Is it our turn to be CEO yet? (Career Rx).

In numerous surveys over the years, Witt/Kieffer has asked physician executives about their career ambitions. Until recently, the majority typically expressed great interest in the post of CEO. Although reality (in the form of recent budgetary crunches) has set in to cool that ardor slightly, the desire to be CEO persists--strongly--despite the fact that physician executives can have few romantic notions left about the role.

Their ringside seats as members of the senior management team have shown the "warts and all" side of what it really means to be CEO, while the mandates and imperatives of resource constraints have continued to grow. It's certainly not always been pretty--and, yet, physician executives continue to aim for the position. Is theirs a realistic goal? How likely is it that these CEO ambitions will be fulfilled? Today, not so likely. Tomorrow, and in the next five to seven years, their chances are much better. Ambition delayed is not, in this case, ambition denied.

CEO search trends

Witt/Kieffer handles many CEO search engagements each year, for a range of organizations that includes hospitals, health plans, integrated delivery systems, and payer organizations. And a shift in candidate qualifications is beginning to take hold. Client organizations (actually, boards of directors in this instance) are beginning to ask to see physicians represented in their CEO candidate slates. The door is opening, but slowly.

Thus far, only a few organizations have shown much interest in having physician executives as candidates for CEO. And even when competitive, viable physician executive candidates are identified for CEO roles, they have not been chosen in significant numbers. However, this should change and physician executives will come into their own as CEOs.

Right time, right place

Why will more and more physician executives be selected to run health care organizations? The reasons they will likely be tapped as CEOs more often include:

* More skills and experience. Physician executives are honing and strengthening their management credentials and experience. This means a pool of highly competitive, executive-level individuals is set to emerge in the near future. These are physicians who have run different sorts of organizations: physician organizations, joint ventures with physicians and health care systems, joint ventures with health care systems and plans, or some other combination of these components. These physician executives have legitimate, relevant professional experience that directly qualifies them for CEO roles.

* Care management. The core challenge facing all health initiatives: While costs have been aggressively stripped from the system, and operational efficiencies have been remedied, care management remains stubbornly resistant to an easy solution. And the happy fact is, no executive is more qualified to deal with medical care management issues than the physician executive. Whatever their title, in one position description after another, physician executives/medical officers are being asked by their organizations to focus on resource management and to effect all the changes necessary to make this happen in the present climate.

Knowing what you don't know 

Physician executives are generally less experienced in operational and financial areas--and this is logical, given their backgrounds as clinicians. There is no reason to believe that this will dramatically change. It's unlikely that physicians will ever function primarily as operating officers for organizations or financial officers--and that is as it should be. Rather, a physician executive brings expertise in medical management, and serves as the convener of an empowered team. With support from capable deputies well-versed in the operational and financial aspects of running any competitive health care enterprise, physician executives can focus on their areas of expertise. That is to say, they will be leaders.

To become competitive as a physician executive who can legitimately aspire to a CEO position, one must go through various transitions. Rather than listing the usual key skills and characteristics (e.g., system thinking, broad reference of scope, and visionary capabilities), I want to review how the transition from physician executive to potential CEO candidate actually plays itself out in real-life careers. Consider the following:

* Executive thinking. Becoming an executive thinker encompasses all aspects of communication and broad thinking, but beyond that, this person possesses everything that is implied in the terms decisiveness, firmness and resolve, steadiness of purpose, and a true sense of responsibility for the organization at large. Executive thinkers understand how to make decisions requiring complex analysis and multiple constituencies. They know how to consider their options and emerge with a direction, build support around it, and galvanize coalitions to move forward. While this would also describe a leader, the word "executive" indicates the institutional accountability and responsibility that are critical for successful health care initiatives.

* Bundling projects. For those in the CEO role, keeping groups of projects in mind is more the norm. Most middle managers are skilled in project management. A key adjustment that must be made is learning to transcend project thinking to considering groups of projects at the highest executive level. Executives have also mastered the management technique of focusing on high-priority projects rather than diluting their energies by becoming involved in a broad range of projects.

* Managing managers. Perhaps the most challenging aspect of becoming a capable executive at the helm of a large complex organization involves managing managers. Management is a challenge in and of itself, but this puts on yet another layer of complexity. This challenge encompasses establishing roles, hiring the right people, delegating, and then trusting team members to carry through on initiatives. It's in this context that a physician executive/CEO facilitates both the strength of the enterprise and that of the overall senior management team by choosing excellent operational and financial team members.

Where are the opportunities?

Even with all that as background, it's still not likely that physician executives in large numbers will be selected to be hospital CEOs. More likely, they'll be chosen as leaders for health care delivery systems--with components of acute care and other services, physician elements, and (although now less likely) a payer infrastructure.

Many health care systems have changed markedly from their appearance ten or 15 years ago. Each medical community has its own history of development, culminating in an array of different health care systems with singular and unique politics, economics, and cultures. That means physician executives are earning credentials and experience when, as it happens, health care initiatives are more interesting than ever. Physician executives are certain to have a great impact as health care delivery right-sizes itself in the next ten years and as physician participation in governance continues to grow.

"Who wants to be a CEO?" If your answer is "I do," your work is cut out for you--but expect the future to be bright for capable, competitive individuals who will be considered for the most exciting, top-level positions. This is a game you can win.

Mary Frances Lyons, MD, is a Senior Consultant at Witt/Kieffer, Ford, Hadelman & Lloyd in St. Louis. She can be reached by calling 314/862-1370, via fax at 314/727-5662, or via email at [e-mail]. Please fax or email questions that you would like addressed in this column to Dr. Lyons.