In this post, I want to explain why it is important to validate your business idea. You may recall that in my previous blog post in this series, I described the factors needed to select a product or service to offer future customers:

• It's an area that you’re passionate about (or reflects your purpose),
• You have expertise or skills to share,
• There are customers with a problem to solve, and
• The customers are willing and able to pay for the product or service.

Try Selling a Prototype or Presell a Course

This trial run does not necessarily have to be a fully developed product. Let's look at an example.

• there are parents of these children looking for online help, and
• they’re willing to spend money to meet that need.

I’ve since found that there are products and services that physicians are willing to purchase to expedite their career transitions. This became evident when I started helping with a Facebook group (Physician Nonclinical Career Hunters) devoted to nonclinical careers two years ago, which now has over 15,000 members.

I now recognize that there's a demand for coaching, mentoring, and training. Several books have been published on the subject of nonclinical careers. There is a growing interest in this niche. And I’ve started to sell my own products.

I created a course dedicated to finding a job as a medical science liaison. That sold fairly well. So, I created more courses. Since I planned to continue developing courses, I decided to accelerate that process and open a membership site. I started with a minimal viable product (in my mind that was 12 courses).

I was able to sell an encouraging number of memberships. Now I've put more time into improving the first 12, and have added 6 new courses. I've recruited several affiliate partners to sell my course to their followers. And I'm relaunching the Nonclinical Career Academy Membership program very soon.

Several physicians I have interviewed who are coaches have followed a similar path. They started with one-on-one coaching. After building a sufficient following, they added group coaching. Some of them later created a course developed from their coaching experiences, which scaled their business, while serving more clients.

Examples include:

• First, Optimize Your Attitude – Interview with Dr. Katrina Ubell – 035,
• How to Be a Successful Physician Entrepreneur – Interview with Dr. Nneka Unachukwu – 123
• How to Be a Shrewd Business Coach and Consultant – Interview with Dr. David Norris – 111

Summary

As you plan your nonclinical online business, be sure to validate your business idea by confirming the demand for your product or service. Begin by looking for others who seem to be successful.

Then sell a prototype, or begin with a limited run of whatever you're selling. If you are a coach, sell a few discounted sessions to get going. Assess the response of your clients and the success of your coaching.

If you're creating a course – develop the first few lessons, then try to pre-sell the soon-to-be-finished course. But only finish creating it if there is interest confirmed by sales. Then use the feedback from your first few students to help direct future lessons.

Coming Next

In the next blog post, I will answer this question: What are the legal and business issues I should address before moving on?

Next Steps

Please add you're thoughts and questions in the Comments. I will respond to them all.

Contact me: john.jurica.md@gmail.com

Thanks for joining me.

Until next time.

The post How to Validate Your Business Idea appeared first on NonClinical Physicians.

I have decided to write a series of blog posts focused on how to get started on your nonclinical online business. It has been a long time since I wrote a dedicated blog post not related to a podcast episode. But it is time to ramp up this part of the web site!

The topics will be about starting and growing a business, entrepreneurship, and all of the online tools and tricks that I have learned over the past few years.

How Did I Get Started?

I started my first blog about four years ago because I wanted to do something creative, hone my writing skills, and help physicians. My first blog, called “Contract Doctor,” was devoted to helping with contract negotiations. The response was modestly positive, but it didn't get a lot of traction.

I found later that I was interested in writing about my experiences as a Chief Medical Officer. And I wanted to encourage physicians to step up to management and leadership positions in the hospital setting. So, I started my second blog the Vital Physician Executive.

I wrote articles about the differences between clinical practice and working as an executive. I addressed topics for physician leaders, including new skills to learn, new attitudes to adopt, and related topics. But it soon occurred to me that this topic of being a hospital leader was a subset of a much broader topic, that of nonclinical careers. So, I started the PNC podcast addressing that larger niche, and now I'm into my 143rd episode.

I’ve since found that there are products and services that physicians are willing to purchase to expedite their career transitions. This became evident when I started helping with a Facebook group (Physician Nonclinical Career Hunters) devoted to nonclinical careers two years ago, which now has over 13,000 members. And I recognize that there's a demand for coaching, mentoring, and training. Several books have been published on the subject of nonclinical careers. There is a growing interest in this niche. And I’ve started to sell my own products.

Reminder – Leverage and Growth Virtual SUMMIT is Live May 11 through May 22, 2020.

I'm a contributor and affiliate partner for Peter Kim's Leverage and Growth Virtual Summit. With over 50 expert faculty, it is incredible that you can access all of the sessions for FREE. It is designed to build freedom into your life through passive and active income streams, and help secure your family's future in these uncertain times.

