Medical Director Musical Chairs.

A reaffirmation of my career in medical management

REMEMBER THE GAME musical chairs? The last one standing when the music stops is out.

It seems that managed care has created a similar version for medical directors. The chairs (jobs) are being taken away, only the field does not appear to be that crowded.

I wrote this article during a period of musical silence. Writing was one part therapy and two parts inspiration. I needed to re-evaluate my career and decide whether to alter my course. Indeed, I wondered whether I should stay in management or go back to practicing.

When the music's over

Jim Morrison said when the music's over "turn out the lights." I would argue the opposite.

The music stops for virtually all of us at least once in our careers. Where medical directors of yesteryear typically underwent a few career changes, they now face the prospect of change every two years or so. It's telling that when I visited the website of my former employer and clicked on "medical director bios" the reply was "this information is temporarily unavailable."

Medical directors everywhere appear to be affected by the forces of managed care.

* The University of Pennsylvania Health System recently restructured, reducing their workforce by 20 percent and announcing plans to form a wholly owned subsidiary of the University of Pennsylvania with its own chief executive and governing board. Even before the announcement, Penn's chief physician executive resigned and several others left to start an Internet company.

* Managed care giants Aetna and Humana eliminated about 13 per cent of their employees, including physicians, in order to realign business strategies with the changing health care market.

As markets change, so do medical directors. Organizational debt no doubt plays a significant role. In all those companies, either large debt or poor performance on Wall Street created vulnerability for medical directors. Physicians with higher salaries and rank appear to be at higher risk of losing their jobs.

A changing of the guard, in the form of new management, also puts medical directors at risk. I've heard several physician recruiters say the number one reason why medical directors lose their jobs is because the person they report to is dismissed and the new boss decides to clean house. Performance alone is seldom a factor in terminating a medical director.

Dodging bullets

Physician executives are not immune to economic downturns and corporate politics. Yet they appear to retain some degree of control over their careers.

Perhaps this is because, for the most part, the health care industry is insulated from economic ups and downs. Aging baby boomers need more medical services and equipment than ever before.

Also, because many health care companies make preemptory job cuts, physicians are able to find new jobs rather quickly. In my experience, and in conversations with other physician executives, it may be possible to dodge a few bullets given these considerations. Here are some tips to consider:

* Maintain good chemistry with your boss.

Make sure you meet regularly with your boss and keep her upto-date. Lunch is always a good idea. E-mail and other types of communication are good, but it doesn't substitute for face-to-face meetings. If your boss is replaced, introduce yourself to your new boss right away rather than wait for a meeting to be scheduled.

* Accept a midrange salary.

High income leaves you exposed, especially when corporate finances are tight. Before accepting a new position, do your best to determine what a reasonable income should be and whether it realistically meets your needs. Sure you have to get your kids through college and save for retirement, who doesn't? It's your right to negotiate a salary, but don't ask for ridiculously high pay. It could come back to haunt you.

* Generate revenue for the company.

Physicians are viewed as a drain on cash flow. It's easy for accountants to redline your salary to reduce overhead because they're accustomed to working the expense side of the equation. Truly creative companies, however, are looking to add direct dollars to the bottom line by hiring people who can bring in revenue. Simply saying you add value by virtue of your core competencies as a physician executive may not be sufficient.

* Develop technical expertise.

In the new world of customer-focused e-health, you must be computer savvy and understand technology beyond the "pushbutton" level. You must possess the skills of a generalist as well as a specialist. Multitasking is a prerequisite for just about any job.

* Work long hours when necessary.

A desk job in medicine does not mean you can adopt a banker's lifestyle or hide behind a desk. Get into the habit of traveling to meet key customers both internal and external to the company. Freud said the measure of a psychologically healthy person was one who could "work and love." Strive to attain this crucial balance.

* Be open to relocation.

