Real executives make career moves will you? (Career Rx).

Witt/Kieffer is a corporate sponsor of the Health Management Academy, which means that twice a year my colleague Alexander H. Williams, III (known to all as Sandy) and I meet with senior physician executives from high-profile organizations to discuss industry issues. Recently, this group asked us a question: "What's the hardest thing for search consultants in working with physician executives?" Sandy and I didn't have to consult on our response. As one, we replied: "Getting them to move."

Physician executives are not unique in not wanting to move. No one does, usually. (But I want to win the lottery, too. You don't always get what you want.) Although moving doesn't seem too complicated for other executives (both in and outside of health care), it continues to be a more difficult matter for physician executives to resolve.

In theory, it certainly seems simple: an executive must occasionally move to a new organization (new city, new region, etc.) to enhance or further a career. Ask anybody from IBM ("I've Been Moved") or any other Fortune 1000 company if at some time in their careers they took a promotion or new job that required a major move. You won't find many executives who haven't taken that step--sometimes, several times. The career move is accepted as a fact of executive life.

However, as a group (and I know there are many exceptions, of course) physician executives and their families have not been as accepting of the career move as a key part of executive life. They feel it's their right to stay put and they do. Career limitations and even stalls are often the result of that limited thinking.

Back to basics

Executive careers have attracted increasing numbers of physicians in the past few years, indicating how the challenges presented to ambitious executives are appealing and exciting. Physicians who enter the executive suite exchange their clinical responsibilities for executive ones--to create health policy and manage people for change. However, the transition from clinician to executive is even deeper and more profound than what is demanded by a careful look at education and skills sets. This distinction makes it important to see where the key shift occurs by re-examining some basics of career planning.

Career emphasis changes

Every time an individual makes a career decision, three factors--position, location, compensation--are considered as tradeoffs to achieve suitable balance. One factor can take precedence at one time in a career and be less important at another.

For example, it's only natural that location would have great significance in the career decision-making process of a clinician. After all, a good physician should be able to earn a decent living anywhere (though not as much as in years gone by)--so why not make the location of your practice the most important factor in your choice? The lifestyle of the clinician's spouse and family is affected by location, so it's a key choice for them as well, And, once clinicians have built relationships with patients and institutions, they may find it difficult to think of making a move to another area and starting over--even when it might be in their own best interests. So, they tend to stay put.

However, an executive who has left clinical work behind (or is attempting to do so) will do well to refocus that location mindset by understanding the new priorities. An executive emphasizes position over other factors when making a job decision. An executive's position and role are essential to his or her effectiveness and success-and the truth is, exciting opportunities don't come around every day. When a great opportunity is on the table, an aspiring executive knows that the actual location where one works is less important than the work itself--and is willing to move to accept an attractive position.

The third career decision component, compensation, is obviously important--but for physician executives, it's a matter that often takes care of itself. Marketplace salary levels are pretty well-known and accepted. (I can't recall ever hearing a physician executive say that he or she either took or left a position solely because of compensation issues. There's always more to the story.)

Spouse support is essential

Before you consider stepping forward in even the most casual kind of job search, be sure your ducks are in a row. Organizations expect that any married executives who present themselves as candidates will have considered a move with their spouse and agreed on the subject as a team. Lack of commitment will make itself known at some point. At the extreme, it's manifested by an executive accepting a job offer and then backing out. (It happens among non-physician executives, too, but less often.)

The pact you and your spouse made when you went to medical school included expectations around lifestyle, both for stability and for economic considerations. Your transition into a corporate career-building track can seem to be a sudden, disruptive "defection." Hence, the importance of discussions at home early and often.

It's not uncommon for a proposed career move to follow a period of lifestyle stability, adding to the discomfort felt by the family. In two-career families (or even two-physician-career families), the potential for complexity is even greater. In every situation, simple or complicated, spouse and family support are critical.

We all strive for "happiness," that elusive goal. My observation is that happy people will usually be happy wherever they go, and unhappy people will remain unhappy. If you've been fortunate and created strong, enduring personal relationships in one place, the likelihood is high that you will succeed again in another setting-because of your intrinsic personality and inclinations. Conversely, unhappy people will find no neat geographic solutions. This is not really about how well you would do with a move, but a fundamental question of who you are.

Or, to quote a prairie philosopher, Abraham Lincoln: I believe that people are generally about as happy as they make up their minds to be." He might have added "or unhappy."

Signs that something isn't right

There are signs that make my search consultant radar sound in alarm. Something is not right when:

* Well into serious consideration, I call the executive candidate at home--and the spouse has no idea who I am or why I'm calling. Or, when I call, the spouse gives me a cold shoulder.

* Although invited on an interview visit, the candidate's spouse does not attend.

* The executive candidate suddenly develops difficulties scheduling an interview with the hiring organization.

* The executive who is offered the job wants too much time to decide.

* The executive has accepted but won't sign a contract...until vague (and previously unmentioned) issues are resolved.

* The executive accepts the job-but asks for an extremely long "transition time" or finds other ways to delay starting the job.

Does your "team" know the score?

Leadership begins at home. Before you think of beginning a job search, or even take a call from a search consultant, get your priorities straight with your spouse. Here are a few suggestions that might make it easier:

* Be sure your spouse understands that as an executive you must make career moves for advancement. This is simple to state but may be agonizing to accomplish. Listen to everything your spouse has to say and meet those issues head-on. This is truly "pay me now or pay me later" work that must be done. You'll know then if you can proceed as a team with a job search. If you're not a team, don't.

* Include your spouse at every step when you are a candidate for a new position. You may have to conduct reality checks more than once in the course of a job search, but it's worth it in the long run to know that everybody is feeling whole.

* Be honest with everyone involved. Look candidly at factors affecting your children--their ages, the transitions they would face--as you make decisions. Full disclosure with your potential employer is essential. If you need to be wooed (within reason), let them know.

* Try to become objective about a potential move early through information--as a team, you and your spouse can surf the web or make a visit to see what the new community has to offer.

* Monitor your interest level closely and let your contact person at the new organization know regularly how you are feeling.

Truth and consequences

The truth is, your career behavior has consequences. This is important for physician executives collectively as they strive for legitimacy in a clinical environment of chaos and uncertainty. The day Is over when a physician executive s reputation could emerge unscathed from this scenario: He or she expresses interest in a new job, goes through numerous interviews with his or her spouse in attendance, negotiates a good compensation package, and receives a sincere position offer--only to refuse it because a spouse is unwilling to move!

Physician executives In the new century must accept the full career responsibilities of senior executives--and that, sometimes, requires making a move for career advancement.

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.