My session is on May 19, so be sure to view it. All of the sessions with be released over the next 2 weeks, starting the day this podcast episode is released on May 11, 2020. Each week's sessions will also be posted again on the respective weekend, at absolutely NO COST. And you can pick and choose each day which sessions to view.

At any point, including the final days of the SUMMIT, you can choose to purchase access to all of the videos if you find them to be helpful. In any case, whether you choose to enroll in the free access or buy the video bundle, please USE THIS LINK. It is the only way that I get credit for sharing this SUMMIT with my listeners and readers. And doing so has no effect on the price if you elect to purchase the videos.

Get Started on Your Nonclinical Online Business by Finding a Niche

But the process that I followed was a bit backward. I now believe that if you want to start an online business, it is best to follow a more intentional path! Let me describe how I think you should get started on your nonclinical online business.

When starting a new business, I believe there are four requirements that must be met. Visualize a Venn diagram. Your niche must exist at the overlapping section of these four.

Engage Your Passion

Identify Your Expertise

Find Customers with a Problem to Solve

Find Customers Who Can Afford a Solution

Summary

As you get started on your nonclinical online business and determine your niche, keep your options open. Consider several. Find others in those fields and see how they are doing.

For a more extensive discussion of this topic, check out Chapter 9 in The Positioned Physician: Earn More, Work Smart & Love Medicine Again, by Mike Woo-Ming, MD, MPH. Mike is featured on the podcast in Episode 19 and will return on Episode 144.

Coming Next

In the next blog post, I will answer this question: Can I go a step further and demonstrate that customers will buy, before I sink a lot of time and money into my potential niche?

Next Steps

Please add you're thoughts and questions in the Comments. I will respond to them all.

Contact me: john@nonclinicalphysicians.com

Thanks for joining me.

Until next time.

The post How to Get Started on Your Nonclinical Online Business appeared first on NonClinical Physicians.

One of the questions that any physician thinking about a career as a healthcare executive will consider is: How well will I be compensated? It is probably not the most important question. But it can be a concern for a mid-career physician thinking of making the transition. A reduction in income may not be acceptable, even if it is only temporary.

Like any decision, this question can be difficult to answer, because there are so many variables. But let’s look at this question and see how the finances might play out.

FEATURED DOWNLOAD: Click here to receive a Free Guidestar Instructional Video on how to look up hospital executive salaries.

Executive Salaries

First, let’s look at recent information regarding the salaries of physician executives. According to the most recent survey collected and published through a joint effort of Cejka Executive Search and the American Association for Physician Leadership, here is what we know about the current state of salaries for physicians executives.

• The average salary for a physician in a leadership position was $350,000.
• The highest-paid cohort of physician executives earned $499,000 and included executives with titles such as Chief Strategy Officer, Chief Innovation Officer, and Chief Integration Officer. These are obviously not the traditional CMO nor VP for Medical Affairs.
• Physician CEOs had an average annual income of $437,500.
• Chief Medical Officers earned $388,000 per year.
• The Chief Quality or Patient Safety Officer earned $375,000.
• The Chief Medical Information Officer had an average salary of $372,500.

Clinical Salaries

Now let’s look at average salaries by medical specialty for clinicians. I will present the recent Medscape Physician Compensation Report for 2016 for averages for physicians in the following specialties. There are other surveys available, and various levels of granularity in the data. But the numbers shown below are a pretty good estimate of average salaries.

These salaries will be affected by how many procedures are being done, how many days are spent in the office and how much emergency call is taken (for the pertinent specialties). Comparing the above statistics and graph, it is obvious that anyone practicing a primary care specialty, or a medicine subspecialty, may well make significantly more income by moving into an executive position.

Click Here to Access My Free Mini-Course – Using Guidestar to Discover Nonprofit Hospital Executive Salaries

Work – Life Balance Considerations

Just as there are on-call and other quality of life considerations with regard to clinical medicine, such considerations affect the executive's role.

An executive position is not a 9 to 5 job by any means. I had administrative call – about once every 8 to 10 weeks, for a week at a time. The call was rather easy, helping managers and directors solve problems that came up during off-hours.

There were frequent dinner meetings and weekends spent in board retreats and strategic planning retreats.  However, overall, I think the quality of life for an administrator can be much better than that of a busy physician. Most of my physician colleagues are on call every third or fourth day, or making hospital or nursing home rounds on weekends or after office hours. Most surgeons of any type work longer hours than the typical physician executive.

Educational Costs

Finally, there are some upfront costs to consider when selecting this new career path. Here are some of the likely upfront and ongoing costs.

