Reinventing my medical career. (The Evolving Role of the Physician Executive).

"HE ALLOWED HIMSELF TO be swayed by his conviction that human beings are not born once and for all on the day their mothers give birth to them, but that life obliges them over and over again to give birth to themselves."

Garbriel Garcia Marquez, Life in the Time of Cholera

About a year before the Allegheny Health System in Philadelphia filed for Chapter 11-bankruptcy protection, I became the Professor and Chair of Pathology at Allegheny University of the Health Sciences. I was excited because I thought there was a chance to blend the best features of the academy with the business acumen of a successful state-wide integrated delivery system. And the money, while it lasted, was excellent. Allegheny CEO's Sherif S. Abdelhak had spoken eloquently in the 1995 John A. D. Cooper lecture at the Association of American Medical Colleges about his innovative vision for academic medicine, and I wanted to be a part of it.

Some of my University of Iowa colleagues questioned the wisdom of leaving a secure position as tenured professor, Executive Vice Chair of Pathology, and Medical Director of Managed Care in a more prestigious medical school to join a risky integrated health care system. Others viewed the new position as a shrewd career move that would likely culminate in a dean's position within five years. I was bored in the relatively early managed care market of Iowa and thought the challenge of running a department in an integrated delivery system in the tough Philadelphia market would test my leadership abilities and be more interesting.

In Fall of 1998, I was on administrative leave from a medical school and health system in bankruptcy; my professorship, chairmanship, five-year contract, and tenure did not provide much job security in this setting. I started to look for a new position for the first time in my life.

Psychological adjustment

My period of bewilderment, bitterness, and depression lasted less than a week, and I threw myself into the job search. Many colleagues who I thought were close friends did not contact me or return telephone calls. Stillman documented a similar experience during a period of unemployment. (1) Later, I learned some of them were uncertain about what to say to me. Others may not have thought the relationship was as important as I did. I was fortunate that several colleagues from Allegheny, Iowa, and the University of California-San Francisco did call or email me regularly with advice, support, and friendship. They will never know how much their simple communications meant to my family and me.

The psychological adjustment of instantly going from the department chair who gives well attended parties, cuts budgets, has meetings from 6:00 am to 7:00 pm, and whose telephone calls are returned to the isolation of job hunting was difficult. I kept myself busy with sending out resumes, calling professional contacts, cruising the Internet to look for positions, and coauthoring an essay for the COTH Report about the Allegheny experience. (2) The few days when I allowed myself to linger in bed long after my children had gone to school and my wife had left for her outpatient gynecologist duties were not happy ones. I found it useful to wake up and "go to work" in my computer room by 8:00 am each morning.

My mood improved when I was invited to interview for faculty and physician executive positions in Dallas, Indianapolis, New York, Chicago, Milwaukee, and Washington, DC. I was surprised to be perceived as an unattractive cytopathology faculty candidate, despite what I saw as an impressive CV and considerable experience a think I would have hired myself). Perhaps, interviewing former chairmen makes others uneasy because it is an unwelcome reminder that we are all more vulnerable than we would like. On the other hand, the interviews for physician executive positions went well and return visits were made.

Considerations and reflections

My family and I discussed the possibility of moving from Philadelphia for one of these positions. With the uncertainty associated with the bankruptcy, my physician wife had gone to work fulltime to ensure a seamless continuation of health insurance coverage for the family. My children had only recently begun to feel at home in Main Line Philadelphia, which did not resemble Iowa City at all. They were not happy with the prospect of starting over again in new schools with new classmates. We had joined a synagogue where my daughter had a successful bat mitzvah and where my son was scheduled for his in the year 2000. My family did not want to move unless the new position was a superior one with job security that I doubted existed in the medical marketplace.

Upon reflection, I questioned whether I still wanted to play the role of change agent in academic medicine: encouraging, leading, cajoling professors to move in the direction the marketplace was demanding. I was not as eager as I once was, and I had lost some of my innocence about managed care. At one time, I had devoured pronouncements from Jackson Hole and plunged into University HealthSystem Consortium events. I wanted to be part of the leadership that would ensure coverage for the 38 million uninsured Americans, eliminate waste, measure quality, and help gatekeepers quarterback care and prevent drug interactions from medications prescribed by uncommunicative specialists.

