Begin Your Career Transition in Earnest

In today's episode, we revisit the topic of 5 persistent myths that clinicians believe when they begin to contemplate a career transition. This presentation was given at the 2023 Licensed to Live online conference.

In today's fast-paced healthcare landscape, many professionals find themselves yearning for a more fulfilling and rewarding career path. To embark on this transformative journey, the first crucial step is recognizing the widely held beliefs or myths that hinder progress. The prevailing misconception that the only way to succeed is by adhering to the status quo may be one of the main barriers preventing professionals from embracing a more fulfilling path. 

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5 Persistent Myths

Once the myths are dispelled, a world of possibilities opens up. This journey often involves exploring alternative career options where one can leverage their expertise and training to make a meaningful impact in unconventional roles. Embracing a different direction, such as pursuing a nonclinical career or venturing into healthcare innovation, allows professionals to find new avenues for personal and professional growth.

In this list, we debunk the following persistent myths:

1.  “There are no jobs.”
2.  “I'm not qualified.”
3.  “The salaries are low.”
4.  “I'm abandoning patients.”
5.  “I won't be respected.”

Best Kept Secret

The first of the 5 persistent myths pertains to available jobs. In fact, there are several large industries that hire thousands of physicians each year to do nonclinical work:

• Hospitals and health systems,
• Pharmaceutical and medical device companies,
• Medical publishers,
• Educational institutions,
• Consulting firms,
• Federal, state, and local governments, and,
• Life and health insurers.

Additional Training Not Required

The next of the 5 persistent myths pertains to necessary training and skills. For most of these new careers, the primary qualification is the completion of medical school. Such physicians have broad exposure to the life sciences, an understanding of the U.S. healthcare system, and how to interact with patients. Additional education during residency and fellowship and board certification are sufficient to qualify us for most of the remaining positions.

Sometimes, additional certifications and degrees may be preferred. But for the most part, it is the physician's unique background, training, and experience that prepares them for these nonclinical jobs.

Incomes Improve

The next of the 5 persistent myths pertains to income levels. Salaries may be less than those for clinical work initially. But that will be offset by improved lifestyles and work-life balance. Benefits and vacation time are often quite generous. And most physicians experience opportunities to quickly advance and enjoy very attractive income levels over time. 

What About the Patients?

You'll be helping patients in new ways and sometimes much broader ways and in larger numbers as you can one patient at a time…

In pharma, you'll help develop life-saving drugs. You'll reduce pain and suffering for large groups of patients in public health. And in consulting, you'll bring new and improved models of care to hospitals, and help implement new service lines.

Reputations Improve

The last of the 5 persistent myths relates to your reputation and identity as a “doctor.” Generally, these positions have an impact on larger groups of patients. And physicians become content experts, managers, and leaders over time by combining their medical expertise with skills in their new industries. 

Summary

In the ever-evolving healthcare landscape, it is vital to challenge long-held myths and beliefs that may hinder professional growth. By breaking free from corporate-style, high-volume models of care, healthcare professionals can unlock their true potential and enjoy their work again. Leveraging one's medical expertise in innovative ways is the key to unlocking a fulfilling and purpose-driven career when the traditional healthcare system fails us.

NOTE: Look below for a transcript of today's episode. 

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Links for Today's Episode:

• How to Kill the Myths About Alternative Jobs for Clinicians – 252
• Month One of the 12 Month Roadmap to a New Career – 269
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 309

Let's Dispel These 5 Persistent Myths About Nonclinical Careers

John: All right, nonclinical nation. Let's get right into today's presentation in which I do my best to dispel five persistent myths about nonclinical careers. Let's start by talking about Dr. Brenda M. She's two years into her first job as a hospitalist, and she's feeling very unhappy and disappointed.

Now, when she was in medical school, she really enjoyed it, although at times it was a little bit overwhelming, but all in all, she felt maybe some slight burnout during certain parts of that for a year program. And then she went on to her internal medicine residency anticipating becoming a hospitalist. And during that time, again, she was happy to be there, but she really started to feel as though she was getting burned out. There just was too much work to do. There wasn't enough support and not enough recovery time before the next shift or the next clinic and that sort of thing.

