Reinventing my medical career - The Evolving Role of the Physician Executive - a physician discusses a career change

Physician Executive, Sept-Oct, 1999 by Kent Bottles

"HE ALLOWED HIMSELF TO be swayed by his conviction that human beings are not born once and for all on the day their mothers give birth to them, but that life obliges them over and over again to give birth to themselves."

Garbriel Garcia Marquez, Life in the Time of Cholera

About a year before the Allegheny Health System in Philadelphia filed for Chapter 11-bankruptcy protection, I became the Professor and Chair of Pathology at Allegheny University of the Health Sciences. I was excited because I thought there was a chance to blend the best features of the academy with the business acumen of a successful state-wide integrated delivery system. And the money, while it lasted, was excellent. Allegheny CEO's Sherif S. Abdelhak had spoken eloquently in the 1995 John A. D. Cooper lecture at the Association of American Medical Colleges about his innovative vision for academic medicine, and I wanted to be a part of it.

Some of my University of Iowa colleagues questioned the wisdom of leaving a secure position as tenured professor, Executive Vice Chair of Pathology, and Medical Director of Managed Care in a more prestigious medical school to join a risky integrated health care system. Others viewed the new position as a shrewd career move that would likely culminate in a dean's position within five years. I was bored in the relatively early managed care market of Iowa and thought the challenge of running a department in an integrated delivery system in the tough Philadelphia market would test my leadership abilities and be more interesting.

In Fall of 1998, I was on administrative leave from a medical school and health system in bankruptcy; my professorship, chairmanship, five-year contract, and tenure did not provide much job security in this setting. I started to look for a new position for the first time in my life.

Psychological adjustment

My period of bewilderment, bitterness, and depression lasted less than a week, and I threw myself into the job search. Many colleagues who I thought were close friends did not contact me or return telephone calls. Stillman documented a similar experience during a period of unemployment. (1) Later, I learned some of them were uncertain about what to say to me. Others may not have thought the relationship was as important as I did. I was fortunate that several colleagues from Allegheny, Iowa, and the University of California-San Francisco did call or email me regularly with advice, support, and friendship. They will never know how much their simple communications meant to my family and me.

The psychological adjustment of instantly going from the department chair who gives well attended parties, cuts budgets, has meetings from 6:00 am to 7:00 pm, and whose telephone calls are returned to the isolation of job hunting was difficult. I kept myself busy with sending out resumes, calling professional contacts, cruising the Internet to look for positions, and coauthoring an essay for the COTH Report about the Allegheny experience. (2) The few days when I allowed myself to linger in bed long after my children had gone to school and my wife had left for her outpatient gynecologist duties were not happy ones. I found it useful to wake up and "go to work" in my computer room by 8:00 am each morning.

My mood improved when I was invited to interview for faculty and physician executive positions in Dallas, Indianapolis, New York, Chicago, Milwaukee, and Washington, DC. I was surprised to be perceived as an unattractive cytopathology faculty candidate, despite what I saw as an impressive CV and considerable experience a think I would have hired myself). Perhaps, interviewing former chairmen makes others uneasy because it is an unwelcome reminder that we are all more vulnerable than we would like. On the other hand, the interviews for physician executive positions went well and return visits were made.

Considerations and reflections

My family and I discussed the possibility of moving from Philadelphia for one of these positions. With the uncertainty associated with the bankruptcy, my physician wife had gone to work fulltime to ensure a seamless continuation of health insurance coverage for the family. My children had only recently begun to feel at home in Main Line Philadelphia, which did not resemble Iowa City at all. They were not happy with the prospect of starting over again in new schools with new classmates. We had joined a synagogue where my daughter had a successful bat mitzvah and where my son was scheduled for his in the year 2000. My family did not want to move unless the new position was a superior one with job security that I doubted existed in the medical marketplace.

Upon reflection, I questioned whether I still wanted to play the role of change agent in academic medicine: encouraging, leading, cajoling professors to move in the direction the marketplace was demanding. I was not as eager as I once was, and I had lost some of my innocence about managed care. At one time, I had devoured pronouncements from Jackson Hole and plunged into University HealthSystem Consortium events. I wanted to be part of the leadership that would ensure coverage for the 38 million uninsured Americans, eliminate waste, measure quality, and help gatekeepers quarterback care and prevent drug interactions from medications prescribed by uncommunicative specialists.