• Membership in the AAPL is $295 per year.
• There is course work in the areas of finance, leadership, management, quality, etc. A three-day live course through the AAPL will run about $2,000 to $3,000. A good cross-section of leadership and management topics would consist of the equivalent of three or four such meetings. This may be subsidized by your medical group or hospital employer if you're already involved in committee work.
• You may seek an advanced degree, such as an MHA, MBA or MMM. The MBA can run from $20,000 to $80,000 or more. The Executive MBA provided by the University of Illinois has a cost close to $100,000. The cost of a straight MBA at a top 20 graduate school will generally run $30,000 to $60,000. In a small private university, near my home, the cost is $24,000. The Masters in Medical Management involves similar costs. Some online MBA programs can be completed for under $20,000.
• Completing the CPE (Certified Physician Executive) will cost another $3,000 after all prerequisites are met.

FEATURED DOWNLOAD: Click here to receive a Free Guidestar Instructional Video on how to look up hospital executive salaries.

Conclusion

The salary considerations definitely should not be a barrier to considering a job as an executive, unless one is a very highly compensated cardiologist or orthopedist. The quality of life will probably be better than that of most clinicians.

For several primary care specialties, a shift to executive leadership may result in a sizeable increase in salary compared to the typical practitioner. However, there may be upfront costs such as the cost of acquiring an advanced degree or completing a certification, such as the CPE.

I previously listed the four steps to take before choosing a management career. Now is time to do the cost-benefit analysis. The costs to obtain the necessary background education, and possibly an advanced degree, are significant. But, besides the increase in salary I experienced, the intellectual challenges and excitement of mastering a new field more than offset the financial and time commitments required.

Feel free to email me directly at john.jurica.md@gmail.com

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The post Does An Executive Salary Stand Up to a Clinical Salary? appeared first on NonClinical Physicians.

My partners and I had started a pension plan and we were making regular contributions. But none of us really knew how we should invest our contributions. I realized that I needed to learn about investing.

I needed to go through a crash course on mutual funds, stocks, bonds and asset allocation. And the Internet did not exist, so there were obviously no blogs like White Coat Investor, Physician on Fire or Future Proof MD to read.

So, what did I do?

Like many medical colleagues who seem to be afflicted with (blessed with?) hypomania and obsessive compulsive disorder, it was time for my first round of post-medical education TOTAL IMMERSION!

I’m sure you have seen this in some of your physician friends, if not yourself. You get into something and it becomes an all-consuming obsession. You need to find and devour every possible resource on a topic – written, audio or video. First, you start with the free and easily available, then move to low-cost, and then high cost, sources of information. I've done this with investing, bluegrass guitar playing, rock-climbing, rollerblading, blogging and other subjects.

For this first obsession resources included:

• Reading articles in Smart Money, Forbes, Fortune, etc.
• Requesting free financial newsletters
• Listening to financial radio personalities like Bob Brinker and Dave Ramsey
• Subscribing to one or two newsletters, like Bob Brinker’s Marketimer and The Kiplinger Letter
• Watching CNBC day and night
• Reading the latest books on investing (too numerous to list – and out of date now!)
• Starting an investment club (see Better Investing)

You get the idea.

So, how does this apply to the physician intrigued by a career in management?

Well, you need to decide if it is really what you want to pursue before spending potentially large dollars and lots of time on it. Unfortunately, there are not as many readily available resources about physician management. But there are a few that should be explored before jumping in.

Let me list what I think are the bests ways to learn about management before investing too much time and money in the effort.

4 Steps to Learning About Management

Let's look at the four steps you can easily take to get a clear understanding whether this might be the right career for you.

1. Reflect on Your Motives

This step has the advantage of being totally free. You should reflect honestly about why you are thinking about beginning this journey.

Is it because you are burnt out, or overwhelmed by your clinical practice? Does the fantasy of sitting in an office, giving instructions to a direct report seem less frustrating and stress-free? Are you thinking that management is a nice pre-retirement way to slow down?

The fact is, you may get just as stressed and burnt out in a management position as a clinical position. There are budget and staff constraints, difficult decisions, accountability for your performance, and more work than the available time. You're paid well, so you must demonstrate a measurable return on investment for your salary. And you must not be timid about terminating underperforming directors and managers on your team.

Are you attracted to management because you wish to help larger groups of patients and work in a team on big projects? Do you enjoy big challenges? Are you comfortable with more uncertainty than the typical physician?

Do you prefer one-on-one interactions with patients? Or do you feel comfortable in front of a group of peers or board members? Do you enjoy working on quality improvement and patient safety? What do you think about confronting your colleagues about unacceptable behavior or questionable clinical practices?

If you are not running from an old career, but embracing a new one, then you are probably on the right track. But there are other careers to consider (such as those discussed in Options for a Non-Clinical Career).

