Your Career Guide

Some are meant to lead. Maybe you.

Want to be a medical director, start your own business, head a large practice, or take on more responsibility where you are? Here's how your colleagues are doing it.

By Cynthia Starr

"When I was managing my practice," says family physician Robert B. Taylor, "my idea of leadership was to come into the office, shout out orders, then go in and see the first patient."

That "leadership" style didn't serve Taylor well when, at age 42, he sold his busy solo practice in rural Gardiner, NY, to embark on a new career in academic medicine. "I learned a number of lessons in leadership and management the hard way," says Taylor, professor of family medicine and former department chair at Oregon Health Sciences University School of Medicine.

To bridge the cultural chasm that separated him from his new colleagues, Taylor devised his own self-study program. He closely watched others' behavior at meetings, read books on management and leadership, and collected all the pertinent information and anecdotes he could find.

Today, he maintains that while many physicians are not born to be leaders, most can gain the necessary expertise. Last September, speaking on "leadership as a learned skill" at the annual meeting of the American Academy of Family Physicians, Taylor advised his audience to discard the traditional medical definition of a leader as "one who will not follow." Instead, he suggested that good leaders "have a vision of how things might be better and are willing to work hard to achieve it. In the process, they persuade others to commit to the effort."

Is a leadership position in your future? It's a definite growth industry in medicine, but one that requires a measure of personal growth—and, in many cases, a measure of formal education.

Seize—or create—the opportunity

Leadership skills are becoming increasingly important in medicine. Consider that membership in the American College of Physician Executives, founded in 1975 as the American Academy of Medical Directors, has grown from 75 physicians to more than 13,000, according to Barbara J. Linney, ACPE's vice president of career development. Members include physician executives with management or administrative responsibilities in government, group practice, hospitals, industry, managed care organizations, the military, and universities.

"I'm seeing more and more people leave private practice for management positions with hospitals or HMOs," says Taylor. George E. Linney, a pediatrician and vice president with the executive search firm of Tyler & Co. in Charlotte, NC, believes there are abundant leadership opportunities for the motivated physician. "As medicine has gone from a cottage industry to more-organized larger entities, the marketplace has recognized that you need physician leadership in those new organizations—and you have to pay for it," he says. "You can't just expect doctors to do those tasks in their spare time after seeing patients all day."

One exciting, if gradual, trend has been noted by the Linneys, who share a marriage as well as teaching duties for an ACPE course on career choices for physician execs: Some doctors are not just the medical directors for large organizations but actually the CEOs. "Physicians may complain that a nonphysician administrator doesn't understand what it's like to take care of patients," says Barbara Linney. "But a physician executive does understand."

While many doctors land in leadership posts by careful design, some offer a nod to destiny. Like people who suddenly fall in love, they discover an unanticipated enthusiasm for management activities and seek out more of them. "They like influencing a broader span of people rather than just one patient at a time," remarks Barbara Linney. "So they just keep moving in that direction."

Internist Lynn Helmer admits she had no master plan. After almost a decade in private practice, she spent a year as co-director of a hospital internal medicine clinic before taking on the management of another hospital's outpatient clinic. In four years there, she accepted more and more administrative responsibilities—and earned promotion after promotion. Eventually she enrolled in an executive MBA program. "As things evolved, I realized that you can do only so much by instinct," Helmer says. "Then you need the facts." Her experience and her new degree recently landed her the vice presidency of medical affairs at Shore Memorial Hospital in Somers Point, NJ.

Ophthalmologist Sreedhar V. Potarazu could be called the accidental CEO. He was splitting his time between a busy private practice and an eye clinic associated with Johns Hopkins School of Medicine when he enrolled in the Hopkins Business of Medicine Certificate Program. "I always wanted to enrich the business aspect of my education," he says. The work was so enjoyable that he applied his credits toward an MBA.

When a marketing class required Potarazu to develop a strategic plan for a new business, he submitted a concept for a company that would offer customized analyses of health care data to hospitals, insurance companies, pharmaceutical firms, and managed care organizations. Subsequent school projects brought the idea closer to fruition.