Hard earned experience has taught me that not all primary care physicians want to be communicative quarterbacks, not all specialists are uncommunicative, not all cost savings go to providing insurance for the less fortunate, and not all change agents are rewarded with job security and appreciation. The irony that the architect of several "successful" cost-cutting campaigns at Iowa and Allegheny was now looking for a job was appreciated.

Reinventing myself

My family and I decided to stay. When the CVs and telephone calls to the other medical schools in the area failed to produce results, I decided to take the opportunity to reinvent myself. Richard Nelson Bolles' What Color Is Your Parachute? A Practical Manual for JobHunters and Career-Changers guided my effort to be happily, gainfully employed in Philadelphia. (3) I discovered that when I packaged my multi-faceted experiences from three medical schools in terms of transferable skills that were easily understood by potential employers, interviews were scheduled. When I translated my 20-page academic CV into evidence that I was a catalyst, problem solver, process improvement strategist, and architect of productive change, employers thought I had something to offer them.

A lot of hard work, networking, and "selling" (something I am not yet used to) my reinvented self resulted in a CEO taking a chance on me and giving me the opportunity to become a health care retained search consultant. She now relates that the out-of-town physician executive positions and the interviews I had in Philadelphia with one of her competitors convinced her to move fast and hire me. I obtained an interview with her through the help of a professional contact I barely knew.

My experience is supportive evidence for Mark Granovetter's conclusion in Getting a Job that 56 percent of his subjects found their jobs through a "weak tie" personal connection. In this study, 83 percent of those who used a personal contact to get a job saw that contact "occasionally" or "rarely." (4) Acquaintances are more important than friends in obtaining employment; one needs to network with acquaintances and rely on the sympathy of relative strangers to reinvent one's self. (5)

I am finding my new position in the private sector allows me to develop skills and interests that were not utilized in my academic medical career. I am also guest lecturing in an executive MBA program in Philadelphia and helping another university design a master's program In business for physicians.

My former academic colleagues are once again divided in their assessment of my decision. Some seem to feel sorry for me, and they perceive a decline in my professional status. They advised me to relocate and take a challenging physician executive position so as to not throw my career away. Others are intrigued by the new challenges I am facing and are emailing me their CVs with queries about how they can change careers. My family and I are delighted that I am engaged in meaningful work in the community where our schools and synagogue are located. My son and I have started to volunteer at a Center City soup kitchen as a direct result of this experience (when I was an academic chair I never found the time to volunteer, and I limited my charity work to writing checks for donations), and my wife has returned to part-time practice.

Conclusion

With all the changes brought on by the global economy and the uncertainties of the health care marketplace, other physicians may be faced with the need to reinvent themselves. A recent New England Journal report quoted a study, which found that 46 percent of the physicians surveyed 'often think about leaving clinical practice." (6) Since there were 738,000 physicians in the United States in 1996, over 300.000 American physicians may be thinking of reinventing themselves. I wish them well; it worked for my family and me.

It is not easy. It can, however, be exciting, rewarding, and full of growth if one is able to perceive surprising changes, like the bankruptcy of your medical school, as an opportunity to redefine one's self and one's career. Luck and hard work both played a role in my transformation from academic professor to private sector consultant; some in the same position will take longer to discover what they really want to do with the rest of their life.

References

(1.) Stillman, A.E. Modern Times. N Eng J Med 1995; 333: 1086-1087.

(2.) Bottles, K., Burgener. A.J. COTH Line: Bankruptcy at the Allegheny Health System: An 'Aberration' or a Glimpse of the Future? COTH Report 1998: 32: 1-4.

(3.) Bolles, R.N. The 1999 What Color Is Your Parachute? A Practical Manual for Job-Hunters and Career-Changers Berkeley, California: Ten Speed Press. 1999.

(4.) Granovetter, M. Getting a Job: A Study of Contacts and Careers. Cambridge, Massachusetts: Harvard University Press, 1974.

