A Fulfilling and Well Compensated Career
This is a solo bonus episode about pursuing a career in hospital management. It's a summary of the presentation that I'm giving at the first Physicians Helping Physicians Nonclinical Career Conference. The conference is being held in Austin, Texas in April 2019.
During the discussion, I answer the following questions:
- What are the most common senior hospital management positions for physicians?
- Why is a career in hospital management so attractive?
- How can we discover the salaries that nonprofit hospital executives are being paid?
- What are the five domains in which physicians typically need training and experience?
- How can physicians acquire those experiences?
- What specialties most easily lend themselves to moving into hospital leadership?
- How do we find openings in the field?
- How do we prepare ourselves for the interview process?
By applying the ideas presented in this episode, you can begin your journey to a lucrative and fulfilling career in hospital management.
Here is an edited transcript of my comments…
Common Hospital Executive Positions
When I talk about working in hospital management, I'm referring to senior executive positions in the so-called C-suite. Jobs starting from the top level include:
- CEO – Chief Executive Officer
- COO – Chief Operating Officer
- CMO – Chief Medical Officer
- CMIO – Chief Medical Information Officer
- CQO – Chief Quality Officer
- CCO – Chief Clinical Officer
- CPSO – Chief Patient Safety Officer
- CPHO – Chief Population Health Officer
As a physician, you're on equal footing with executives managing multiple departments, the hospital, and health system. Being an executive is not an entry-level job, but an ultimate goal.
Why Is a Career in Hospital Management Attractive?
Why would you want to go into hospital management? Here are four main reasons:
Displays Leadership Skills
I believe that physicians are natural leaders. The training that we go through helps us overcome challenges and puts us in a position to be excellent leaders. Applyng our leaderships skills is fulfilling and meaningful.
According to the Medical Group Management Association (MGMA) and other resources, physician executive salaries and total compensation is usually about $300,000-400,000 annually. You can definitely make more as a senior vice president/CMO than you would clinically in primary care. There are only a few nonclincial jobs where you may make more, such as an expert witness or entrepreneur.
It is stimulating, keeps you on your toes and lets you develop new skills. Physicians are lifelong learners. Once you've spent your life learning and settling into a clinical career, it can become boring and tedious. And so, doing something like this can definitely be interesting and stimulating.
Opportunity to Help More Patients
Executives have advanced knowledge and experience regarding quality improvement and patient safety. They’re able to identify and fix errors and implement lean processes. Their efforts save hundreds of lives, if not more. Their work helps lower mortality, injury, and accident rates in operating and emergency rooms.
Use GuideStar to Determine Possible Salaries
There are surveys of hospital executive salaries you can review.. But I like to visit GuideStar.org, which publishes information about non-profit hospitals, health systems, and other organizations. Included are 990 Form, which hospitals are required to submit every year to the Internal Revenue Service (IRS). They report financial information, including salaries for its executives and other employees.
GuideStar charges a fee to view the more current forms submitted, but not to access forms from past years. However, a CMO or CEO's salary in 2016 is not be much different than it would be today.
For example, a 990 Form for a large hospital with more than 600 beds in Illinois reported the following top annual salaries in 2016 for some of its leaders.
- Executive VP/CMO: $900,000
- Chief Quality Officer: $400,000
In comparison, a large system that employs hundreds, possibly thousands, of physicians and runs a multi-hospital system, reported the following salaries in 2016:
- Executive VP/Chief Medical Officer $1.948 million with a $310,000 bonus
- Chief Nursing Officer: $900,000
- President of Physician and Ambulatory Services and Affiliated Medical Group: $1.3 million
Some of those salaries may seem extreme, so don’t expect to make that much in most situations. But it demonstrates the opportunity that exists in some fo these positions.
If your goal is to get a job with ever increasing responsibilities, intellectual challenges, and potential compensation, then you're not going find a much better opportunity than working in a hospital or health system.
Best Positioned Specialties
Which specialties are best for moving into a hospital management career? It's difficult if you're an outpatient-only dermatologist or pediatrician who hasn’t set foot in a hospital for 10 or 15 years. That probably won’t work. CMOs mostly come from the ranks fo hospital-based physicians.
When I started as a family physician, I spent a lot of time in the hospital doing obstetrics (OB). I took care of newborn patients. At that time, I also did medicine and some pediatrics.
These days hospitalists, general and cardiac surgeons, anesthesiologists, pathologists and emergency medicine physicians would be well positioned to move into management positions in the hospital setting.
Physicians in major surgical specialties sometimes find it difficult to strike a balance for a potential salary. For example, if you’re a neurosurgeon and make $800,000 a year, you may have to take a pay cut initially.
If you're doing internal medicine, gastroenterology, or cardiology and don’t generate lots of relative value units (RVUs) or very busy, then you’ll be fine. Your salary may start lower, but will catch up quickly.
How many management and leadership skills do you have as a physician ready to pursue such a career? I estimate about 70 to 75%. What employer would not want to hire someone who's accountable, responsible, and takes their job seriously? That's how physicians are trained. They can focus, learn quickly, and are very intelligent.
To make it into college, medical school, and residency, you've overcome many challenges. Also, you know a lot of disciplines, especially because of your science and math background. You know medications, anatomy, physiology, and health care. So, you're partially prepared for these jobs.
How Do I Gain Experience?
There are skills and things that physicians need to learn more about along the way.
Most of it, you can learn as you go. You interact with other people in the hospital setting. As a physician, clinician, or executive , you have to learn how to work with direct reports, keep people accountable, meet with them, run meetings, and report to your supervisor, whether that's the COO or CMO. It takes practice. You don't just show up to your meetings and wing it.