2. Talk to Physician Leaders

If you are acquainted with a chief medical officer, vice president for medical affairs, chief quality officer or someone in a similar position, ask them to sit down over coffee and answer a few questions. Ask them how and why they went into management. What were the barriers to entry? Where did they learn about management and leadership?

This is also one of the best ways to find a mentor. Talk with several such persons. And make it a point to follow-up with them several months later. You don’t need to ask them to “be your mentor.” That can be scary to a leader. It feels like they need to commit to a formal role with a major time commitment. But just getting together to talk about management issues and career choices three or four times a year is not so threatening.

3. Read Everything You Can About Physician Leadership

You can scour the Internet for articles using Google Alerts. Look for articles that include keywords like physician executive, leader, administrator and manager.

You can pick up books like Growing Physician Leaders: Empowering Doctors to Improve Our Healthcare, The Six P's of Physician Leadership and Essentials of Medical Management.

4. Join the American Association for Physician Leadership

Here is where an investment will be required. Membership in the AAPL currently runs $295.00 per year. This is well below the annual cost for many professional societies. But it is a small investment given the resources that are available to members. (I have no financial incentive to recommend membership, but I have been a member for about 23 years).

Joining the organization will jumpstart the other three steps, because membership includes access to a journal, books, a job board, and online educational materials. There are several live conferences each year where networking can occur and mentorships can be developed.

I believe it is helpful to join even if you have not made a personal commitment to seek a management position, because the available resources will help to inspire you, and to decide whether to proceed or not.

Start the process outlined above and see if a management career is right for you.

For more of my thoughts on healthcare and leadership Subscribe here.

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Feel free to email me directly at john.jurica.md@gmail.com with any questions about anything. I am here to help you excel as a physician leader.

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Thanks so much and see you in the next post!

The post 4 Crucial Steps to Take Before Choosing a Management Career appeared first on NonClinical Physicians.

There is more need today than ever for skilled physician leaders. There are several specific steps that hopeful executives can take to enhance their competencies. But each physician will need to determine his or her own path based on his or her circumstances.

When trying to acquire these skills, it is best to follow Steven Covey’s admonition: “Start with the end in mind.”

Resources for the Emerging Physician Leader

Here are some resources that I found very helpful while I pursued my dream to become a physician hospital executive.

Join Pertinent Associations

Join organizations that provide support, education and networking. While I was actively working as a hospital CMO, I was a member of the American College of Healthcare Executives (ACHE). It provided some very good resources, including an annual conference to attend.

Since my hospital belonged to the American Hospital Association, I had access to its resources.

The dominant physician-led organization is the American Association for Physician Leadership (AAPL). I joined the organization in 1994 and have been a member ever since. In addition to conferences, workshops, and on-line activities, it publishes a monthly journal and hosts a job board.

Consider an Advanced Degree

Obtaining an advanced degree such as an MHA, MMM or MBA is not required. But it can be quite helpful for developing new management and leadership skills. In 1993, I completed a master's degree in public health, with a focus on occupational medicine. At the time, I was working as part-time medical director for an occupational health clinic.

Had I joined the AAPL before starting the MPH, and fully considered my long-term goals, I may have chosen to pursue an executive MBA or MHA. The MPH has been useful, nonetheless, in my work in quality, safety and population health initiatives.

Although it is not an advanced degree, the Certified Physician Executive (CPE) designation is evidence of competence in many physician leadership skills. It can be obtained by those with or without an advanced business degree through the Certifying Commission in Medical Management.

Get Training in Business and Management

Formal training relevant to the physician leader can be obtained through workshops, conferences and on-line programs. The organizations mentioned above all provide extensive education in business and management topics. If you are on staff at a hospital, you should be able to access some of the AHA programs. If employed, even part-time, by a hospital or other healthcare organization, you can probably access the ACHE conferences and workshops.

I attended many conferences organized by the AHA and ACHE over the years.

I also recall attending training provided by the Advisory Board, the Studor Group, Press Ganey, and the Greeley Company. Also, specialty societies, state medical associations and the American Medical Association offer additional learning opportunities for the emerging physician leader.

The additional benefit of attending AAPL courses and workshops, including on-line courses, is that many of them count toward CPE certification.

Read Books, Journals and Blogs

There are many good books to read on the subject. Some are written by physicians such as Atule Gewande, some are about physicians leadership (by Mark Hertling). Most of them address general business and leadership topics (by experts like Jim Collins, Peter Lencioni, Susan Scott and Sean Covey).

The AAPL publishes the Physician Leadership Journal monthly. Modern Healthcare is useful, as is Medical Economics.

There are several blogs devoted to leadership. This is a resource that was not available to me when I began my career journey into the executive realm.

