Stay and fight or cut your losses?

IN THE TRENCHES

You are so unhappy about the direction the health care provider has chosen you talk about it incessantly. Your family and friends leave the room when you mention your woes. The organization's flagrant mismanagement fills your dreams. You've presented your arguments, reasons, statistics, and suggestions for a different course of action and you've been turned down flat. Should you give up?

Maybe the problem is a personal issue: You are being treated so badly--sexual harassment, overwork, or sheer abuse--that you wonder whether you should fight the boss, the system, and top management or get another job and cut your losses. All of us, at some time, have felt so strongly about a workplace issue that it became an obsession. When that happen. Before you call a lawyer, consider this: Organizations dispense justice poorly if at all. Fighting it out requires strength of character and the hide of a rhino. Is it worth it? Talk to people who've done it and then answer the questions in this column.

Why do you want to right? Does the issue matter to you personally? Here's an example. A woman MD working in the most backward, benighted division of a Fortune 500 pharmaceutical company was approached regularly by other women who wanted her to make a stand for women in the organization. She'd been there 20 years and was the highest ranking woman in the organization. Her husband had recently begun a new career, and they needed her, salary. While her colleagues were quick to call on her for help, what were they putting at risk? She was risking her family's livelihood, and they weren't risking anything. Unless it matters to you personally, let the others fight the war. Had she felt that her situation was intolerable, she should have taken up the cudgel, but not for people who might decide that, after all, they were quite happy with their jobs.

Is your ego on the line? They don't want you, but you'll get no severance if you quit. You've done nothing wrong. In fact, you're highly productive. The medical director and the CEO don't like you. Why not stay and make their lives miserable? It doesn't work that way. Anyone who's tried this strategy will tell you that they'll get you before you get them. There's only so much ostracization you can stand before you begin to wonder if you are indeed the problem. Once you've confirmed that you can't get a severance package or outplacement help, get a new job and move on.

Is it a personal vendetta? This is the worst. You cannot or will not rest until the perpetrator is humiliated, fired, escorted from the premises, etc. You want revenge, and nothing less will satisfy. Money, a new job, relocation, a better boss, winning the lottery wouldn't make you feel better. Revenge is never as great in reality as it is in fantasy.

Most people imagine a scenario in which their enemies are not merely vanquished, but humbled. It rarely works that way. Even the worst boss, organization, or co-worker has some redeeming qualities, Thus, pure revenge is never pure. If you're obsessed with the idea of humbling a boss or co-worker, seek psychological counseling. It won't happen. If it does, he or she will believe it was distemper on the part of the gods. There's no way to win!

Are you strong enough to take a stand? Is your personality strong enough? Do you have a good support system? What else is going on in your life? If you're in a strange town, away from family and friends and going through a divorce or break up, don't add a lawsuit to your troubles. We've seen otherwise normal people reduced to a breakdown by just one more emotional burden, and a lawsuit complete with a hostile boss and cold shouldering by other physicians is at least two more.

Jack took a new job as department chair of oncology with high expectations. He'd been there less than two months when he could document serious verbal abuse and sexual harassment from the vice president for patient care. He talked to an attorney who told him he had a case that he could take to the Equal Employment Opportunity Commission. (The attorney also briefed him on the length of time it would take EEOC to resolve his case and warned of possible career damage if he sued the hospital. Because Jack lived and worked in a small town, a lengthy investigation would be lonely if co-workers shunned him. If he left town to take a new job, how much time could he take off to work on his case?

Summary of Previous Scenario

Dr. Verde has been head of the department of medicine at Altrusa Hospital for more than 10 years. Over that period he has gained valuable experience in running a department and has been actively involved in the committee work of the medical staff. He firmly believes that his next step in career development is to a full-time medical director position, preferably at Altrusa. The problem at Altrusa is the opposition of the president of the medical staff, Dr. Fosse. Jim Lento, the hospital administrator has indicated that he favors the establishment of a medical director position and the filling of that position by Dr. Verde, but Dr. Fosse has successfully fought all attempts to do so. Dr. Fosse considers the proposal an unwelcome intrusion into his affairs and clearly is unwilling to share power. While Dr. Verde has been patient, he now wonders if his approach is wise. He's in his mid-40s, and he is convinced that he needs to make a move. He dislikes the idea of leaving behind all he has built at Altrusa, but he suspects his skills are portable. Should he wait a few more years, he wonders, and risk disappointment if the position does not appear? Or should be strike out and achieve his management goals elsewhere?