This is another area where most physicians don’t have a lot of experience. Getting an MBA may help, but it doesn't help as much as looking at profit and loss statements (P&Ls) and balance sheets. Physicians are not usually expected to be that knowledgeable, until after they accept the position.
There are basic business practices that are different from leadership skills. Things like running a meeting, project planning, project management, lean processes, and SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.
Understanding quality improvement reports. Learn how to view, analyze, and share quality improvement and patient safety information to create action plans that address deficits or opportunities. Other types of data to review and understand include growth, including volumes in different service lines, flow, throughput, turnaround times, root cause analyses, and never/ sentinel events.
Understand that certain skills that leaders learn and apply are different from management skills. A leader must do strategic planning, and know how to develop the mission, vision, and values for an organization, and interact with board members and community leaders.
Those are the five areas that physicians should brush up on through additional training.
How do you get started? The easiest way is to get a part-time job in the hospital setting that allows you to learn some of these skills, while providing value to the organization. Such positions could be in utilization or case management, clinical documentation improvement, informatics, and medical directorships over specific units.
Once you're hired, apply existing skills and learn new ones. Don’t just coast into the job and do the minimum work needed. Try to learn as you go and always expand your influence and management activities.
Other areas where physicians can gain experience include medical staff officer jobs. It's unpaid, but if you work as a chairman of a department, president of the medical staff, or chair of the quality improvement committee, you'll learn leadership and communication skills.
5 Universal Strategies
In a previous solo episode, I mentioned five universal strategies:
- Find a mentor
- Build your network
- Join physician organizations, including American Association for Physician Leadership (AAPL) and American College of Healthcare Executives (ACHE)
- Use LinkedIn
- Create a resume
These strategies will definitely be applied in this situation.
Will I Need an MBA?
Should physicians pursue a business degree such as an MBA, a Master's in Medical Management (MMM), or a Master's of Healthcare Administration (MHA)? There's also the MPH (Master's in Public Health) , which is not strictly a business degree. Some organizations offer a Master of Science in Management.
I don't think you need the management degree. If you have the management degree, I think it's more helpful on paper to demonstrate a commitment to leading and managing. I know many physicians with an MBA who have never applied it. To the extent that you can apply what you learned, it is helpful. An MBA teaches you how to read a P&L and balance sheet, and to understand a budget.
Also, AAPL’s Certified Physician Executive (CPE) designation adds a bit more credence than an MBA or MHA, in terms of experience. The CPE requires an advanced degree or extensive number of hours in leadership and financial management, plus a demonstration of experience.
Even if you have an MBA, but never chaired a committee or worked in an environment where you had exposure to talent and data management, then you’re not eligible for the CPE designation. Recruiters often include CPE as a “like to have,” although not necessarily a “must have.”
How Do I Find Jobs?
The best way to find and get your dream job is through networking. LinkedIn is a good place to network, find a mentor, post your resume, and work with recruiters. There are several large physician executive recruiting firms, such as Cejka, and B.E. Smith. Most of the top 25 executive search firms recruit physicians.
Also, LinkedIn and AAPL have their own job boards. Check out Indeed and other online job boards.
Preparing for Interviews
Take courses offered by AAPL. Or, start on an MBA, but you don't have to complete it before beginning your job search. Ask if an employer is willing to pay for the majority of your education, such as for an MBA or MHA, or CPE coursework. Start or enroll in courses for an MBA now because many programs take two years to complete. An exception is the University of Tennessee Physician Executive MBA only requires one year.
Even after you enroll, or before you start classes, start looking for your dream job because those efforts indicate to potential employers that you're serious about what you're doing.
The other part of preparation is being intentional by including specific keywords and appropriately designing your resume. Before you submit your resume and a cover letter, research the companies that you're applying with, so you can customize it for each potential employer.
Then, customize your cover letter. Find a specific person to send it to, instead of uploading it to a generic spot on a web site.
Rehearse for Interviews
If you’re fortunate enough to get an interview after applying, rehearse for it. Practice with another person, who should ask you questions that will most likely be posed to you during your interview with the company.
To some extent, you can't be prepared 100%, but you become better the more you practice. You're not going to get every job that you apply for, and when you move from clinical to non-clinical, there is more competition. Other physicians are wanting these jobs. Employers always interview several candidates. They're going to be very picky about who they hire.
So, if you’re not offered the job, don't consider that a failure. Each interview is a learning process. Believe me, if you do three, four, five, six interviews, by the time you do that fifth or sixth one, you're really coming across clearly. You've got your message well rehearsed, but you want to make it all sound very spontaneous.
In a nutshell, that’s my overview of the approach to becoming a hospital executive, or to work in hospital management. It's very challenging and rewarding, plus it pays well. I hope that you take what I've said to heart and start working toward it, if you have any interest at all. It's a great career to pursue, if you're ambitious. After all, more physician leaders like you are needed in health care.
This podcast is made possible by the University of Tennessee Physician Executive MBA Program offered by the Haslam College of Business.
The UT PEMBA is the longest running, and most highly respected physician-only MBA in the country, with over 650 graduates. It only takes a year to complete.
University of Tennessee PEMBA students bring exceptional value to their organizations. The curriculum includes a number of major assignments and a company project.
If you want to acquire the business and management skills needed to advance your nonclinical career, contact Dr. Kate Atchley’s office by calling (865) 974-6526 or going to vitalpe.net/physicianmba.
I hope to see you next time on the PNC Podcast.
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Podcast Editing & Production Services are provided by Oscar Hamilton.
The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life or business.
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The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counsellor, or other professional before making any major decisions about your career.
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