I like blogs because they are contemporaneous, and often more focused and brief than a journal article. Also, they often allow for interaction with the blog author or other readers through the Comments section.

There are some great blogs devoted to leadership that provide free content and engagement with others interested in leadership, like MichaelHyatt.com, JohnMaxwell.com and SkipPrichard.com. I have been unable to find any blogs written for the physician leader that don't require membership in a parent organization like the AHA or ACHE.

Volunteer Your Services

A good way to get experience is to lead hospital based teams, and participate in professional society committees and nonprofit boards. At my hospital, I volunteered to work on the CME Committee. That led to being asked to join the Illinois State Medical Society's Committee on CME Accreditation. I later served as chair for that committee for five years. In that role, I attended the ISMS Board meetings.

Work on the Committee on CME Accreditation led to working as a CME surveyor and appointment to one of the Accreditation Council for CME's subcommittees.

In later years, I joined the local hospice board of directors, where I now serve as Vice President and President Elect. I have also served as a member and chair of our local health department board.

All of these experiences have given me an opportunity to set agendas, lead meetings, participate in strategic planning and review financial statements.

All of these experiences have helped me to hone my business and management skills over the years.

Take the Plunge

Once you have some education and experience, you will be ready to seek that full- or part-time job as a physician executive and leader. You will never be fully prepared. It is like marriage, the only preparation for being a physician leader, is to become a physician leader.

Now, take a deep breath and jump in. Our profession and our patients need you.

Have you found any blogs devoted to physician leadership? If so, please mention them in the Comments Section.

Don't forget to Subscribe to Future Posts.

And feel free to contact me directly at john.jurica.md@gmail.com

The post Resources for the Emerging Physician Leader appeared first on NonClinical Physicians.

This is a very exciting time. You want to make a great impression. If we were sitting down for a cup of coffee, here are a few suggestions I would make as you prepare for your first interviews.

1. Do Your Research

Spend some time learning about your prospective employer. Look at its website. Identify the mission, vision and values of the organization. Find a copy of its most recent annual report.

If it is a hospital or health system, look at quality data published on HospitalCompare.gov and HealthGrades. You might even check out the enterprise on Guidestar if it is a not-for-profit institution.

2. Review Major Issues

Brush up on common issues that a physician executive will need to be knowledgeable about. If the position is for a hospital VPMA or CMO, the following topics will often come up:

• Process improvement models like Toyota’s Lean Process and Six Sigma
• Medicare’s Core Measure and Hospital Inpatient Quality Reporting Program, including HCAHPS and CG-CAHPS
• Truven Health Analytics 100 Top  Hospitals (see previous blog post)
• National Quality Foundations' Endorsed Measures List
• Patient Safety Measures such as those by the Joint Commission or the AHRQ
  • Sentinel Events and performing a root cause analysis
• Electronic Medical Records and Meaningful Use
• Experience with Code of Conduct and the so-called “disruptive physician”

3. Prepare for These Leadership and Management Questions

Each organization, and each interviewer will have their own pet questions. But be ready to answer some of the following.

• “Tell me about a project that you led successfully.” You might discuss opening a new unit or starting a new service line. If you are not that experienced, perhaps you have led a team to create a new set of quality guidelines. Ideally, you would have data to show the success of the project in terms of volume or quality metrics.

Interviewers are taught to go deep on a topic to verify that the applicant is not just generally knowledgeable but has specific experience in an area, to parse out those participating from those actually leading.

• “Describe your greatest weakness.” Be careful on this one. Don’t get cute by answering with false humility (“I’m sometimes too committed to the point that I spend long hours in my job.”). The best approach in your interview would be to honestly describe a weakness AND the steps you have taken to try to overcome it.

• “Why are you leaving your current job?” The object here is to focus on the positive reasons and to avoid assigning blame or complaining. Employers are looking for someone who is positive and optimistic, and avoiding applicants who are not seen as accountable.

4. Be Inquisitive During the Interview

I think the most important suggestion I could make about your interview is to be curious and honestly seek answers to these and similar questions:

• What do you see as the most important goals for a new VPMA or CMO over the first 90 days and the first year?
• What new strategic initiatives will need to be supported?
• What have been the greatest challenges for the previous CMO?
• Are there any serious medical staff/physician issues that need to be tackled?
• How would you describe the executive team? Is it well-integrated? And how will the new CMO be integrated into the team?

5. Don't Discuss Salary on the First Visit

Here are a couple of thoughts on the discussion of potential salary.

• I think it is best to postpone salary discussions until after you have had a chance to fully assess the opportunity. Even if the employer brings it up first, I would respond in this way: “I think we can have that discussion once we agree that I am a good fit for the organization. I am confident that we will come to an agreement on salary when we get to that point.”

