Physician executive's path comes full circle: Doctor uses management education to land full-time management job and eventually takes up teaching medical management

Physician Executive, Nov-Dec, 2004 by Barbara Linney

Marc Richmond, MD, MMM, didn't exactly plan to move into medical management; it happened to him gradually.

Frustrated with the early forms of managed care that emerged in the early 1990s, Richmond--then a full-time family physician in Irvine, Calif.--wanted a better understanding of the business of medicine.

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"I had been reading medical management literature for a little while, and in 1993 I received a mailer from the University of California at Irvine announcing a weekend certificate program for health care executives," Richmond recalls.

He wondered how he could ever manage to juggle his clinical work with weekend studies, thinking he'd be exhausted. Nevertheless, he decided to check out the program.

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"There were about 20 people in the class from various occupations--the CEO of an ambulance company, a lawyer who specialized in health care, an architect who did health care design, a few physicians and nurses," he says.

And while the schedule was demanding, "after the first several classes, it became very evident to me that these sessions recharged my batteries. The different venue for thinking, interacting with different people and getting a different perspective about health care was really stimulating."

The classes, mainly introductory courses on medical management, energized Richmond. "When I was sitting in these classes, I would think, 'Oh, the hospital board would want to know that. I wish somebody from the board of directors was here.'"

Soon, he took the initiative and began making presentations about what he was learning in class to the board of his hospital.

"I had become friendly with the hospital's CEO who truly valued what I was doing," Richmond says. "So one day he asked me if I would be interested in being a half-time physician director of integrated health services for the hospital. That was my first real management opportunity."

Intrigued by the offer, Richmond took the job.

"I was the clinical liaison between the hospital administrative team, the local IPA and the medical community. I was working with the hospital to evaluate opportunities to merge or buy practices, identify service gaps, identify areas for quality improvement and assess activities that the hospital might want to get involved in."

After completing the UC Irvine course, Richmond continued his management studies with ACPE courses and a Leadership for Physician Executives program at Harvard University. His hospital footed the bill for his studies. Richmond paid for his travel and lodging.

Out of the blue, in 1997, a recruiter called and offered Richmond a job as the chief medical officer for an emerging health delivery system in Little Rock, Arkansas. "The timing was terrible because our youngest child had just started high school. My wife and I talked about it quite a bit and ultimately decided it was one of those opportunities for a full-time management job that probably wouldn't present itself again," Richmond says. "Everything was right except the fact that it was in Little Rock and I was in Irvine. We agonized for a while, but ultimately I took it."

Richmond helped form a consortium of five entities to bring managed care to the area, a developing network of about 3,000 doctors and roughly 40 hospitals throughout Arkansas and some nearby states.

In Little Rock from 1997 until 1999, Richmond continued his education by enrolling in the Masters in Medical Management program at Tulane University. "So I was commuting from Little Rock to New Orleans every three months for a week at a time," Richmond recalls. "But the courses helped me do the management job, and the management experience helped me in the courses."

For example, "One of the things that we had to do in the MMM was to write a business plan. I used the company that I was working for as the model for doing that. And once I did the plan, I was able to present it back to the executive director of the company, where it was well received."

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Richmond earned his MMM in 1998 and soon received another offer from a recruiter, this time for a job back in Northern California as CEO and executive director for Napa Valley Physicians, a group of 150 doctors and 2 hospitals.

"My wife said, 'I don't know about you, but I'm moving back to California,'" so Richmond took the job.

One of his duties was dealing with insurance companies--PacifiCare, Healthnet, Blue Shield, and others--and that eventually led to another job opportunity. "One of PacifiCare's medical directors mentioned that a position would be coming available as their regional medical director for the San Francisco Bay area and the Napa Valley position was the most difficult job that I'd ever had, and appeared to be in increasing financial difficulty. So, at the end of a year I accepted the job at PacifiCare in San Francisco. Eventually, another opportunity arose within PacifiCare in Southern California, and I was able to move my family back home."