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What do you have to do to become a medical director?

Medical management is a large and growing profession. the need for physicians in management roles grows unabated in hopitals, managed care organization, group proctices, and myriad other environments. But entry is not merely a matter of wishful thinking. Painstakingly assembled credentials and skills are the order of the day. The advice in this column is distilled from Medical Directors: What, Why, How, a new College Monograph.

Physicians who are considering moving from clinical practice into management often ask, "What do you have to do to make the change?" There are no hard-and-fast rules for this or any other profession, but the physician who wants to start his or her new management career in a way that ensures success will follow a few simple guidelines.

Become a board-certified clinician who practices 3-5 years.

Residents who are interested in management and who do not want to practice clinically have asked, "Why do I need to be board certified when I am not going to practice?"As a medical director, you will be working with physicians, in some cases telling them what they can and cannot do. Physicians respect other physicians most for their knowledge of disease and their capacity to take care of patients.

Only gradually do they come to respect them for their management skills. They will not take instructions from someone who has not had to cope with an overcrowded schedule, shrinking resources, government regulations, the threat of malpractice suits, and night call, to name a few of the frustrating realities of being a practicing clinician. You do not have to practice full time, but it has to be in a setting where you are fully responsible for some patients.

Get management experience.

Serve on committees and task forces. Let people see you doing management activities--working with people and tackling problems. If you serve on the long-range planning committee, the utilization review and quality assurance committee, the credentialing committee, you can claim all of them as experience when you are ready to move more into management.

Get involved in the county medical society, the state medical society, the American Medical Association. Some HMOs and insurance companies hire people to do utilization review and quality assurance part time. This is valuable experience for a management career.

"If you think you might be interested in hospital management, you would be wise to do what you can to move up in the elected or selected hierarchy of your hospital medical staff. Express interest in becoming chairman of your clinical department or be willing to serve on the hospital executive committee. Be available to take a job as an elected officer of the hospital staff. The same would be true for those aspiring to positions in management in medical group practices or various types of HMOs."(1) Volunteer for committees throughout your career to continually learn new activities, to make yourself visible in the organization, and to have experience to put on your resume should you decide management appeals to you some day.

You may have to take a management job that is not quite right in order to get the necessary experience. Once you go into the management arena, you may have to move every 3-5 years. You need to think about whether you want to do that.

Get education.

The Physician in Management seminars of the American College of Physician Executives are an excellent source of training in basic management skills. Attend the College's National Institute, which has even more concentrated areas of study. Be on the alert for informal educational opportunities from other national professional organizations and from local colleges and universities. Get a master's degree if you have the time and financial resources. Be aware, however, that a master's degree will help you do a management job, but it will not guarantee that you can get a management job the way the MD or DO guaranteed that you could go some place and practice medicine. You will still need experience to get the management job.

Find a mentor.

Mentoring takes less time than many people think. The person does not have to be in your organization or even your town. You can call them and say, "Can you listen to me for a while--20-30 minutes?"

Mentoring does not have to be regular. I have heard people try to set up formal situations--a contract where I'll help you with your weakness and you help me with mine. Once in a while that might work, but a formal commitment to a specific amount of time can scare people off. They may give you that much time because they get interested in you, but they don't want to promise it.

In some companies, mentor situations exist where someone spends a considerable amount of time at another company-at another hospital in the same hospital system or at another staff model in the same managed care system. A new medical director can be sent to the site and walk around with an experienced medical director for a week and learn how he or she does things.

"Information interviews are valuable and may be the beginning of a mentoring relationship. There are two types. First, you can have an information interview with a physician in management who has a job that you think you would like. For instance, if you are interested in group practice management, interview several physicians who are medical directors in group practices. These information systems may lead to a long-term mentor relationship."