Responses

Dr. Verde is in a position faced by many physicians seeking to move from clinical to administrative careers. He is in an organization that has nurtured his management interests but that may not be able to support a transition to full-time administration. If he is truly ready for this move, Dr. Verde must look actively for an organization that can accommodate his aspirations. There is no assurance that he can become medical director after Dr. Fosse leaves. Dr. Verde should assess the level of support that would exist for electing him president of the medical staff when the position is vacated. Only if there is very strong support from the medical staff should he consider biding his time at Altrusa Hospital, waiting for the desired medical director slot.--Richard Rohr, MD, Medical Director, Cedar Lane Rehabilitation and Health Care Center, Waterbury, Conn.

If job descriptions for the Medical Director and President of the Medical Staff positions do not already exist, Dr. Verde should ensure that they are written as expeditiously as possible. The job descriptions should clearly indicate the differences between the roles and responsibilities of the two positions. Somewhere, it should also be clear what the term of office is for the medical staff president. Surely it isn't for life, unless the politics at Altrusa Hospital are especially bizarre. Next, Dr. Verde should use the job descriptions to proselytize on behalf of the medical director position and to determine the level of medical staff support for its creation. Medical staff opinion leaders' views will be critical in this process. If there is an "automatic" succession policy for elected medical staff officers' advancement, they should be particularly informed of the many ways a medical director can ease their burdens when they become president of the medical staff. If Dr. Verde determines that there is a substantial level of support for the position, he should push harder for its creation. If the support isn't there, or his additional pushing is without effect, he should search elsewhere for career advancement.--Kenneth C. Cummings, MD, FACPE, Vice President for Medical Affairs, St. Joseph Health Center, Kansas City, Mo.

It's time for Dr. Verde to move along with his professional management career and to start looking at other opportunities. Mr. Lento has made it clear that he is reluctant to upset the status quo. Even if, and when, Dr. Fosse retires, it is doubtful that Mr. Lento will bring Dr. Verde onto his management team. If Dr. Verde has made the professional and personal decision to move full time into medical management, he should pursue his goal.

If Dr. Verde decides to wait it out, he will be placed in a situation where hospital administration has made it apparent that it will accommodate the medical staff first and foremost. This does not sound like a team organization. Dr. Verde aspires to a position where the deck may be stacked against him from the start, as he will be in a position perceived by both the medical staff and administration as having little power. Unless the administration changes, this will lead to a no-win situation for Dr. Verde that will come to a head rather rapidly when the administration is forced to decide between Dr. Fosse (or his designate) and Dr. Verde. Given that the hospital has had a mutually profitable relationship with Dr. Fosse, it is unlikely that administration will be willing to share power with Dr. Verde.

If Dr. Verde has assessed his situation and feels that it is time for him to move full time into medical management, it's time for him to test the waters, but not at Altrusa. Other opportunities will open to him once he has made the decision. If he leaves Altrusa on good terms and develops professionally, there may be the possibility that he can come back to that facility in the future, if its goals have become more in concordance with Dr. Verde's professional goals at that time.--Joel V. Brill, MD, Associate Medical Director, Blue Shield of California, Folsom, Calif.

He documented the charges and talked to the human resources department. The hospital gave him generous severance to go away quietly. Jack feels justice wasn't done, and he's disappointed. He shouldn't be.

Can you afford financially to take a stand? Assume you'll be out of a job at least temporarily. If the issue will involve a lawsuit but doesn't fall under EEOC, you'll have to hire an attorney. Do you have dependents? Debts? Other family obligations? Are you "putting children through school" If rich Aunt Martha just left you a legacy, is this the way you want to spend it? Too many people assume that because they're filing a complaint, they'll have no expenses. What if your organization fires you? It will be years before you see any cash restitution, much less reinstatement.

