The people's business: management careers in the public sector

Physician Executive, Jan-Feb, 2005 by Christopher Gorton

As is true for many professions, physician executives tend to pursue career paths that are extensions of their past and current experiences. Whether new to management or looking for that next opportunity, people take the advice of Dorothy from the end of "The Wizard of Oz" and seek their hearts' desires in their own back yards.

Besides maintaining the thread of the familiar, this approach builds on past expertise, leverages current relationships and permits people to comfortably accrete influence and responsibility.

The downside is that it limits career possibilities and opportunities. Search firms understandably focus on successful performers in particular health sectors and many jobs are still filled by friends of friends through tried and true word of mouth networks. That means that you need to actively seek out fresh chances to learn and grow.

Sure, you might be a good academic health care executive, but maybe you would be a great medical device entrepreneur. Dorothy learned an awful lot on her trip to Oz, after all. It is very important to periodically assess the entire range of physician executive opportunities and consider what you might gain from spending some time in a different field of endeavor.

Going public

So what are the sectors of the health care world that offer opportunities for physician executives?

Hospitals, health systems and group practices quickly come to mind, as do insurance companies and managed care organizations. Academic institutions and pharmaceutical and medical device manufacturers are common choices. A growing number of physician executives are finding fulfillment in the high-tech realm of health informatics. There is, however, a frequently overlooked option--public service.

Public service?

Why would an aspiring physician leader want to do that? Because the public sector of health care is huge, growing and full of lots of opportunities with plenty of potential for upward mobility.

Within the public sector, the need for high quality physician leaders is great--in the last generation government has shifted from a dependence on clerks to reliance on technical information experts in the fields of information systems, finance, engineering and health care.

Work in government or affiliated non-governmental organizations involves a wide variety of scope and geographic options--from your county health department and state Medicaid program to the federal Agency for Healthcare Research and Quality and the World Health Organization. While most of health care is about helping others, public sector health executives often find they have job descriptions that center on making the world a better place for everyone.

As with the rest of health care, the public sector has a variety of management roles. Physician executives can work as elected officials, agency heads, government program managers, independent consultants or as part of contracted vendor organizations.

Having recognized the limitations of burdensome bureaucracies, government is increasingly using private sector partners or full-scale outsourcing to delivery a high quality, cost-effective product to the populations served. In many localities, government is the largest employer. Plus, public payers purchase the majority of health care used across the country. Opportunity abounds, if you know where to look.

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Plenty of possibilities

The public sector is heavily segmented. Here's a list of some of the major segments:

* Public Health -- The government agencies and non-governmental organizations (NGOs) involved with protecting and advancing the health of populations. In international health these include the World Health Organization (WHO) and NGOs like Doctors Without Borders and Catholic Relief Services. The Centers for Disease Control and Prevention (CDC), as the lead agency, coordinates and integrates the efforts of state, county and municipal health departments.

* Public Payer -- Government health programs are the largest purchasers of health care. The Centers for Medicare and Medicaid Services (CMS) coordinates an enormous network of payment systems, including carriers and intermediaries for Medicare, state Medicaid and S-CHIP programs; and a large number of contracted managed care organizations.

* Public Provider -- Many government programs fund, employ or manage practitioners involved in the direct delivery of care. The Veterans Administration runs what is arguably the largest integrated delivery system in the country and has been a pioneer in patient safety and formulary management. The Department of Defense uses an array of employed civilian and military providers as well contractors to meet the needs of service members and their dependents. State, county and city hospitals are critical safety net providers for many populations. Correctional health practitioners meet the complex needs of millions of prisoners. The Health Resources and Services Administration funds federally qualified health centers as well as rural and migrant health centers. The Public Health Service and the Indian Health Service deliver care to thousands of underserved individuals.