But she thought, "Well, I'm going to try and find a really good job in a location that I'm interested in, and by then, things should get better." And we've all heard this, right? And some of us have felt it recently. It seemed like the burnout from medical school to residency to practice just kept building on each other.

But she joined a group. She thought, "Well, it seems like the coverage is good. There's enough of us to take care of this hospital." She was promised a certain number of days off each month, and things were going well at first, but then the support staff seemed to be falling off and not being replaced. And the volumes that she had to see during those two years kept increasing to the point she felt like she never really could keep up. She had to go back and do her medical records when she was at home online. And she just thought that things were not going the way she anticipated.

Now, she was really starting to think, "Well, maybe this just isn't what I thought it would be, and maybe I need to do something else." But every time she had those feelings, she sat back and thought "There's just no way I've spent my life learning to do this job. I don't really have other options. I'm going to see a drop in my income." With still having some outstanding loans, even though there was some partial payback through her employer, she felt constrained. That's what someone in the past called the golden handcuffs, in a sense. You make a good living, but at the same time, there's huge pressures. The income doesn't really seem to go up unless you just work longer and harder. And it also seemed as though she would be letting people down if she were to not continue on in her clinical career. Her family, her friends, and even her patients.

This is a common thing that we see in today's healthcare environment. And if you're frustrated or disenchanted about your work in healthcare, if you feel as though you're being ignored and taken for granted, or that you've been forced to forfeit your autonomy to do what's best for your patients, then it is entirely reasonable and even necessary to consider a nonclinical career in order to maintain your integrity and maybe even maintain your sanity.

You certainly aren't alone. In fact, tens of thousands of clinicians over the last decade have come to the same conclusion. However, many of us like you are hesitant to do that because of several myths that our employers and training programs promote in order to maintain the status quo.

We continue to suppress our feelings that something is wrong and delay implementing the solution to these problems. So, what is the solution? Well, for the most part, it is to take the next step in your professional life and join all the other professions who make at least five to seven job changes, and try and find a career that leverages your training and experience outside the traditional unrewarding assembly line corporate style approach that is currently the predominant way that healthcare is being provided.

But to do that, one of the first steps we must take is to recognize these widely held beliefs or myths that hold us back and dispel those myths and enthusiastically embark on the next phase of our professional lives. That is really the major solution. Other solutions would be to retire early, do something else. If you're independently wealthy or you have a spouse who's willing to provide the financial while you do other things, that would be great. But basically what we need to do is set ourselves on a new path. But first, most of us have to try to overcome these widely held myths that hold us back.

All right. So, let's talk more about that. I think if Dr. Brenda does the same thing, she will find herself in a better place. And so, I want to answer these questions today as we go through this discussion. First of all, what do I mean by nonclinical career or nonclinical job? What are the five most common persistent myths that we encounter? And how can I dispel those myths and prepare you to find a nonclinical or non-traditional career, if that is your goal?

All right, what I'm talking about today when I'm talking about a nonclinical or non-traditional career, it's an alternative career, an unconventional career, one that is based on your background, your education, training, and experience in medicine, or even nursing or dentistry or pharmacy. Because a lot of the concepts I'm talking about today apply to those other clinicians that often find themselves on the same team and in the same situation as we are in which is we're being overworked, we're being abused, and we need to try something different.

Now, those nonclinical jobs usually include a term that indicates that it's still within the healthcare system. For physicians, it means it might include the term physician or medical. For nurses, it'll include nurse or nursing. And dentist, dentist or dental, those kinds of things.

For example, I'm talking about careers like physician advisor, medical director, medical writer, executive medical director, chief medical officer, chief medical information officer. It could be the same thing. Chief nursing officer, nursing director, that kind of thing. And these kinds of jobs also apply to those other specialties in other fields that I mentioned a minute ago.