Will you suffer long-term career damage? What are the chances that making waves, legal or otherwise, will haunt you? What if your organization starts a whisper campaign in your industry that you're a troublemaker? If you live in a small town or in a town where your organization is highly visible, you may have to relocate. If the organization fires you or tortures you out, are there comparable organizations you could work for in a similar position? Think a long time about temping while you await resolution of a suit or find another job.

What will you win? Even a large cash settlement is bought with extreme stress. (And your lawyer will tell you that six-figure settlements are not the norm.) Smaller severance looks good in comparison. Many physicians tell us they must do what they're doing. That's scary language, isn't it? They must? What must happen before you feel you can get on with your life and career? Don't let your principles hold you hostage. If you've said to yourself or aloud, "It's a matter of principle and that's what I'm fighting for," you should rethink it.

Will your one-person crusade save the organization? No one can rescue an organization with a death wish. Don't you suppose thousands of employees at companies such as International Harvester, IBM, and American Express recognized those companies needed to rethink their strategies? In the end, it was jump or go down with the ship. Reasonable people jumped.

We see many people for whom the problem is a matter of principle. They will not gain a thing, not money, not promotion, not job security, if they win. If they lose, they'll alienate enough people to fill the Superdome. Even when told, "You're right, but we're not going to do it," they fight on, unable to get closure. They need counseling.

On rare occasions, there are emotional payoffs. Two people we talked to did confront a boss over abuse and hours. Both lost. However, both felt they'd won simply because they were able to get closure on situations that had tormented them for years. It's worth it to confront a boss when you've decided that the job isn't more important than your self-respect. Often, another employer who hears the story is more likely to agree than disagree. Courage is a highly prized asset in the '90s. We've been amazed at the number of headhunters who've been asked to look for just that quality. For most people--if the ramifications of a confrontation are calmly and rationally weighed--it's best to resign and leave quietly. You'll be healthier, less stressed, and far better able to job hunt. The battle weary are terrible interviews. They look terrible, they feel terrible. Who needs them, especially in health care which has its own wounds to heal? If you wipe something out, deliberately erase it mentally, you are far more impressive to a prospective hirer.

The best technique we've seen for getting the courage to walk away is to record your arguments on video. Explain your side, theirs, What you want, what they want, and then play it back. One client reported, "It was scary. I became furious and red-faced over incidents that when seen on television, seemed insignificant. I was complaining that my boss didn't like me. Of course he doesn't. I can't stand him either! At that moment, I realized only a nut would keep trying to change the mind of someone he or she couldn't stand.

If the problem supports a lawsuit and you're still convinced it's the only way to go, get a new job, work at it until you're reasonably comfortable, and then file. Don't even consider filing before you get a new job. Your organization can retaliate, and you'll have a hard time convincing prospective employers that you are not a troublemaker.

If this seems too one-sided, it is. The good news is the organization may settle, because it's cheaper than going to court. The bad news is the CEO may decide he or she must fight to discourage other such charges.

If you do decide to cut your losses and leave, there are other things you can do. Never miss an opportunity to tell the facts to people who might contemplate working for that organization. If one star turns down an offer and says why, the organization may see a different reality. You must stick strictly to verifiable facts, no conjecture or speculation. The latter could involve you in a slander or libel suit. Check with a lawyer. Write to the CEO. You have nothing to lose. Possibly he or she is unaware of whatever problem has driven you to greener and saner pastures. The point is this: Fighting for your rights should benefit your peace of mind, bank account, and career. It rarely does--an excellent reason to consider all your options first.

If you are in a situation where the risks are so high that you will pay dearly in emotional health and financial security even if you win, ask yourself what you'd advise someone else to do.

Marilyn Moats Kennedy is Managing Partner of Careeer Strategies, Inc., Wilmette, Ill., and a long-time member of the ACPE faculty.