The reluctance to relocate sounds the death knell for many physician executives. I worked for a national managed care organization, and the second question I asked when my position was eliminated was whether there was an opportunity elsewhere in the company, even if it meant relocating. (The first question was whether I could cut my salary 10 percent in exchange for maintaining my position). Refusing to relocate may jeopardize the career of any physician executive. The danger is greatest for those who aspire to climb the job ladder the highest.

* Demonstrate leadership skills.

Leadership, regardless of how it is defined, is the most critical element for the success of a physician executive. It's cliche to say that physicians must learn to "walk the walk" as well as "talk the talk." But your skills must be apparent to everyone. As evidence of the importance of leadership, my former organization spent significant time and money developing leadership skills among its physician employees and even changed the name of the medical affairs department to the clinical leadership organization.

Avoiding traps

Experts point to five ways to sidestep career traps when you lose your job. Deal with the first two immediately -- within a few hours.

1. Don't blame yourself or the company for your misfortune.

Blaming yourself leads to instant demoralization and paralysis. You won't be able to undertake the search for your next job (see trap number 3). Blaming the company or management does not lead to constructive action either. In fact, your anger may cause you to say things or do things you'll regret later. Another cliche to remember at this time is "don't burn bridges." Never badmouth your former boss and colleagues. You must control your emotions and hold the line between narcissistic rage ("I want to murder them for ruining my career!") and grandiose ideation ("I'll show them who's boss; I'll be the CEO in my next job!").

2. Don't disagree with your boss on the "parting line."

If the two of you don't stick to the same story, your colleagues and potential employers will be confused and your boss may not provide a reference. Recognize you have virtually no leverage in this situation. Regardless of the reason you were let go, hopefully it will be categorized as a resignation and you'll receive a severance package. Have a frank discussion with your family and close friends. Tell others on a need-to-know basis.

3. Don't assume that you're imminently employable.

It is true physician executives are in high demand and physicians who lose jobs will find new ones soon. Nevertheless, you'll have to polish up your resume, choose colleagues who can provide letters of recommendation (and discuss your circumstances with them beforehand), and possibly brush up on your interview skills. Make your job search full-time. Spend 35 to 40 hours each week doing research, making contacts and following up on leads. Explore the classifieds and the Internet and work with recruiters. In addition to e-mail, snail mail, and the telephone, network in person; try lunches and coffees. Outplacement agencies can provide just about anything from career counseling to temporary office space, but they can't find you a job. That's your responsibility.

4. Don't panic and take the first available job if it doesn't fit your interests and goals.

Taking a job on the rebound can be just as harmful as starting a relationship just after being jilted. It's understandable to want to rejoin the workforce as soon as possible. In our society, work and recognition and self-esteem are directly related. Make sure, however; you're not making a short-term decision that will have a major long-term impact. Of course, this must be balanced against the panic of having to pay bills and support your family.

5. Don't be too demanding and wait for an overly specific position and salary.

As a rule of thumb, you should be able to land a new job within three to six months. Beyond that, evaluate what kind of opportunities you passed up and what you're willing to reconsider. Do an accurate assessment of yourself and your abilities. The key thing to remember is not about your most recent experience, but your transferable skills. You've honed the skills of a physician executive and you can deploy them in a variety of health care settings.

The road ahead

Medical management is the road less traveled by physicians.

Robert Frost and M. Scott Peck wrote about this road. Jimmy Page and Robert Plant observed: "Yes there are two paths you can go by, but in the long-run there's still time to change the road you're on." And of course Paul McCartney sang about the long and winding road.

The point is: physicians interested in management should understand that the grass is not greener in management; it's just different compared to practicing. Once you give up the white coat for a business suit you become no different than executives who never went to medical school.

If anything, the power of the microscope intensifies on physicians who swell the ranks of management. An advanced degree in business or public health confers no advantage other than the additional knowledge associated with those areas of study. Despite the ability of dual-degreed doctors to bring a truly balanced scorecard to the health care arena, the decision-makers are still largely MBAs without medical degrees.

Arthur Lazarus, MD, MBA, CPE, FACPE, is director, regional medical research specialist, in the medical department of Pfizer Pharmaceuticals Group, in the Great Lakes region.