Now, I'm not addressing what some might call self-limiting beliefs, the feeling that I'm not good enough, I might fail, there's something wrong with me. It's too much to learn, it's too hard to do. Those are internal, again, self-limiting beliefs that are really generally pretty easily overcome. We had to overcome those kinds of thoughts when we contemplated going to medical school or nursing school, or get our PharmD or our DDS, those kinds of things.

I'll list the five most common myths that I encountered. I'm going to list them, state them in a way that is at the extreme. What we're saying to ourselves, what our former instructors and professors and employers wanted us to think while we were in training and even in our current positions.

And these are the kind of things they want us to think we fall victim to. One is that there are no jobs for us that aren't within healthcare, per se, in patient care, that I don't have the qualifications. I have no qualifications. I'll make no money. Obviously, you'll make some money, but the money I'm going to make is going to be completely inadequate. That I won't be helping patients anymore, which is what I really went into healthcare and medicine, or nursing or pharmacy to do. And then I'm going to lose my stature. I'm going to lose all my respect because I'm just going to step away and do something that's not as noble in a way.

I'm going to take each of these individually, describe them in more detail, and then address how to really understand why these are myths and therefore, kind of take away those barriers to you moving forward with your next professional advancement and next stage in your professional career in that field. You can be a physician, you can be a nurse in the nursing field, in the medical field, but not in the same clinical way that we've done in the past.

I remember a colleague and a mentee of mine, Dr. DH, I'll use his initials. He was a vascular surgeon, and he really got to the point where he just felt like he could no longer do his job. He was in this situation, we often find ourselves in, particularly if you're a specialist, which is relatively uncommon. What happens is you end up working somewhere and there's a few number of you helping each other, supporting each other, and covering for each other.

So you go to, let's say, even a big academic center, and they say, "Look, we need to have a service of three or four vascular surgeons." Okay, great. That's a profession that takes a lot of training. So you're careful. You do all your interviews, you find you're going to join this group of three other vascular surgeons, you're going to be able to do this surgery that you want to do, and not be doing general surgery, for example, when really you were trained to do vascular.

And some of the vascular surgeons even narrow that down further, of course. Well, Dr. DH found that he was there and things were good at the beginning, and then they had EMR issues, and they had to change EMRs. And all of a sudden he was having to do a lot of documentation at home and on weekends, because it wasn't really that efficient. They were still trying to bring it on and develop better protocols and order sets and so forth. So that didn't help.

And then the staff, again, I mentioned this with Dr. Brenda, the staffing was cut back on the areas where he was working, whether it was in his clinic or even in the OR. And then it turned out one of his partners left and they dragged their feet. Even though he was recruited to be one in four, they dragged their feet, then he was one in three call, and then if someone took vacation, it was one in two call for a week or two at a time.

And there seemed to be no effort to really find a replacement and no ability or desire to hire locums, even to provide some temporary relief. And so, he found himself in an untenable situation. Meanwhile, his kids were growing up, he was working long hours, he didn't get enough time to spend with them, and he found it was time to make a change.

At first, he thought "I'm going to have to look for a different kind of clinical job because of this myth of I don't know how to do anything else or I can't earn enough money." He was a really good one to remind me about this common myth that "There aren't any nonclinical jobs that a vascular surgeon can do. I hear about my primary care friends doing these jobs, but I don't think there's anything I can do."

I'll come back to his story in a moment. But before I finish off with Dr. DH, I want to explain something to you about maybe one of the best kept secrets in medicine and healthcare, and that is this. What we're taught and what people talk about, especially in medical school, in our residencies, in our fellowships, is that there is this process.

You go from medical school to residency, you may have a fellowship after that and then you make a choice. You go into an academic practice, maybe you go into an employed situation that's not academic or in a small percent, you may even find yourself in an independent practice. And that's it. Basically, that's what you have to choose from. You have to kind of make a choice. Academic, large employed, maybe you can do something independent with two or three partners come in initially as an employed physician, and then later become a partner.

But what's going to happen in all those situations is as payments to physicians go down, even though you're sheltered a little bit from that in an academic setting or an employed setting, eventually it's going to trickle down to you that you need to produce more RVU and see more patients and do more procedures to maintain the income that justifies your salary.

