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Ask the coach: physician executive experts answer your medical leadership and management questions.

Picky Job Candidate May Not Really Want New Post

* Dear Coach,

I'm the board chair for a group of not-for-profit clinics that serve community and ethnic groups in our area. We've been searching for a new CEO and have come up with a guy who, on paper at least, seems perfect. The problem is that as we negotiate his employment contract he keeps coming up with an amazing number of nit-picky problems. This has been going on for eight weeks, involving everything from the nature of his cell-phone benefit to the kind of furniture in his office. The latest glitch is that he doesn't want to sell his house or move his family to our area until his middle son graduates from high school (about 20 months). Any thoughts?

A Chafing Chair

* Dear Chair,

Yes, don't hire him. I've seen this several times before and each time it's meant the same thing. Either this guy doesn't really want to come work for you or perhaps his wife and family don't really want to move. He's looking for interim employment. The odds are very high that he will only last a short time and that you'll be searching for another CEO in the near future.

If you don't believe me try a simple test. Tell your perfect candidate that you're out of negotiating time and need a full-time CEO on campus within 30 days. It's simply not acceptable to your very community-oriented organization that their CEO be a businessman who flies in and out of town every weekend. If you wanted that you would have just hired a consultant.

Tell him you need a fully committed, community-oriented CEO. Make it unequivocal. My guess is that, after discussing the situation further with his family, your candidate will change his mind. Don't worry about it. You'll find someone who's a much better fit in the months ahead.

* Dear Coach,

How do you get your salary increased? I'm the VPMA at a mid-sized hospital. I make about $195,000 plus the usual benefits. I like it here but all the ads I see seem to offer higher salaries for similar jobs. My boss is a well-known skinflint. I've hinted several times but he doesn't ever seem to take the bait. Any suggestions?

Underpaid and Unhappy

* Dear UU,

My friend Sue Cejka, founder of Cejka and Company and currently senior partner at Korn Ferry in St. Louis, has surveyed and consulted in this area for years. Here are some of her personal suggestions.

* "If you believe you're under compensated, you need to approach your boss directly. A tightwad will definitely ignore indirect approaches."

* "Before going in make sure you've done your homework. First, look at your own accomplishments. Pick out your top five achievements. Make sure they're quantifiable and significant, particularly any improvements in quality or profitability. Put them on paper in a format that your boss will easily understand, i.e. bar graphs, line charts, etc. Your boss sounds like he'll be more influenced by your contribution to his organization than any external comparison you might cite."

* "Once you've made the case for your own contributions, show him the inequity in your compensation versus the market. Bring some statistics with you. This combination of your own contributions and a documented pay inequity will make a compensation case really difficult to ignore."

* "Be sure you know what you want to achieve before scheduling this kind of meeting. If your boss asks you what you want, have a firm dollar amount in mind and give him an answer. Finally, unless you're prepared to leave immediately over this issue, make it clear throughout the conversation that you're committed to your job and just trying to resolve this one uncomfortable issue."

Sue's advice is excellent as usual. If you follow her recommendations exactly, I think both your unhappiness and your compensation will improve. By the way, good sources for market compensation data include Hewitt Associates, Hay Group, Physician Executive Management Center, the MGMA and the ACPE.

Good luck UU and please let me know how it goes.

Dear Coach,

I'm the chief of surgery at a 200-bed private hospital. I really need some help with a "marginal performer," a guy who throws instruments in our OR and screams at nurses on our wards. My two predecessors say they've both counseled him with no improvement. Our VPMA and hospital administrator say they're concerned but believe our hands are tied because this behavior falls outside the confines of peer review. Needless to say, this guy is the hospital's highest single admitter, accounting for nearly 8 percent of all surgical admissions. Any thoughts?

Frustrated in Florida

Dear Frustrated,

Yes, but none of them printable. This is nonsense. You have two marginal performers, your surgical colleague and your hospital administration. To deal with the former, it looks like you'll have to start with the latter.

No hospital should tolerate physical threats or verbal intimidation of its increasingly scarce employees by anyone, not even its biggest admitter. You can often deal successfully with such situations but you'll need two things

1. Clearly defined expectations of appropriate physician behavior in the wards and operating suite

2. A well-defined range of consequences for noncompliance

Your medical staff bylaws probably refer vaguely to professional conduct but the issue here is the specifics.

To develop these two components you 11 probably want to work through your department or through the medical staff executive committee, depending on the circumstance. The expected behavior is fairly easy to define and various organizations attach potential consequences ranging from loss of privileges, fines, reduced benefits or memberships, formal reports to termination depending on the exact situation.

Such expectations and potential consequences need to apply evenly to all physicians, not just to your miscreant colleague, and should be vetted by your hospital attorney, VPMA or board as appropriate.

Once so armed, experience shows you'll have approximately a 60:40 chance of helping your colleague fix his problem. From what you've said, a referral to anger management or to mental health counseling certainly seems likely along the way.

If this behavior continues, you're better off finding a new surgeon.

Howard Kirz, MD, MBA, FACPE, is a retired physician executive and past president of ACPE who provides executive coaching to health care boards and to a number of successful senior physician and health care executives. Questions for his future columns are encouraged and should he sent directly to
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Author:Kirz, Howard
Publication:Physician Executive
Geographic Code:1USA
Date:Mar 1, 2003
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