Physician executive experts answer your medical management questions - Ask the Coach

Physician Executive, July-August, 2002 by Howard Kirz

I'm a chief medical officer in my second year. I'd really like to position myself to be a CEO some day. What are the most important things I should do?

CEO-in-waiting

Dear CEO-in-waiting,

John Pollard, MD, MBA, CPE, FACPE, and a veteran CEO (1979-1995) of the Cane Clinic in Illinois, says the keys are treating everyone with respect ("Both your enemies and your friends have votes.") and volunteering for the tough assignments along the way ("If you win, you're a hero. If not, it was just a tough assignment.")

Martin Hickey, MD, MS, CPE, FACPE, CEO (1998-2002) of Lovelace Healthcare in Albuquerque, N.M., adds that a history of "bottom-line performance" in both finance and quality is the sine qua non of CEO selection.

I agree with both of them. No one ever got to be a CEO without demonstrating an unequivocal ability to deliver the numbers. You can do this by accepting clear P & L accountability at every opportunity you get along the way, as a department head with a budget, as a medical director or as a CMO.

From a legal point of view, corporate boards have fiduciary accountability and simply can't afford to appoint CEOs without demonstrated abilities to maintain their organizations' fiscal and service integrity.

Next, perform, perform, perform in everything you do. CEO credentials are best built from solid platforms of performance in previous jobs. If you're in charge of quality, do a great job, exceed everybody's expectations and build a reputation for excellence.

Making periodic reports to your board or corporate headquarters, getting articles published and making presentations both inside and out are excellent ways to enhance your reputation for sterling performance.

And finally, with all this emphasis on profit and performance, never neglect your personal relationships and your networking. Ultimately, the decision to appoint a new CEO is made by a few people in a room, whether that's a boardroom, a corporate headquarters or a luncheon of key stakeholders.

Such decisions are always highly personal and rely heavily on personal knowledge. The more people you know, and the more people they know who know and respect you, the more likely you'll get the final nod.

I'm a CEO. Over this past yeah my previously effective physician COO became dissatisfied with his job, with our division in the company, even with our city. Over the past six months he looked at several job possibilities, sharing aspects of them with me and other team members. Three months ago, he accepted a terrific job. It has excellent growth potential; it's within our national company and in a desirable location. We jointly announced his departure, started the search for a replacement and held a goodbye party. Then, disaster struck. Yesterday he called two weeks into his new job and begged me to take him back. His family's absolutely miserable in the new city and he's already told his new boss that he doesn't' think he'll be able to stay. I really like and respect this guy. He was once a fine operating officer. What should I do?

In a Dilemma

Dear Dilemma,

Probably nothing.

Unfortunately, your friend and ex-COO may have made a mistake. Don't compound the problem by making one of your own.

Your organization has already separated itself emotionally from him (if you don't believe me, just ask some of your direct reports). Your job is to move ahead.

The likelihood that your old operating officer can be reincorporated into your team and be satisfied where he was previously very dissatisfied is quite low. From your organization's point of view, it's probably not worth the risk.

There's one piece of good news in this otherwise painful situation. "Buyer's remorse" is quite common during job changes like this, particularly among family members whose lives are disrupted.

How about just offering a steady hand here. Would they consider a little family counseling? Is their old house still on the market and do some family members want to lag behind to see how it goes on the new job?

What about advising them to just take a breather and not make any more decisions for six months? Something tells me this might work out better than you fear.

I think I'm a pretty good physician executive. But one thing continues to bug me, even after 11 years of experience. I keep having episodes when my management responsibilities overwhelm me. I hate the sense of having too many things to do and the thought of doing a bad job. Right now, I'm recruiting for several new docs, participating in strategic planning, completing performance reviews on my 14 direct reports, getting ready for JCAHO, revising two contracts and handling several conflicts with staff members. All these are on top of my "usual" responsibilities. Any thoughts?

Burning the midnight oil

Dear Burning,

You sound like a fine physician manager--but you're not a very good manager of your own time. And you're in good company, too. Many people reading this column have had similar feelings.

You need a different frame for thinking about your management work. Start with the notion that all management jobs are capable of filling and exceeding all available time.