• From a negotiating standpoint, when the time comes, I recommend you ask the employer to specify the salary range, rather than you suggesting what you want in a salary. The employer will already probably have a copy of your W-2 and know your previous income. In order to negotiate from strength, it is best to have the other party begin with an offer to which you can respond.

What other issues do you think are of top importance when preparing for an interview? Would it be useful if I provided a post devoted to negotiating your salary? I look forward to your comments.

The post Five Tactics for a Powerful Interview appeared first on NonClinical Physicians.

My First Direct Reports

The CEO suggested that we take things slowly to allow me to acclimate. He initially assigned the directors for physician services and quality improvement to me. I knew both of them very well, having worked with them for years on various medical staff committees.

Yet I experienced a bit of culture shock having these two well-trained and very capable professionals reporting directly to me. It was no longer a matter of simply serving as an adviser. I woiuld not just be signing off on policies and procedures, as I had done as a medical director. I was now part of the formal hospital management hierarchy. So, I would be accountable for the “output” of my new departments.  And I would be monitoring and evaluating the performance of my two direct reports.

A second major eye-opener would come later in the year. In October I was expected to understand fully the details of both directors' budgets. And I would be helping to present them to the COO and CFO.

The Executive Team

The other event that occurred simultaneously was the weekly planning meeting with the senior management team, chaired by the CEO. I had become aware of reticence by members of the team about having a physician join them. The team had included other full-time nursing executives, but had never included a physician.

During those early meetings, I could sense that the executives around that meeting table had respect for its medical staff, and a realization that the very existence of the organization ultimately depended on the physician-patient relationship. But physicians really weren't interested in, or capable of understanding, the business side of the hospital enterprise. And would this new member of the team bring the kind of ego-based grandstanding that they had so frequently experienced in medical staff meetings?

These were the opinions once shared by executives at hospitals across the country. Although some of them had already abandoned such opinions as a result of employing one or more physician executives. But at the time there were many hospitals and health systems that had not yet joined that growing trend.

Over time, I was accepted as an integral member of that team. And I learned about managing my direct reports, working on and leading teams, and other important lessons necessary to be an effective part of a successful organization.

Three Domains of the Physician Executive

In a previous post, I talked about four new skills that I first recognized when I began as VPMA. But there are more such skills that the executive physician must acquire. I thought about how to organize these new aspects of competence and performance. It seems to me that they all fall into a larger construct of major domains of expertise.

Three domains of executive physicians

To me, it boils down to three areas that need nurturing and attention in order to function effectively as a physician executive. Those areas are:

• Leadership
• Management
• Executive Teamwork

Leadership

Physicians are natural leaders. They are trained to be decisive, to collect and analyze information and implement a course of action that gets a desired clinical result. They are well-trained. They are accustomed to leading small teams, whether in the clinic or the operating room. Some of the gravitas that physicians have in these arenas is a consequence of their professionalism and extensive and lengthy education and training. Many have a learned “presence” as a result of being the decision maker in urgent or emergent medical environments. They take control when necessary.

But those attributes are not sufficient to make a great leader in the corporate world. Leadership in a healthcare organization is different. It demands the ability to:

• define, communicate and model the organizational mission and vision
• actively listen and integrate input from others
• engender trust and loyalty in others
• enlist others in your cause
• see the big picture and think strategically
• collaborate with others to achieve organizational goals
• model integrity and accountability

Management

This domain is typically seen as separate from leadership. Not all great leaders are even good managers. But a clinical executive, whether physician, pharmacist or nurse, must learn to fill the management role that is needed to keep their division, department or unit achieving its goals and meeting its core responsibilities.

Management responsibilities are much more practical and clear-cut. These include:

• Understanding financial reports and preparing budgets
• Working with direct reports to achieve organizational goals
• Goal setting and project planning
• Directing quality improvement, patient safety and risk reduction
• Hiring, firing and succession planning
• Running effective meetings
• Understanding contracts
• Implementing performance improvement processes
• Collaborating with peers

Executive Teamwork

The final side of the physician executive triad is the domain of “Executive Teamwork”. I am still not sure if this is the best term to use to capture this important domain. We have all experienced working in teams and have a sense of what it means to be a productive team member.

However, being a member of an executive team is unique in my opinion. This is a concept that took me several years to begin to fully understand.

While working as VPMA, I always considered “my team” to be the direct reports that worked with and for me: directors of laboratory, imaging, physician services, pharmacy and quality improvement. I spent much of my time interacting with these team members, mentoring them, helping them think through problems, partnering with them when coordinating with other departments and representing them to other members of the executive team.