"A second type of information interview would be one in which you interview someone who works for an organization that you might like to work for. If you desire an information interview with a health care executive in a large insurance company, plan two or three questions that you would ask that person and tell him or her ahead of time that you do not intend to take more than 15 minutes of his or her time. You should have the key questions written out so you could at least get them answered if there is not time to get other questions dealt with. Of course, if you already know the person, it would be all right to expect a longer interview or possibly an interview over lunch that you pay for."(1)

Don't continue a mentoring relationship if sexual stuff gets in the way. It is very natural for people who work together to become good friends. The sparks of creativity generated by good minds thinking together can sometimes lead to sexual thoughts. If either person acts on these thoughts, it is wise to end a mentoring relationship. The trouble you can get into can outweigh any benefits you might receive.

Lee Kaiser says, "...we are all mentors for the people who have not moved as far on the path as we have, and at the same time we are dependent on mentors who are further along on the journey to help us take the next step....You may never be able to help the people who help you. Your service is to those who are coming along behind you."(2)

Improve interpersonal communication skills.

One physician CEO has said that his position depends on constant attention to development of interpersonal skills, including patience, tolerance for delays, comfort with ambiguity, and learning to negotiate win/win situations. "Never before were listening and communication skills more important."(3) The need for communications skills has to be extended to public speaking, a common responsibility of the physician executive, particularly as the individual climbs the career ladder.

Also, if you want a job where you will be in line management and directly responsible for people, get some training in performance evaluation. Performance evaluations in health care organizations are generally not done well. "None of us is born knowing how to give appropriate criticism and constructive feedback." You need to speak dearly and concisely in a calm, firm voice when giving people feedback about changes they need to make in their behavior. If you look all around the room or fidget nervously, you convey uncertainty and fear. You want to appear confident. If this is difficult for you, practice in front of a video camera until you improve.

Spend time on your resume.

Put together a short powerful resume, as opposed to a long curriculum vitae. You tell not only where you showed up for work and when (the items usually included in the CV), but what you accomplished while you were there. List your professional experience in reverse chronological order. People want to know most what you have been doing in the past 3-5 years, even though they want to read about all of your experience.

When you choose items from your curriculum vitae, most likely you will have to add information. True, you worked at St. Vincent's Hospital from 1986 to 1990, but what did you do while you were there? Did you help lower costs in the emergency department? Tell how much. If you worked for a managed care facility, you might say, "Developed four new satellite offices, recruited eight primary care physicians over a two-year period, and reduced the length of stay from 350 to 300 days per 1,000, which has resulted in a first-time operational surplus for the plan."

Notice the numbers. People like to know that you have saved an organization money or increased its revenues, and they want to know how much and over what period. Use numbers to prove your general statements whenever you can.

Use networking effectively.

Get to know more people than you know now. Most people get a job because they know someone who knows someone. People have to know who you are and what you can do in order to recommend you for a job. They need to see you tackling problems and working with people. I've known a few people who didn't have all the experience that the company wished that they had, but someone knew them and thought they had the qualities it would take to do the job. So they got the job.

How do you network? Increase your visibility--make speeches, write articles, serve on committees. Make phone calls, attend meetings and talk to people while you are there, send letters, send thank you notes, call people again, read journals for advertised positions, contact search firms. It's more work than most people want to do, but few people get to skip it.

Contact search firms. Get to know the professional recruiters in several search firms that deal regularly with the sectors of the health care industry of interest to you. The American College of Physician Executives can provide you with a list of reputable search firms. Professional recruiters are excellent networkers and can help you find the job you want at no cost to you as well as help you to expand your network.

These suggestions for moving toward a medical director position take place over an extended period. Some people who call me want to be a medical director in a year, others in 5-10 years. Recruiters and career counselors can help you decide where you are in the process of getting the experience, education, and contacts you need.


1. George E. Linney Jr., MD, FACPE, Health Care Consultants, personal communication, 1992,

2. Kaiser, L. Lifework Planning. Brighton, Colo.: Brighton Books, 1989, p. 7.

3. Henry, R. "The Road to System CEO." In Roads to Medical Management: Physician Executives' Career Decisions. Tampa, Fla: American College of Physician Executives, 1988, p. 39.
COPYRIGHT 1993 American College of Physician Executives
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Author:Linney, Barbara J.
Publication:Physician Executive
Date:Mar 1, 1993
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