Strong career plan helps turn dreams into reality. (Leading Questions).

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Physician executives have come a long way in a short time. Within just a few years, many physicians transformed themselves from pure clinicians to executives and leaders of health care organizations.

But there's still a long way to go. Establishing important, realistic goals for executive success and setting out to achieve them is still surprisingly difficult for many physicians. It seems that many physician executives do not reflect enough on where they want to go and how they will get there.

To modify Avedis Donabedian's guiding precept (structure sets the foundation for process, which ultimately results in expected outcomes), we can develop a perspective for career leadership that may have a powerful application for physician executives in establishing a guide to career development.

The essential leadership idea is that the people are in charge of their own careers. It's up to each one of us to set the sights, make the choices and do the hard work that ultimately will become a career. The Donabedian formula in this executive career context looks like:

* Structure = Education and academic training

* Process = Experience and on-the-job training

* Outcomes = Career goals and achievements

Physician executives who use this formula as a guide for career development will have a clear understanding of each stage in their career growth and development.

Begin with desired outcomes

Many successful physician executives begin their career planning with a specific career goal in mind. Some deliberately, and many by accident, decide to become the chairman of an academic facility, or the CMO of a health system or a CEO of a hospital.

How attainable, or how much it may be an unrealistic dream, is not their first priority in setting the goal or outcome. They apparently can see their goal and enjoy the picture of success it creates.

Reality comes crashing in, however, when those who are not prepared test their candidacy in the marketplace are rejected.

Dreams become plans

Here are a couple of cautionary tales that exemplify how focusing only on the outcome can leave you foundering. The general areas of competence that a successful physician executive candidate can reasonably be expected to possess include:

1. Clinical credibility

2. Research and publishing success

3. Teaching experience

4. Administrative expertise

5. Leadership presence

Take the position of a clinical chair in a prestigious academic institution. A hiring organization is most likely to put emphasis on excellent credentials in the first three areas, while remaining more flexible in the fourth and fifth.

Administrative and leadership skills are vitally important for this role, but they may take a back seat to the others in the hiring organization's thinking. In any case, it's apparent that an individual who lacks a strong clinical background, research achievements and a solid teaching career record is not going to be selected as an academic chairperson.

And yet, Walter Mitty, MD-like, some physician executives dream on until they are rudely awakened by a career stalemate.

Similarly, some envision themselves as the CEO of a health system. Clinical, research and teaching expertise have little or no direct impact on this role. They may contribute to a gorgeous curriculum vita, but it's the last two areas, administrative and leadership experience, that will make a candidate stand out for a CEO role.

A physician executive with the best clinical and research credentials in the world who lacks administrative and leadership skills will not be hired as a system CEO.

Back to Donabedian

Having the proper structure and the appropriate process will help ensure the desired outcome. So if your goal is to become a health system CEO, you must be poised and ready for that position by the time you're in your early 50s. Boards tend to hire individuals who can remain with the organization for a decade or more, ensuring seamless continuity.

Working backward, then, you need to develop 10-15 years of management experience, completing a management degree and other administrative training as basic qualifications. In reality, to become a health system CEO by age 50, you must make some of the key decisions and take action by age 35 or so.

A few years one way or the other is an acceptable margin. But it is not at all realistic to aim for a health system CEO role in your late 40s or 50s without substantial experience in a top executive position.

To illustrate, write down your career goal in a statement. The statement may be about the ultimate outcome desired or an intermediate step. Then, look at the careers of other successful executives (physicians and non-physicians) in that type of position.

What type of foundation (education) did they develop? What type of process (career development) did they experience?

Now, write down the ideal education and career progress to achieve your desired outcome. It may be necessary to break each of these steps down into sub-outcomes to fully map out a path to success. If you can tell a plausible story for your career development, the vision is more likely to become reality.

And yet...

It is also true that health care organization boards want the kind of leadership that physician executives can offer and they are even willing to make adjustments to their expectations from time to time.

For example, a physician executive who may communicate well with the board, have strong philanthropic and governmental ties and know a lot about finance and quality, may not have sufficient management experience to handle daily administrative tasks.

However, if those administrative duties can be passed off to someone else, the physician executive may be the perfect choice for the job.

Also, an effective physician executive who has the confidence of the medical staff and is their leader can lead the organization. By contrast, the best health care administrator in the world who does not work effectively with the medical staff will ultimately fail.

Boards look for what works, and that is more and more likely to be a physician executive as leader.

Scott Ransom, DO, MBA, MPH, CPE, FACPE is vice president at Witt/Kieffer in Oak Brook, Ill. In addition, he serves as an associate professor in health management and policy at the University of Michigan and associate professor in obstetrics and gynecology at Wayne State University School of Medicine. He can he reached by phone at 630/575-6130 or by e-mail at [e-mail]