Through a series of onsite retreats, led by our CEO and facilitated by an executive coach from Vistage, the senior executive team (CEO and VPs) came to understand that this was our primary team, not our individual divisions. And we learned that as a member of the team, if we wanted to achieve outstanding organizational results we would need to:

• embrace accountability
• commit to shared goals
• engage in conflict when needed
• build a platform of trust within the team

We essentially followed the model described by Patrick Lencioni in his book “The Five Dysfunctions of a Team“. I have since concluded that the ability to trust, to engage in fierce conversations, to commit even when not fully aligned and to be 100% accountable for results are abilities that MUST be learned in order to become a vital physician executive.

Coming Up

I have begun to describe a model that helps categorize the skills needed by the evolving physician executive. In future posts, I am going to discuss specific tools and skills that the new clinical executive might find useful. I also plan to explore in more detail the concepts described by Patrick Lencioni and other authors that are pertinent to the physician executive.

Please join my mailing list, and share these posts with your colleagues to stimulate more discussion. And post your own thoughts on these ideas so I can see if I am on the right track or not.

Thanks so much.

The post The Three Domains of the Physician Executive appeared first on NonClinical Physicians.

Five Steps for the Physician Executve

It always seemed to me that my classmates in medical school and residency were more intentional than me regarding their life choices. I generally just rode the wave of the “path of least resistance.” During my first year of medical school, many of my classmates were enrolled in the “Med Scholars” program, which meant they were simultaneously working on their M.D. degrees AND a Ph.D., M.B.A. or J.D. They obviously had a plan.

I had chosen to go to medical school as a default, because I had gotten good grades, enjoyed studying science and that’s what smart kids were doing. I didn’t really have a master plan. I didn’t know which specialty I wanted to pursue or where I wanted to practice. And initially I was quite fearful of interacting with patients. But I made it through, and selected the speciality of Family Medicine, mostly because it was generic and matched my internalized concept of a physician that had been formed by watching TV shows like Dr. Kildare and Marcus Welby, MD.

Curious Realization

I made an unexpected discovery as I reached the end of my second year of residency: I liked working with colleagues, staff and the faculty to try to fix things. So, one of my classmates and I threw our hats into the ring for the position of chief resident for the following year. My colleagues selected me for the job!

I found that I enjoyed meeting with staff and residency leadership, providing my insights and observations, and solving problems in the clinic. I also liked taking on projects, such as updating and expanding our list of elective rotations, coordinating grand rounds and bringing teams together to plan special events.

The New Practice

I joined two family physicians and the medical staffs of the two local hospitals and began to build my patient panel. I found myself attending the OB/Gyne, Surgery, Pediatrics, Internal Medicine and Emergency Medicine Department meetings in addition to my own Family Medicine Department meetings. I wanted to keep up with clinical issues in those fields, and get to know the persons that I would be referring my patients to. I personally wanted more CME opportunities than were available, so I coordinated a weekly CME series for my Family Medicine colleagues for the next several years.

At the time, hospital medical staff were encouraged to participate in one of the many medical staff committees (Quality, Bylaws, Credentialing, etc.). I was generally an introvert and non-political, so I avoided controversial issues. I was drawn to being involved with coordinating CME, because it seemed so politically neutral. I started attending CME Committee meetings and became chair of the committee by default when the previous chair retired from practice.

Chairing that committee really started to introduce me to the non-clinical side of working in a healthcare organization. And it led to being appointed to the Illinois State Medical Society’s Committee on CME Accreditation, which I later chaired. And that led to being recruited to the Accreditation Council on CME (ACCME), which exposed me to another level of management and administrative activities.

Becoming Intentional

Up to that point I had been riding a wave of opportunity and the fact that these organizations often had difficulty finding volunteers. But I enjoyed the work. Meanwhile, in order to generate some additional income, I began “moonlighting” at the local “STD Clinic”, the hospital-owned family planning clinic and an occupational medicine clinic. Because of a “vacuum” of interested physicians, I found myself serving as part-time medical director for both the family planning clinic and the occupational medicine clinic. I discovered through these various activities that I was learning on the job how to plan, communicate, lead, delegate, collaborate and manage in ways that were different from the skills applied in the realm of the practicing physician.

That's when I became much more intentional. I began thinking about formally evolving from practicing physician and part-time volunteer leader to exclusive full-time physician executive. Here are suggestions for starting the process, based on what I did.

