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How do you get experience?

To get a management job, all recruiters say you need experience. How do you get experience? The question brings back memories of high school when you wanted a job, but in order to get a job, everyone wanted you to have already had one. It is an aggravating, humiliating feeling that reminds you of being immature and inexperienced. No wonder people don't respond well when I try, to explain what's needed.

To get experience, I say, "Volunteer, volunteer, volunteer too serve on and lead committees, such as utilization review, quality assurance, strategic planning, privileging, and credentialing. Get elected to the medical staff executive committee. Go up the ranks until you are President. Be Chair of the department or service. Let people see you doing management activities - helping groups solve problems, dealing with budgets and schedules. Be excited about the new informatics system. Volunteer to teach others to use the system in an upbeat, cheerful way. Check out the HMOs and insurance companies in your area. Try to work for them part-time, doing utilization review and quality assurance. Do you know a physician who works or contracts with an HMO? Talk to him or her about whom to contact in the organization to try and get the part-time job."

When I say these things, people say, "Uh huh." Then they look at me with a face that implies, "Tell me something else. I don't want to do that." So I asked a focus group of five physician executives to tell me how they obtained the needed experience. Here are their stories.

John E. O'Malley, MD, FACPE

I've been Senior Vice President for Louisiana Health System, in Lafayette, Louisiana,. a conglomeration of acute care hospitals, nursing homes, urgent care centers, and other facilities since January, 1996.

The first position I had was as Director of Consultation at the Children's Hospital Medical Center., in Boston - I was to put the service together and meet the needs of the general hospital. That gave me some introduction to coordinating people and schedules, talking people into doing things. The second was as a Medical Director of a new adolescent psychiatric hospital with the Greenville Hospital System. It involved more people, more tasks, and a lot of support from hospital administrators. Then I became Vice President of the Devereux Foundation, a national mental health provider with 22 centers in 13 states and the District of Columbia, which increased the complexity being a physician leader.

My current position is based on experience. The skills that were required along the way, I learned through experience and having the opportunity to learn management through Physician in Management seminars. I don't have an MBA. Part of what I have to do now is to get an MBA. I am in a master's pro-gram in health administration at the University of Colorado.

The knowledge of how to provide coverage for a variety of hospitals and physicians came from other physicians and administrators who had done it for a long time. I watched them sit down and put a schedule together, prepare a budget. A finance course does not help you do a budget. What helps me do a budget is other people who have done it for 19 years showing me how to do it or pointing out that I haven't allocated money for such and such. It was mentorship from a variety of people who already had those skills - mostly administrators - people who have been in the business for a long time.

John R. Sanders, MD

I've been Vice President of Medical Staff Services at Greenville Health System since January and have been an orthopedist for 20 years in Greenville, South Carolina.

I've been on every committee there is. Every time something came up, I either volunteered or got appointed to it. Sometimes I volunteered myself, but too many times, I didn't know how to say no. I had mentoring from individuals who had put budgets and plans together. I gained skills about strategic planning, whether it be for programs, departments, blending departments, or fighting battles of cross credentialing. You learn people skills and coping skills. It's the school of hard knocks. I've gone to a few courses here and there, but I've not had formal MBA training.

N. L. Saxton, MD, FACPE

I've been Vice President of Medical Affairs at Antelope Valley Hospital Medical Center, in California, for one-and-a-half years. I've been a Medical Director for 17 years, and this is my fourth hospital. I went from my private practice in Iowa of 11 year's into academic medicine at Texas Tech University School of Medicine. It was during that time that I began doing tasks that had minor administrative responsibilities - scheduling, working out conflicts between residents and faculty, and designing medical record systems.

The thing that helped me the most during that time was that I became a leader in the Boy Scouts. They have a training program called Woodbadge - their highest level of adult training. Participants learn how to teach young people and manage others. The program teaches 11 competencies, such as counseling, setting an example, and running meetings, ending with two weeks in outdoor survival. Those are the same skills that are being taught in business management training programs.

Without realizing it, I was in a management training course. Texas instruments used to require some of their leaders to work for the Boy Scouts. benefitting both company and scouting. You have to commit to two years of using those competencies before receiving the Woodbadge Award. That did more for me than anything. I recognized that I needed to learn more about those skills, so I started taking courses with ACPE. I am approaching 900 CME hours. I've been coming to meetings for 17 years. I haven't missed the May or December meeting in all that time.

Gary A. Fleming, MD

I am Director of Medical Affairs for Athens Regional Medical Center, Inc. in Athens, Georgia.

When I joined a pediatric group in Cumberland, Maryland, I soon became Chairman of the Department of Pediatrics. It gave me an opportunity to be in the executive committee meetings and to observe the leadership skills of the CEO of the hospital. The sister of the Catholic hospital soon found out I was interested in how mentally handicapped people were cared for in Maryland. She invited me to be on the Board of the Mental Health Advisory Council for the Allegany County Commissioners. She became my mentor. particularly after I became Chairman of the Advisory Council.

She stressed two things: (1) "Keep it, Simple Stupid," or KISS. When the Advisory group made its presentation governor and the state legislature, it was simple and direct; and (2) the sheepdog form of leadership where, if you expect the medical staff to do anything, you have to talk one-on-one to them, and when they are all moving in the same direction, you move around in front of them.

It was the mentoring by this administrator that taught me the management skills and helped me get the necessary experience to become a physician executive. She was pleasantly upset when I wound up being the Medical Director for a competing hospital in the same area.

Randy S. Ellis, MD, FACPE

I am Clinical Director for ProMed in Charlotte, North Carolina - ambulatory care units that do about 50 percent acute care and 50 percent occupational medicine.

I fell into my first management job sort of by default, which I think a lot of people have said here. You take a job and suddenly, they give you administrative tasks to do because you are the only one who will do the paperwork. You are the one who is suddenly going to the committees, writing the policies, and trying to do the quality assurance. I did a lot of work in utilization review and cost containment.

I became Medical Director of an Emergency Department at Washington County Hospital in Hagerstown, Maryland, where we saw 57,000 patients a year, and I had a staff of 20 physicians. I had no management training. I worked for a company that staffed emergency rooms. The hospital viewed me as non-administration. The medical staff saw me as administration. The company saw me as out there in Podunk, and nobody was interested in training me.

I said to myself - "I've got to learn something here," so I started going to career track seminars on presentations, communication skills, and management styles. That,s how I started picking up skills, and later I heard about the American Academy of Medical Directors (now ACPE) and began attending classes there. That's where I began a lot of my formal training in management.

Jack Kushner, MD, in Preparing to Tack, When Physicians Change Careers, reminds physicians when they go into management that they are essentially starting over. "Whether the field is law, business, or health care management, doctors should equate their skills in a new field with the skills that an intern in medicine possesses." Getting experience may be inconvenient, but it is essential.

Key Concept: How to Gain Needed Experience/Why Volunteering Works/ Mentorship

How do you go about getting the experience you need to land a job you're coveting? Barbara Linney asked five physician executives to tell her how they obtained the needed experience in a recent focus group. From admonitions to volunteer to finding a mentor(s) to learning special competencies from a Boy Scout training program, here are their stories.

Barbara J. Linney, MA , is the Director of Career Development at the American College of Physician Executives in Tampa, Florida and a member of its facility. She can be reached at 800/562-8088.


[1.] Kusher J. Preparing to Tack, When Physicians Change Careers, New York, NY: Vantage Press, 1995, p. 42.
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Author:Linney, Barbara J.
Publication:Physician Executive
Date:Oct 1, 1996
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