Some large institutions, especially procedural ones, an ortho, other surgeries and cardiovascular can subsidize that through those procedural activities. But the bottom line is you're going to have to do more, and you're going to have to do them faster, and you have to see more patients to feed into that. And so, the whole system kind of breaks down, and it usually leaves us really disappointed and disillusioned.

What most people don't really realize, especially while they're still in their training and early in their career, is there is something beyond those options. In fact, as I think about it, I can define and describe at least nine major industries, all of which hire hundreds or thousands of physicians every year to do nonclinical or non-traditional work. Let me just go through that list. And again, your instructors, your professors, your employers, they won't tell you about this, but sometimes you'll see it. It's obvious. If you're working in a hospital system, you'll find out, "Wow, there are people who are leaders, who are managers in these health systems." Whether it's a freestanding hospital, a three hospital system, a large academic system. They all pay physicians and other non-physician clinicians to do management and leadership.

Pharma companies hire tens of thousands of clinicians every year to work full-time jobs in pharma that do not involve direct patient care. The insurance industry that includes disability insurance, somewhat more so life insurance. And then the big one is really health insurance. They hire a lot of physician advisors, medical directors, who become senior medical directors, who become chief medical officers. There's a lot of education by physicians in which they're doing straight education. It doesn't have to be in the context of direct patient care. It could be at universities, at medical schools, at PA schools, nursing schools. It could be online.

And there are, again, thousands of jobs. There are medical writing jobs. That's one of the most common nonclinical careers. There are consulting jobs, both freelance, individuals, small groups, consulting, as well as national and international companies that hire consultants.

There's consumer health, which means teaching the consumer about medical care, about the healthcare system, about anything related to that. There's government jobs, and a lot of those are in public health and so forth. And then there's lots of nonprofits that are related to the healthcare field that have to hire physicians with their expertise.

Again, I just wanted to remind everyone of this first one, that it's foolish to think there are no jobs. In fact, there are thousands of jobs. And it turns out that these jobs are available for every specialist in any area with any length of training, with any degree of experience. That's myth number one that we need to really put aside. You have to realize there are a lot of jobs out there.

Sometimes you've got to learn and do a lot of research to find the jobs, and there's some strategies to that. I'm not going to get into that today, but let me just say, go on LinkedIn, look up medical director, and you'll see page after page after page of jobs, and then it's necessary to figure out which of those might be appropriate for you, located in the appropriate places, and then begin the process of trying to find them.

That's exactly what Dr. DH did. He really started doing research. He was involved in a mastermind that I was running. So he had the opportunity to engage not only with myself, but with other physicians in various stages of their career transition. And he really did reach out to other past colleagues, did some networking, and within a very short period of time, had two or three options. Some of them were part-time clinical options, doing just a very smaller part of his specialty.

And he was looking at wound care and vascular, but other types of non-traditional jobs that did not require being on call, did not require long hours, didn't have complicated and difficulty use of EMRs. But ultimately he found a utilization management job in which he could apply his vascular background. And he became a UM physician advisor or really a medical director when you, when you're working for a healthcare plan. And he was the vascular surgery specialist as well as doing some general reviews. And he's been very happy so far.

Okay, that's myth number one. Now, what is the second myth? Well, that is like I said, "I don't have the training. I have no expertise." Sometimes I hear this put as "Well, all I know is medicine." And if you think about that, in a way, medicine isn't a thing in and of itself. We obviously talk about as though it is, but to provide medical care is really a compilation of many, many skills in different areas that one outside of medicine wouldn't think of putting together necessarily. I usually like to go through this thought experiment where you're at a large ship and the ship is sinking and everyone's jumping into the life rafts to try to get somewhere safe, to someone can come by and pick you up or find yourself on a desert island.