Five Steps for the Budding Physician Executive

• Read anything pertaining to your new interest (key words: physician, leader, leadership, executive, manager, business)
  • Blogs
  • Books
  • Articles
• Join associations like the American Association of Physician Leaders (AAPL) (formerly the American College of Physician Executives) and the American College of Healthcare Executives (ACHE)
• Learn – consider seeking additional formal training
  • MBA
  • MHA
  • MPH
  • MMM
• Seek part-time roles
  • Part time medical director
    • Clinics
    • Hospital units (ICU, Observation Unit, Dialysis, etc.)
    • County Health Department
  • Hospital committees
  • Local and state medical society and specialty society committees
• Attend conferences devoted to physician leadership and issues of interest to physician managers and executives (provided by a variety of organizations including the Greeley  Company, the Healthcare Advisory Board, the American Hospital Association, the ACHE, the Studor Group, the AAPL).

Back to My Story…

Let me summarize what I did in a little more detail. I opened my schedule and my thinking to consider serving as medical director for a variety of clinical areas. Since I was working as an occupational medicine physician and medical director, I enrolled in a Master's Degree Program in Occupational Medicine through the Medical College of Wisconsin. I read everything I could, joined the AAPL and began attending their physician leadership meetings.

Since the local hospital that had helped to recruit me to the community did NOT have a formal physician leader (other than those in the volunteer medical staff structure), I began a conversation with the hospital CEO to create a new position. He ultimately hired me as its first vice president for medical affairs (VPMA). I continued to practice medicine, but gradually reduced those hours and increased my management duties as I took on more responsibilities as an executive. Later, I transferred all of patients to my partner and became a full-time Senior VP and Chief Medical Officer.

That's the path I took. Yours will surely be different. I don't think having a business degree is absolutely necessary (after all mine is in public health), but focused study of business practices and management  in the healthcare setting will be very helpful. In my case, I also went on to become a Certified Physician Executive through the Certifying Commission in Medical Management, which can be obtained without having a business degree by completing formal coursework and an intensive one week tutorial.

In a future post, I will describe some of the specific new skills used as a healthcare executive, and some of the biggest lessons I needed to learn as I progressed in my career.

The post Five Steps for the Budding Physician Executive appeared first on NonClinical Physicians.

John V. Jurica, MD, MPH, CPE

My name is John Jurica and I am a physician, entrepreneur, and former hospital executive. I have practiced medicine for 30 years, studied public health, started several medical practices, studied physician leadership, and worked as an integral member of a highly effective executive team. Along the way, I became a Certified Physician Executive (CPE). Welcome to my blog.

Thanks for joining me.

My purpose for writing this blog is to share stories, insights, tips and tools based on my experiences as a physician executive over the past 20 years of my career.

My Mission is to inspire and inform physicians as they consider the move into management, and to help them become effective executives as they grow into their careers. I hope to serve as a guide and coach and curator of new information for my readers. My Vision is for a world with physicians taking more of a leadership role in any business that involves patient care.

I intend to:

• provide practical tools and advice that will enhance your skills as a physician leader, manager and executive
• steer you to useful articles, websites, books, conferences and other resources
• regularly solicit your suggestions and questions
• provide commentary on news that impacts the physician executive

I am calling this site the Vital Physician Executive. I selected the name because of the two important meanings of the word “Vital”:

1. Vigorous, energetic and strong – as in VITALITY
2. Needed, important, critical and INDISPENSABLE – as in being indispensable or vital to your organization, your CEO and your team

The Future

Here are some of the topics I plan on addressing in future posts, checklists, ebooks, audio recordings, podcasts and other resources (not necessarily in this order):

• Is a Non-Clinical Career Right for Me?
• How Do I Move into a Management Career?
• What Are the New Skills I Will Need as a Physician Executive?
• Top 10 Books to Help Me Prepare and Grow as an Executive?
• How Do I Effectively Work With (Manage) My Direct Reports?
• Why is CLARITY So Important as a Physician Leader?
• The Physician Executive as Both Leader and Manager
• How to Be Indispensable
• The MOST Important Issue for Your Career Success
• How and Why Is TRUST So Important?
• Why Is Confrontation Good?
• Understanding and Having Fierce Conversations
• Making Meetings Powerful and Effective
• What It Takes to Be a Top 100 Hospital
• How Do I Define My Team?
• Should I Write a Blog as Physician Executive?
• How Do I Facilitate Accountability in My Managers and Directors?
• Patient Safety
• Components of an Awesome Quality Improvement Program
• Working on Physician Employment Contracts

Keep in Touch

What do you think about these topics? What other topics would you like to read about? Please enroll in this Blog using the applet below. I will then send you a short email each time there is a new post.

And please let me know if this thing is not working, if the posts are difficult to read, if the links are broken, etc. It's the only way that I will be able to fix problems as they arise.

And take the time to add comments so we can keep the conversation going.

Thanks again for looking around. Please respond to this and future posts by sending some comments and let me know what you would like to read about that's not on the list – or the topics that I should prioritize!

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