(5.) Gladwell, M. Six Degrees of Lois Weisberg. The New Yorker, January 11, 1999.

(6.) Bodenheimer, T. The American Health Care System: Physicians and the Changing Medical Marketplace. N Engl J Med 1999: 340: 584-588

RELATED ARTICLE: KEY STEPS IN TRANSFORMING YOUR CAREER

Decide what you want to do

Play to strengths

Get frank advice from colleagues, relatives, and friends

Consider formal assessment instruments, such as Meyers Briggs, Lifestyles Inventory, aid Strong Interest Inventory

Decide where you want to do it

Geographic location

Small versus large firm

Nonprofit it versus private sector

Start your own company

Identify contacts and network

Get a face-to-face meeting with the person win can create your new position (this person never works in the human resources department)

Use the Internet to research companies and individuals

Network with everyone you know and meet

Ask for ten-minute interviews with strangers to get mentoring Be persistent:

Use reinvention as an opportunity to adjust your lifestyle

Volunteer work

More tine with family

Develop atrophied or new skills aid interests

Kent Bottles, MD

RECOMMENDED READING FOR FOB SEARCHES

Asher, Donald. The Overnight Job Search Strategy Berkeley, California: Ten Speed Press, 1993

This book concentrates on how to make contact with the person who can give you a job that you have designed. Good on identifying leads, research, getting an appointment, and interviews.

Asher, Donald. The Overnight R sum

Berkeley, California: Ten Speed Press, 1991

The best single resource I have found for r sum s that actually work. The usual physician CV does not impress employers or search consultants.

Bolles, Richard Nelson. The 1999 What Color Is Your Parachute? A Practical Manual for Job-Hunters and Career-Changers

Berkeley, California: Ten Speed Press, 1999

This book helped me identify my transferable skills when Allegheny went bankrupt. I will always be grateful to this book and this author. I do not really like the style of writing, but the content helped me become a consultant.

Lucht, John. The New Rites of Passage at $100,000 plus New York, New York: The Vioeroy Press, 1993

The best written of the books I have read. He discusses each of the four ways to get a job in detail personal contacts, networking, recruiters, and direct mail.

W endleton, Kate. Through the Brick Wall

New York, New York: Villard Books, 1992

One of the best general guidebooks to how to search for a job.

A M A Books

Managing the Job Interview

The Physician s R sum /Cover Letter Workbook

Leaving the Bedside/Closing Your Practice

Assessing Your Career Options

Evaluating and Negotiating Compensation Arrangements

These books are all good, solid efforts that can be quite useful. Please call A M A books at 800/621-8335 for ordering and price information (all books published in 1997).

Kent Bottles, MD

LEARN HOW TO NETWORK AND NOT HATE YOURSELF IN THE MORINING

The following books are recommended reading for physician executives interested in learning how to sell themselves.

Alessandra, Tony and Barrera, Pick. Collaborative Selling

New York, New York: John Wiley and Sons, 1993

Most books on sales are horrible. This one is essential reading.

Rackham, Neil. Spin Selling

New York, New York: McGraw Hill, 1998

This book is quite good aid based on the largest data set of research in the field more than 35,000 sales calls.

Tracy, Brian. Advanced Selling Strategies

New York, New York: Simon Schuster, 1995

Some excellent ideas about how to actually sell yourself are presented prospecting, presenting, aid motivating.

Kent Bottles, MD is a health care consultant and retained executive search managing director in Philadelphia, Pennsylvania. He has written for the op-ed page of The New York Times, Medical Economics, Trustee Magazine, Medscape General Medicine, and Physician Practice Options Newsletter. He can be reached by calling 215/656-3596 or via email at kbottles@'divsearch.com.

Ket Bottles, MD

The Physician Executive Journal Club will further explore the theme of the evolving role of the physician executive. We invite you to join us online from September 15- October 10 to discuss the articles published in this issue, such as "Reinventing my Medical Career" by Kent Bottles, MD, who will facilitate this discussion. Log onto the American College of Physician Executives' Website at www.acpe.org to participate.