And in the experiment, just think about the professions of the people you would like to be in the boat with. Just think of all the people you run into. Sales people, managers, directors, instructors, police, welders, taxi drivers, you name it. If you were going to be able to choose the people in the boat with you, and there were two people you'd want to be with you in that boat, who would they be? And I contend that they would be an engineer and a physician. And some of this relates to the broad experience, a broad education both of those types of people have.

But how many times the people come to you to ask a question, whether it's about chemistry, whether it's about their pets, experts in medicine. There's many, many sub, I guess I would call them, expertise that we have that makes us attractive. And we're excellent employees.

I'll give you an example too of Dr. MA. She was a foreign medical graduate, basically, and she also did some work in preventive medicine, but she was having difficulty finding a position in the US because she couldn't get licensed. She started networking, she started taking a lot of courses, and she became aware of the fact that there was a job called the medical science liaison, which is quite often open to those without residency or a license or board certification.

And after about a year of networking and taking courses and joining the MSL society, she landed her first job. And really everything that she does as an MSL does use her skills as a physician, as an MD or some places would be an MBBS and so forth. But everything that we know is included in the curriculum applies to jobs like this. The biochem, the pharmacology, physiology, pathology, microbiology, anatomy, epidemiology, statistics, laboratory interpretation, physical examination, interacting with patients, radiography, interviewing skills, teaching and presenting to colleagues, healthcare, economics. There's just so many areas that we become experts in when we're going through our medical education. And there are many jobs even for those with the medical school background, a medical degree without residency.

If you're a physician, if you're a nurse, especially with an advanced degree in MSN, definitely an APN. If you're a physician assistant, if you're a PharmD, you have a lot of skills, knowledge, and also work habits that employers are looking for.

And so, let's really dump myth number two is that you need special qualifications, or you need an MBA, or that all you know is medicine, when in fact you know a lot and the combination of things that you know put you in a position to fill a lot of these jobs, otherwise, you will not be qualified for.

Now, the big one that also affects us more so in the last 10 to 20 years is this idea of really making no money or making an inadequate income because a lot of us have loans and those have to be paid off. And sometimes you get a clinical position where they're going to help you knock off $10,000 or $20,000 a year on your loan. But if you've got $150,000 out there, it's going to take a long time to get that paid off unless you're making a really, really super high salary, and you can accelerate that. And thinking, "Well, I know I'm going to take a big hit in this career in my salary, this nonclinical career, then it'll really hold you back."

I can think of Dr. ML, who was an OB-GYN, and she was very busy. A lot of OBs, a lot of weird hours, a lot of call, similar situation. Staffing was cut back. Some of her partners left, even though she was part of a large multi-specialty group. She was employed, and it just became quite miserable. And she thought, for sure, I don't have any special skills and there aren't that many jobs out there in a nonclinical field for an OB-GYN and also it's not going to pay enough for me to pay my bills.

Well, she ended up looking around, networking, working on her resume, working on her LinkedIn profile, and she ended up landing a job after several months of search, working for a Medicare MAC. For people that work in the hospital that have anything to do with billing, they will know that a MAC is a Medicare Administrative Contractor, and it's an intermediary that processes the payments between CMS and hospitals. And she became a chief medical officer at a MAC.

And so, she made a very good income. She had to work fewer hours. In fact, mostly now she's working from home, which was enhanced a little bit by the pandemic. But she has children at home so she can be available for them, work for this Mac, make a very good income that is commensurate with her clinical income.

And again, as I mentioned before, our incomes are going down, Medicare's paying less for each patient care visit, not keeping up with inflation. And a CMO job pays very well. In fact, if you look at some of the stats out there, this is from last year, from salary.com, the typical physician advisor, which remember includes some that are not licensed, that simply have the medical degree, would be about $134,000 a year. Now, that's a median. So people make more, people make less.

If you're an experienced clinician, you become an MSL and you've already got some contacts for that job, you're definitely going to make well over $200,000. Overall average for a medical director is $295,000 per year. And quote, chief medical officer is over $400,000 a year.

I don't know what she was making per se. I would say that she's probably at least in the 300 thousands. I think those higher salaries are for CMOs and hospital systems, pharma and big insurance companies. But definitely if you have a CMO position, that is usually a very awesome, well-paid position.

