Physician executive's path comes full circle: Doctor uses management education to land full-time management job and eventually takes up teaching medical management.

Marc Richmond, MD, MMM, didn't exactly plan to move into medical management; it happened to him gradually.

Frustrated with the early forms of managed care that emerged in the early 1990s, Richmond--then a full-time family physician in Irvine, Calif.--wanted a better understanding of the business of medicine.

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"I had been reading medical management literature for a little while, and in 1993 I received a mailer from the University of California at Irvine announcing a weekend certificate program for health care executives," Richmond recalls.

He wondered how he could ever manage to juggle his clinical work with weekend studies, thinking he'd be exhausted. Nevertheless, he decided to check out the program.

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"There were about 20 people in the class from various occupations--the CEO of an ambulance company, a lawyer who specialized in health care, an architect who did health care design, a few physicians and nurses," he says.

And while the schedule was demanding, "after the first several classes, it became very evident to me that these sessions recharged my batteries. The different venue for thinking, interacting with different people and getting a different perspective about health care was really stimulating."

The classes, mainly introductory courses on medical management, energized Richmond. "When I was sitting in these classes, I would think, 'Oh, the hospital board would want to know that. I wish somebody from the board of directors was here.'"

Soon, he took the initiative and began making presentations about what he was learning in class to the board of his hospital.

"I had become friendly with the hospital's CEO who truly valued what I was doing," Richmond says. "So one day he asked me if I would be interested in being a half-time physician director of integrated health services for the hospital. That was my first real management opportunity."

Intrigued by the offer, Richmond took the job.

"I was the clinical liaison between the hospital administrative team, the local IPA and the medical community. I was working with the hospital to evaluate opportunities to merge or buy practices, identify service gaps, identify areas for quality improvement and assess activities that the hospital might want to get involved in."

After completing the UC Irvine course, Richmond continued his management studies with ACPE courses and a Leadership for Physician Executives program at Harvard University. His hospital footed the bill for his studies. Richmond paid for his travel and lodging.

Out of the blue, in 1997, a recruiter called and offered Richmond a job as the chief medical officer for an emerging health delivery system in Little Rock, Arkansas. "The timing was terrible because our youngest child had just started high school. My wife and I talked about it quite a bit and ultimately decided it was one of those opportunities for a full-time management job that probably wouldn't present itself again," Richmond says. "Everything was right except the fact that it was in Little Rock and I was in Irvine. We agonized for a while, but ultimately I took it."

Richmond helped form a consortium of five entities to bring managed care to the area, a developing network of about 3,000 doctors and roughly 40 hospitals throughout Arkansas and some nearby states.

In Little Rock from 1997 until 1999, Richmond continued his education by enrolling in the Masters in Medical Management program at Tulane University. "So I was commuting from Little Rock to New Orleans every three months for a week at a time," Richmond recalls. "But the courses helped me do the management job, and the management experience helped me in the courses."

For example, "One of the things that we had to do in the MMM was to write a business plan. I used the company that I was working for as the model for doing that. And once I did the plan, I was able to present it back to the executive director of the company, where it was well received."

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Richmond earned his MMM in 1998 and soon received another offer from a recruiter, this time for a job back in Northern California as CEO and executive director for Napa Valley Physicians, a group of 150 doctors and 2 hospitals.

"My wife said, 'I don't know about you, but I'm moving back to California,'" so Richmond took the job.

One of his duties was dealing with insurance companies--PacifiCare, Healthnet, Blue Shield, and others--and that eventually led to another job opportunity. "One of PacifiCare's medical directors mentioned that a position would be coming available as their regional medical director for the San Francisco Bay area and the Napa Valley position was the most difficult job that I'd ever had, and appeared to be in increasing financial difficulty. So, at the end of a year I accepted the job at PacifiCare in San Francisco. Eventually, another opportunity arose within PacifiCare in Southern California, and I was able to move my family back home."

PacifiCare Health Systems is one of the nation's largest consumer health organizations with more than three million health plan members and approximately nine million specialty plan members nationwide.

Richmond works with PacifiCare's contracted medical groups, IPAs and hospitals in PacifiCare's network to make certain that they understand PacifiCare's policies and procedures, and that they are able to identify members who are eligible for one of PacifiCare's many disease and population management programs.

"PacifiCare deploys nurses who gather clinical information on our members in the hospitals, in addition to the medical groups' clinical staff. I round with our nurses on a fairly regular basis. We discuss the cases. If necessary, I will work with the hospitalist, the hospital staff and the medical group staff to make certain that the member is at the appropriate level of medical care. We also do a fair amount of medical management training."

Richmond also worked on a pilot project that enables nurses to use Blackberry PDAs to capture clinical information from the hospital chart while they are in the field. They sent the information to a central database. It has reduced costs considerably in terms of time and errors," Richmond says.

Once he returned to California, Richmond also put his long years of management studies to good use by doing some teaching.

"I love teaching. I did it with the board of directors when I first started in management and I continue to find ways to do it." He landed back where he began; teaching a course at UC Irvine called "From Residency to Reality."

"I developed the curriculum based on some of the practical topics that aren't taught in a traditional medical school curriculum. It is a practice management curriculum to teach first, second-and third year family practice residents, and third- and fourth-year medical students all the "stuff" they never learned in medical school, such as hiring and firing, human resources, building your team, 401Ks and how to avoid malpractice suits."

Richmond also has taught courses at PacifiCare for new MBA employees who have no medical background, helping them better understand the business of medicine--exactly what Richmond set out to do himself more than a decade ago.

By Barbara Linney, MA

Barbara Linney, MA, is vice president of career development for ACPE. She can be reached at 800-562-8088 or [e-mail]