Sage Advice

Physician Executive, July, 2001 by David O. Weber

Experienced physician executives share the secrets of their success

THERE ARE AS MANY roads to executive leadership in health care as there are physicians with the desire, imagination, pluck, and fate to travel them. There are, however, common lessons to be learned on the journey.

Looking back over careers, a group of former physician executives--most recently retired from active organizational roles--speak from similar scripts when asked what advice they'd give those who would follow in their footsteps.

Here's what they had to say:

"Be a good doctor first," counsels Roger Lindeman, MD, FACPE, who retired after 20 years as chairman and CEO of Virginia Mason Medical Center in Seattle.

"That may not be a popular approach any more, but if you're a good doctor first and actually practice, you know what it's like and it gives you a certain credibility."

For the "physician piece" to be helpful, says Dick Gaintner MD, FACPE, you must have completed residency and actually practiced medicine. "You can't just be a 90-day wonder."

Gaintner is former CEO of New England Deaconess Hospital in Boston and, until his April retirement, was CEO of the University of Florida's Shands Hospital in Gainesville.

Although he had to sacrifice an active practice of internal medicine to the demands of management, Gaintner says his medical credentials convey to the organization that "you obviously know the business. You've been there, done that, seen it, felt it, touched it. You have credibility with your medical colleagues. They see you as a manager but also as one of them."

John "Jack" Pollard, MD, MBA, CPE, FACPE, jokes that "the surgical dressing room was the root of all evil. People were always chewing on you in there. But (as a manager and physician) you could talk back."

Pollard devoted a quarter of his time to cardiology until his retirement in 1995 after 16 years as CEO of the Carle Clinic, in Urbana, Ill. And even in management, he worked a lot of weekends.

"I would always leave my paperwork for Saturdays and Sundays so I could spend time walking around the place. People get used to seeing you, and they tell you things, and you can head off many problems. You pick up what's on the grapevine -- and you put back on it what you want. It's better than the Internet, the grapevine."

"Never forget you're a physician," stresses John Anderson, MD, JD, CPE, FACPE, whose 27-year career in the Air Force was capped by the award of the military's highest honor for total quality management.

"Sometimes we drift so strongly into the business side we forget the ethical basis of medicine. That's where we got into problems with managed care. It's more focused on the ethics of insurance. ... The person best suited to turn the whole situation around is the physician."

"Be prepared. Get some business training," says Lindeman. "An MBA is not essential, but having it helps. If I had it to do all over again, I would definitely get one."

"Become a physician, do your residency, get some experience under your belt, then get an advanced degree in business of some kind," echoes Gaintner.

"You need that nowadays. There are executive MBA programs; Tufts has a joint MD/MBA program. If you're older, ACPE has wonderful programs. Then take on some management roles -- but stay involved clinically, because you may find out that you don't like the additional responsibility."

Joseph Lindner, MD, MPH, FACPE, ex-dean of the University of Cincinnati School of Medicine and CEO of St. Barnabas Medical Center in Livingston, N.J. operated his own headhunting firm specializing in recruiting health care leaders.

"When going into a job," Lindner says, "it's absolutely imperative that you find out what the job really is. Do your homework, then recognize that the interview is a two-way street. You have to ask very specifically, 'What job do you want me to do?' Because sometimes the agenda is not very explicit, and that can set up conflict.

"I once said to an individual who'd played a very significant role in the process when I'd taken a job, 'You didn't lie to me, but you didn't tell me the truth either,'" Lindner recalls.

"If I'd told you the truth," he replied, "you wouldn't have come."

Seek out mentors and develop a network, says H. Connie Bonbrest, MD, FACPE.

That's easier said than done--especially for women, she adds. "Women often don't know how to be mentored and don't know who to go to to ask for mentoring. And women don't network very well. Men do it as easily as breathing."

Rising from a staff internist to medical director of Chicago's Mile Square Health Center, then from associate dean of the University of Illinois at Chicago College of Medicine to assistant vice chancellor and medical director of the institution's HMOs, "my mentors were men," Bonbrest says.

Even within the last several years, she says, "I've heard from women who were being actively or tacitly discouraged from management ambitions, and from others who were being shabbily treated by men who should have been bringing them along."