at [e-mail].

Being Fired Can Get You Fired-up for a New and Better Career

These days "Your Fired!" is heard often in physician executive ranks. The April issue of ACPE News contains a survey with 620 American College of Physician Executive members, 47 percent of whom said they had been involuntarily fired. (1)

This should come as no surprise. Hospitals and HMOs, which hire many physician executives, had a bad year. Hospitals had record low operating profits of 4.3 percent in 1999, and the predicted hospital CEO turnover rate will be 18 to 20 percent in 2000, compared to the normal rate of 10 to 14 percent. (1) Nearly half of HMOs lost money, and HMO profits plunged from $274 million in the first quarter of 1999 to $69 million in the third quarter. (2)

To gain a perspective on tired physician executives' prospects, we turned to Bill Frank, CEO of CareerLab, in Denver, and to Lorne Weeks, MD, Executive in charge of CareerLab's Physician Career Network, a confidential sounding board for physicians seeking new careers. Since 1978, CareerLab has worked for more than 250 major U.S. corporations on the issues of career management and outplacement. Weeks, an orthopedic surgeon, joined the firm in January of 2000 after retaining Frank's services to prepare for a career change. They spotted an opportunity to serve disenchanted physicians attempting to survive in the turbulent managed care environment.

The job search campaign

What should a fired physician executive do? "First, let the dust settle and evaluate your career in terms of what's a good future fit," says Frank. "Often a corporate job doesn't work out because it's the wrong chemistry, the wrong size organization, or the wrong political structure. Sometimes it's a merger and acquisition, but often it's an interpersonal dynamic that causes a job to fail. Second, approach the market and start a job search campaign."

"Doctor up, no pun intended, your resume, emphasizing the triples and home runs. Broadcast that resume to everyone--80 percent of jobs come from friends and business acquaintances. You get jobs from informal sources and not from want ads, recruiters, and more formal job-hunting sources. Always start by engaging your personal network," emphasizes Frank.

Weeks says being a physician carries its own psychological baggage. "Physicians are used to controlling their destiny and enjoying successful careers. When 'you're fired' news arrives, it falls initially on deaf ears. Once you're over the shock, take a critical look at your transferable skills, inside and outside of health care. I tell physician clients to develop skills, clinical and non-clinical, to serve as a safety net against managed care and health care industry uncertainties. To assess these skills, we use the Birkman Method to measure about 66 factors and to paint a career profile that fits best with a person's skills. Usually the new career will be tangentially related to past career paths and there will be a 75 to 80 percent overlap with what they've done before.

Frank elaborates, "New careers for physicians may include quality assurance in manufacturing companies; doing medical research in facilities such as Battelle Labs; becoming CEOs and executives of internet websites and e-businesses; consulting for law firms; teaching at the high school, college, university, and medical school level; becoming military physicians; or consolidating their backgrounds as physicians, scientists, and executives to run biotechnology or e-health companies. Physicians' talent banks make them highly marketable--if they conduct a carefully thought out job search."

Diversification is a safety net

Frank says it takes three to six months for physician executives to launch a job campaign and secure an equivalent or higher level position. Weeks adds, "Career variety is one's best protection against career and professional burnout, and can also generate diversification of the physician's income sources, which again protects against marketplace vagaries. Diversification is a safety net, and it's based on the physician's transferable skills."

Age isn't the barrier it once was. Says Frank, "Our experience has been that professional growth and career satisfaction bears no relationship to one's age and appeals to the 65 to 70-year-old retiree just as much as it does to the first year intern fresh out of medical school. We placed my father, a retired 67-year-old internist, in a new career with the American Association of Retired Persons.

The Harvard Business Review recently had a piece about an experienced MBA who didn't enjoy working for large organizations and yet had diverse and powerful executive talents. He declared himself a "virtual CEO" and now works for multiple companies as a temporary CEO. (3)

Similarly, a physician executive could become an advisor to half a dozen different technology or biotechnology companies and create a very nice living and lifestyle. A major problem in the e-health, biotechnology, and managed care industries is that those in the executive suites don't truly understand the physician mindset and culture. Physician executives can bring that knowledge to the table--how doctors think, what products they will accept, and what organizational directions they will take. This knowledge is a huge asset.

A sword with two edges

"Working for someone else or working for yourself is like a sword with two edges," concludes Weeks. "When you work for yourself, your hours may be longer and your pay may be higher, but you may have no family life. When you work for someone else, you may have lower pay and more time with your family, but the potential always exists that you may receive that pink slip saying 'you're fired.'"

"You can't have it both ways. If you want an improved lifestyle, the ability to walk out of the office at 5:00 p.m. and turn off the beeper, you also have to realize the potential of that sword falling. And you have to prepare for that eventuality by identifying and recognizing those transferable skills that will catapult you into another--and often better job."

References

(1.) Terminated! New Survey Finds Physician Executives Fired Frequently, ACPE News, April 2000, volume 3, issue # 3.

(2.) Kowalcyz, Liz. HMO Profits Plunged in U.S. in '99, Report Says, Boston Globe, April 27, 2000.

(3.) Komisar, Randy. Good-bye Career, Hello Success, Harvard Business Review, March/April, 2000, volume 78, issue # 2.

Bill Frank, CEO of CareerLab in Denver and Lorne E. Weeks, MD, Executive in charge of Physician Career Network, can both be reached by calling 303/790-0505, via email at [e-mail] or [e-mail], or through their website at www.careerlab.com.

Career

Physician executives often find it necessary to reinvent themselves and locate new opportunities in a health care field that is under constant change. The American College of Physician Executives can help you with your career needs with the following services:

Most requested career and advancement questions

ACPE members can find abundant information regarding the field of medical management, how to find a job, what advanced education is needed, networking, recruiters, salary and contract negotiations, and more by logging www.acpe.org/members/commonquestions.html.

ACPE CareerLink

This new online service connects physician executives to organizations and recruiters seeking qualified candidates. At no charge, physician executives can review and search for career opportunities around the nation by logging onto www.acpe.org/career/. Plus, you can post your resume on the ACPE CareerLink website for potential employers and recruiters to review. Employers can also post jobs on the website (call 877-700-0195 or email [e-mail] for additional information).

Resume Review Service

Most physicians have a Curriculum Vita, which is not the acceptable document to use for a management job search. ACPE has a resume guidelines booklet to help you convert your current self-description. We also offer a fee-for-service review and critique of your resume for style, content, and format ($45 for members; $175 for nonmembers).

Career Choices Program

This one-day seminar introduces the skills and procedures necessary to take charge of your career path. Plan to attend alone or with your spouse to explore the possibilities within medical management.

Individual Consultation

Contact ACPE by phone [phone]), fax [phone]), or email ([e-mail]) for answers to career questions or to schedule an in-depth session to develop communication skills or explore life-work planning.

Physician Executive Advisory Service (PEAS)

Available to members only, ACPE has experienced physician executives who will offer advice and answer questions about specific work-related problems. Call 800/562-8088 to talk with an ACPE Advisor about a career issue or for guidance around a specific project or task.

Richard L. Reece, MD, is a health care writer and Editor-in-Chief of Physician Practice Options. He is on the board of VPmanager.com, an Internet start-up company that provides independent physicians with business support services. He can be reached by calling 888/457-8800 or via email at [e-mail].