So, this whole idea that there's inadequate income, it's a farce. And plus you have to compare apples to apples. If you end up working a job like she's doing, which is for sure no more than 40 hours a week, most times, most of these nonclinical jobs are 40 hours a week, sometimes even less. Often they offer complete or at least part-time remote work from home and while traveling. To compare that to a OB-GYN who's doing 60, 70 hours a week of work minimum, being on call and having a really disastrous schedule, because you never know when you're going to have to leave home, really, there's no comparison if you have to take a little bit of a pay cut.

But everybody that I've talked to that's started a nonclinical job, within two to three years, they have surpassed their clinical income because now they're really hitting their stride and really providing benefits and support, and really are doing something at the job that really helps their employer succeed. That's three of the myths.

Fourth one, patients. "I dedicated my life to patients, and I won't be helping any patients in a nonclinical career. And it's hard for me to do. I don't want to abandon people." Well, here's the thing. If you look at it from a different perspective, there are reasons these jobs exist, and there's reasons why these jobs need a physician, because a physician or a nurse or a pharmacist is providing the expertise that's going to benefit patient care. That's the whole point.

You can go through almost every industry, and maybe it's not 100% across the board, but if you're working for a hospital system, you're probably helping with quality and improving quality improves patient care. If you're working in pharma, you're developing new drugs to either save lives or improve lives. There are some extreme examples. Imagine the people that worked on Gleevec. Now there's a drug that took what was a pretty much uniformly fatal disease and turned it into nothing. If you take Gleevec every day for that particular illness, you will never have a recurrence. I personally know a family member that's been using this drug for 15 or 20 years now. And there's hundreds of those drugs coming out every year.

And so, obviously, if you're a physician working in pharma, as a medical director or a chief medical officer, you're definitely benefiting patients. What if you're working in UM in the insurance industry? Well, I'll just say that you will on occasion stop patients from having a procedure or surgery that really was unwarranted to begin with, and you've avoided a possible death or disability or error resulting from that procedure. You're teaching in any capacity. You're helping bring on the next group of nurses, pharmacists, doctors, PAs, NPs, who are going to help patients.

Writing. You're educating by writing or doing journalistic writing or doing technical writing to protect patients. Again, I can go on and on. Consultants are bringing new services to hospitals and pharmacies and pharmaceutical companies and home health, consumer, health wellness nutrition, helping patients, sometimes better than the actual physician is helping them. When you step into a nonclinical, non-traditional clinical job, oftentimes you are greatly enhancing patient care, community care, and so forth.

All right, the last one that I want to talk about is "I won't get any respect." It reminds me of Rodney Dangerfield. Do you remember the comedian? He's been deceased for a few years, but he always talked about not getting no respect. He gets no respect. I guess I'll use myself as an example. We all have a decent amount of respect and admiration and a certain recognition in our communities as physicians. Everybody knows it's hard to do. It's a difficult career to pursue and maintain. It's a lot of hoops to jump through. And there's licensing and there's board certification and recertification.

And so, we think, well, we have that stature in the community, and it's fun, and it's good. It helps to interact with people, and it puts us in a position that helps us to help people actually. So, if you go into a nonclinical job, your reputation, your influence is going to be gone. Could say your gravitas as a physician might disappear.

But I'll use myself as an example. I was a physician, family physician, and back in the day when I first started, I was working at the hospital. I had admitting privileges, I had nursery privileges, and I even had OB privileges. I knew a lot of people. I did all those things as long as I could so I could grow my practice and over time I started to cut back. And I also did other things because I was interested in that. So I did physician advisor for a while and medical director for a family planning clinic and some other things.

But I was one of a hundred primary care doctors on staff at that hospital. I had no special sway or pull, people didn't listen to me a whole lot like the other family physicians. They had a little more likelihood of being heard if they had a concern or a request at the hospital, at least if they were a surgeon, particularly an orthopedic surgeon, neurosurgeon, cardiac surgeon, and so forth.

