What Is It Like to Work for a Big Five Consulting Firm?

Q: How did you get a job with one of the big five consulting firms?

Gessler: I got it through networking, which as you know, is how you get into most everything. I talked to a friend who asked me if I knew what another friend was doing, and he said he was working for ABC Consulting Firm. I called him, he described his job and said they needed more physicians. He gave me some names and I made the contacts.

I went through the interview process, which was rather lengthy because they don't move quickly. I had several phone interviews and then finally I met with a group of three who said, "We have been told from Chicago that we are going to hire you and we are not to mess this up." It was a matter of making sure I was compatible with these people. We went to lunch, came back, and they offered me the position. I went to Chicago to talk to the national leader--we met in the airport, had an hour meeting, and at that point I accepted the job. They assumed what my capabilities were based on my background. I had been in academic medicine before I got into managed care. I had been CEO of PCA in Texas, a $500 million company, for ten years. That is what they were basing their real interest in me on.

ABC employs two types of physicians. They hire young physicians, some who have come directly out of medical school with little or no clinical experience. They go in as entry-level consultants. If they do well, they can work their way up to partnership. They have starting salaries similar to other entry-level consultants--sometimes a little higher because they are physicians.

ABC also hires more experienced physicians for their specific skill set. If you want to go in as a partner, you can sometimes make that happen, but it takes an extended period of time--probably six to nine months in the interview process. I went in at a level below that, which is called a director level. It depends upon your age and what you want to do. You have the opportunity to work toward partnership. If you're older and want to do this for a few years, you can stay at the director level.

There are a lot of changes going on in the big five firms. They are divesting their consulting and audit practices because of the Securities and Exchange Commission's (SEC) independence rule. The SEC said, "You are going into all these major institutions and giving them consulting advice on the one hand, and then auditing them independently on the other hand, and we think there is a problem with that." At ABC, there were three different areas involved in health care consulting of one kind or another. They are combining them into one group, which includes managed care, physician practice management groups, academic medical centers, general industry, and consulting on legal issues.

Q: What type of physician is satisfied in the consulting environment?

Gessler: For a physician wanting to go into consulting with one of the big five firms, he or she has to have the right type of personality. There are a number of things you have to do as a consultant that you don't ordinarily do as a physician. One of these is that you must go out and sell the services of the firm and yourself. You are not there just to be assigned jobs and go do them. For the amount of money they pay the physicians, they expect them to bring business in. You must become a sales person, which, in some ways, is foreign to physicians. In their clinical practices, they have to sell themselves, but this is quite different.

Also physicians generally aren't used to being told no and that happens pretty regularly because these are high priced engagements. You have to convince the client that they need the services and that the services are worth the amount of money the organization is going to pay for them. Some physicians feel uncomfortable with that. If they don't like to do selling, consulting is not a place for them to be.

Physicians are used to making decisions by themselves and carrying them out. In the consulting world, for the most part, you are part of a team. Occasionally you might be hired as an expert witness, but those opportunities are rare. You may or may not be the leader of that team. You have your input into the report that goes to the client, but it may not be exactly what you agree with because you are just doing a portion of it. The report is based on objective data that the company pulls together and the contributions of various experts. You have to sell your position and then go along with whatever the team decides.

Once you give the report, in many cases, you go away and you don't know if it is implemented, if it is implemented correctly, or what the results really are. Some physicians are uncomfortable with that because they are used to following their patients until they are well. Sometimes you would be hired to implement the plan once you've submitted it, but other times you are not.

Q: How much travel is required?

Gessler: The companies often let you live where you want to because you are going to be traveling to where the engagement is. The companies may vary a little with this, but at ABC travel was to be done on your own time, meaning you should travel during the evening, not during the business day when you should be in the organization consulting.

Often you are in two or three places during the week. You fly in at night and are at the client site first thing the next morning. It's fun for about two weeks and then the novelty wears off. However, if you enjoy travel and anticipate it, it's not that bad. When you are not with a client, you go to your office and do the marketing. It's not traveling all the time, but the busier you get, the more traveling there is. If you've been there for a while and built the business up, you might leave on Sunday night and come back Thursday or Friday night.

You travel in coach unless you are at the partner level. If you log in more than 50,000 miles a year, which is pretty easy to get to, then you are allowed to travel first class if your destination is over a certain distance. You are allowed to keep your frequent flyer miles.

Q: What are some actual tasks you did when you were consulting?

Gessler: The first job I had was facilitating a meeting for a large employer. They wanted to meet with their managed care venders to get them to be more responsive to the organization's needs. Another time we were doing business with a physician management group. We were reviewing all of their operations. I was interviewing physicians who were part of the group. We had financial people looking at the finances. We had utilization review people looking at those processes. There was a whole team of people who came together afterwards and reported their findings, and then organized what we were going to recommend. More often than not, I was interviewing physicians or top administrators. Sometimes I was in charge of developing the report and sometimes I was just contributing my ideas.

The younger physicians become NCQA specialists, for example, and go around selling that expertise because they don't have the broad experience. ABC only had about ten physicians and half of them were younger, but it was just trying to get into the health care arena. Another firm had 30 to 40 physicians.

There was quite a bit of turnover--a lot of the physicians would come and go. The physicians would think, "Consulting, oh, I can do that," but sometimes they would find they were not necessarily the experts they thought they were. Even if you are an expert, sometimes the organization is not willing to pay what the consulting firm is going to charge for your services. They have to pay your salary, the partner's portion, and the overhead. When I was there, they charged $500 an hour for my services.

Q: What are the pluses for working for a big consulting firm?

Gessler: They are major companies so you get all the benefits--retirement plans, 401k, health care, etc. You get a lot of variety assuming you are not specialized into one area, as are some of the younger physicians. Every client you go to is different and will offer you different problems. From that standpoint it is fun. You meet a lot of people in the firm and in the client organization. You make a lot of contacts, so if you don't like what you are doing, you have opportunities to network for your future. You are free to use those contacts.

Barbara j. Linney, MA, is the Director of Professional Development at the American College of Physician Executives in Tampa, Florida and a member of its faculty.

KEY CONCEPTS

* Consulting for a Big Five

* Selling Yourself, Your Ideas, and Your Firm

* The Pluses of Consulting

* Working as a Team

* How to get Hired as a Consultant

Is consulting for a big five a career direction you've thought about pursuing? In this column, Barbara Linney interviews physician executive Don Gessler, MD, MBA, CPE, FACPE, to talk about his experience in working for a big five consulting firm. He discusses how he got his position at ABC Consulting Firm, the nature of the work, the rigorous travel schedule, the pluses, and the type of physician executive that is satisfied in this environment. He describes some of the projects and tasks he has been involved in as a consultant. He emphasizes that if physicians don't like to do selling, consulting is not a place for them to be and that it is a very team-based structure.