"I never pursued the MBA with the notion of starting a business, but it became apparent that I was sitting on a gold mine," Potarazu says. "It was an opportunity that comes once in a lifetime." His homework assignment has now materialized into Medical Internet Solutions, or MedIS. Among other things, his customers can learn how their products and services are used by a particular demographic group.

In contrast, pediatrician Maria Young Chandler "always had an idea of doing something big," an ambition she communicated to her boss, the medical and executive director of a nonprofit pediatric clinic affiliated with the College of Medicine of the University of California, Irvine. Chandler accepted all responsibilities offered her and, in short order, became the clinic's assistant medical director. After earning an MBA, she was promoted to medical director.

Chandler's favorite achievement is the design and implementation of a joint MD-MBA degree program at UCI (see "It's academic: Three routes to an MBA"). "Even if they don't become surgeon general, dean of a medical school, or a CEO, they will use this education," she says. "This is the way I can have an impact on the health care industry. I'll train physicians to go out there and do some of the things I thought I could do. But this way, I'll have a whole army."

Cultivate communication skills

Among the requisite set of leadership skills, one that cannot be underestimated is the ability to communicate. "If you can't bring people along to understand your idea and follow you, you're not going to get anywhere as a leader," says FP Robert Taylor. "You have to be able to express your vision with great clarity. I use the example of Martin Luther King's 'I have a dream' speech, which is one of the greatest vision speeches ever written."

Next time you have the opportunity, check out the way leaders conduct themselves in public. "Don't just listen to the words, but pay attention to what they do, how they act, and how it works," Taylor advises. He also suggests reading up on what the management gurus have to say. Two experts that he particularly recommends are Burt Nanus and Warren Bennis. He also recommends biographies of successful leaders, such as Bill Gates, Martin Luther King Jr., Mikhail Gorbachev, Dwight D. Eisenhower, and Gandhi.

One-on-one communication is every bit as important as speaking to groups. James A. Avery, a pulmonologist and medical director of The Hospice of the Florida Suncoast, finds himself doing a lot more writing and talking than he did in group practice. "A lot of it is teaching physicians what their responsibilities are—what I've termed the noble mandate to represent medicine on their hospice teams," he says. When doctors don't have the heart to speak frankly about prognoses or end-of-life care, Avery offers to pay a visit to the patients himself.

He also helps the nurses polish their assessment skills and recognize when a physician should be called. One of the nurses' favorite presentations is Avery's session on how to talk to doctors.

Go back to school

While it's helpful to listen and learn from those around you, preparing yourself for a leadership position often requires more-formal education. You can opt for individual courses or certificate programs, such as those offered by the ACPE and the Johns Hopkins Business of Medicine program. Find out whether your organization will foot the bill for some business instruction.

A more vigorous strategy is to go for the MBA or other business-related master's degree. "When I decided to attend Harvard Business School in 1986, my friends and family acted like I was leaving the priesthood," says Alfred M. Martin III, a family practitioner in Atlanta. "But it was the best thing I ever did."

Martin believes the degree allowed him to become an integral part of ambitious ventures from which he otherwise would have been excluded. Among the more recent was Medstop, an ambulatory care center that he started and then sold to HealthSouth. Martin is currently working on a pair of Web sites. One targets the business needs of health care professionals and the informational needs of consumers (www.cyberMEDguide.com); the other uses cartoon characters to teach children about health care (www.mightymed.com).

Barbara Linney predicts that in five years, doctors without a business-related masters degree won't be considered for certain executive jobs. "Physicians who are going into administration on a full-time basis definitely need the degree," says Douglas Hough, who directs the Hopkins Business of Medicine program. Those who are committed to staying in clinical practice but want additional exposure to management principles should look for a more limited program, he adds. Michael J. Stahl, director of the University of Tennessee's Physician Executive MBA program, agrees. "If a physician wants to learn more about managed care, but does not want to take a leadership role, I suggest a short nondegree program that focuses on trends in managed care."

Volunteer for duty

Even with an MBA, you won't get far without practical experience. Put your hand up when your hospital asks for help with committee work or when someone is needed to run a meeting. "If a problem needs solving, volunteer to solve it," says Barbara Linney. "That will help you get the experience people are looking for." Adds Robert Taylor, "Leadership is service, and you move ahead by serving your organization and the people in it."

Gastroenterologist James W. Brown is in his second term as CEO of the Wenatchee Valley Clinic, a physician-owned multispecialty group with 170 doctors in Wenatchee, WA. In grooming the organization's next leaders, he looks to those who've taken part in committees and programs. "We've been fortunate that people have stepped up and said they're interested," Brown says. "It's from those people that you get your future leadership."

While he encourages candidates to take management courses, he believes "there's more to being a physician leader than crunching numbers. For that, we can hire MBAs." Rather, he seeks physicians with honesty and integrity "who see beyond their own concerns and take an interest in how this clinic is going to stay strong and succeed."

Another essential that eludes many physicians is the need to network. "You've got to get to know people to find out where the management jobs are and who's doing the hiring," says George Linney, whose own early management jobs were the result of networking. (See also "Job search strategies that really work," in our Jan. 8, 2001 issue.)

Networking is particularly important if you're on either end of recruiters' ideal age range of 45 to 55. If you're younger, prospective employers may think you lack experience; those older than 60 may face a handicap, as well. "We do see physicians moving into management careers in their 60s, but they have to show they have plenty of energy and are not interested in retirement," Linney says.

Seattle internist Francine R. Gaillour suggests that you simply figure out what you really like to do. "You can do a lot with your knowledge and skill, so dig deep into what you enjoy, not what you saw some other physician do," she says. "Once you understand that, the world of possibilities is infinitely expanding."

The author is a freelance writer in Ridgewood, NJ, and a former senior editor of Patient Care.

It's academic: Three routes to an MBA

If you're interested in furthering your business education, you can do so through traditional on-campus executive MBA programs or a variety of long-distance courses.

Either way, look for an accredited degree. For example, the American College of Physician Executives offers a master of medical management degree in conjunction with Carnegie Mellon University, Tulane University, and the University of Southern California. Students combine long-distance course work with three separate one-week stays on campus. They can take up to seven years to finish. "You pick the time of year, location, and specific hours you want to study, and move at the pace you want to go," says Barbara Linney, ACPE's vice president of career development.

The accredited Physician Executive MBA (PEMBA) program at the University of Tennessee lasts 12 months. "About 50 percent of the contact hours are earned in four one-week residency periods on campus," explains Michael J. Stahl, PEMBA's director. The rest is delivered via distance education on the Internet. Classes are held every Saturday from 9 am to noon, Eastern time. If a student can't be at the computer at the scheduled time—because, say, a patient has an emergency—the audio and data components are stored digitally, and the physician can play back the class later. Students who have questions can contact the professor by phone or e-mail.

Enrollees in the Johns Hopkins Business of Medicine program commute to the Baltimore medical school campus one night a week for a three-hour class. The 17 required courses take about four years to complete, says Program Director Douglas Hough. "We've tried weekend courses, but physicians tend not to want those," he says. Some 40 students form a cohort that progresses through the program together.

"A pediatrician in the program, who practices with her husband, has begun running the practice and has seen revenues go up 30 percent over the past year and a half, in part because she now understands the mechanisms of billing and getting paid," Hough says. The school is planning to offer a long-distance program once it "gets the technology down."

Students at the University of California-Irvine can earn their MD and MBA degrees simultaneously over five years (www.com.uci.edu/mdmba ). The opportunity is offered to 5 percent of each class, says pediatrician Maria Young Chandler, MD/MBA faculty adviser.

Students start with three years of medical school and begin their clinical rotations in the summer following the third year. In the fall, they interrupt their clinical training to do a full school year of MBA work. Come summer, they step back into the clinic for about six months, then finish off the academic adventure with another two quarters of MBA studies.

 

Cindy Starr. Some are meant to lead. Maybe you. Medical Economics 2001;2:85.