But over time, as I became VP for medical affairs and then chief medical officer, instead of being one of 500 primary care doctors that didn't bring a lot of revenue to the hospital, I became basically one of the most well-known and go-to physicians on the medical staff or in the medical and administrative hierarchy because I was responsible for quality and safety and hiring new physicians and recruiting groups to work for our hospital. I was over the lab in the pharmacy and people would come to me talk about formulary.

Really, when you get into these other positions, you're still a physician. Everybody's still calls you doctor, but now your influence and reputation in certain areas will actually be much more enhanced. And so, I've never really felt or heard or talked to anyone who said that as a result of them moving into a medical director role, or chief medical officer, chief quality officer, any chief role, for sure, that they had less of a reputation or felt like they were contributing less, and that it was recognized than when they were a physician.

You're still a physician. You'll always be a physician. You're likely going to end up managing a team. You're usually seen as a content expert. That's why they're hiring you in the first place as a physician for that role. And you're often a leader. In the hospital setting, you've always got a CEO or COO, but you've got a chief medical officer, chief nursing officer, and so forth. Same thing in pharma, same thing in health insurance. You're going to end up there if you persist.

That's what I wanted to talk about today. There were five common persistent myths that I hear about all the time and that are concerns to physicians, nurses, pharmacists, trying to move into a nonclinical career so that they can have a better lifestyle, they can have more control, more autonomy, and less feeling like an assembly line worker.

And so, these myths are wrong and there are a lot of jobs. You are already qualified for most of those jobs. In some cases, you might need to do a little bit more. You'll learn on the job for sure. Sometimes getting an MBA or an MHA or an MPH or something would be helpful or another certification. But basically you've already got the qualifications you need.

You will make a similar salary and you'll have the opportunity to make even more. I made much more as chief medical officer than I would as a family physician. You'll be helping patients in new ways and sometimes much broader ways and larger numbers as well than you can one patient at a time, and you'll still be respected. You'll still have that gravitas or that recognition.

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The post Let’s Dispel These 5 Persistent Myths About Nonclinical Careers – 309 appeared first on NonClinical Physicians.

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Before I jump into today’s content, I need to tell you about a new “how-to-guide” I’ve written. It’s a 24-page manual, complete with checklists for 5 nonclinical careers. It outlines the steps you can take to pursue a career in utilization management, clinical documentation improvement, informatics, medical writing, and hospital management as VP for Medical Affairs.

I wrote it based on my personal experiences, and what I’ve learned doing interviews for this podcast. I was thinking of selling it on Amazon as a Kindle Book. But for now, it’s completely FREE for listeners to this podcast. To download your copy, just go to Free Career Guide.

A Listener's Question

I was on a phone call the other day, talking with a physician listener interested in exploring a new career. She was working as a gastroenterologist in a fairly large medical group and had become involved in quality initiatives at her local hospital.

Let’s call her Nina.

She didn’t have a formal leadership role in the hospital or medical group, but she really enjoyed working on quality improvement projects. And she wanted to explore a career in quality improvement.

She was thinking that she might ultimately want to work as chief quality officer at a hospital or a large group. And, she asked me how to best pursue such a career.

I thought you’d like to hear the advice I gave her, so I’m presenting that today. But first, let me give you a little more information about this relatively new senior hospital executive position.

A New Position: Chief Quality Officer

As hospitals have begun to shift from volume- to value-based care, someone must be responsible for collecting and submitting data needed to demonstrate the organization's quality. And there are multiple processes, tools, and departments that must coordinate their efforts to make that happen.

Let me point out some of the duties of the CQO:

1. Implementing quality improvement measurement tools that can provide risk-adjusted outcome measures;
2. Implementing a tool that will cull clinical data for the purpose of reporting to CMS;
3. Writing and implementing a quality improvement plan that addresses all QI activities, such as
   • physician peer review,
   • chart reviews for quality monitoring,
   • implementing mandatory quality initiatives, such as those for central line infections and DVT prophylaxis,
   • initiating QI projects using QI models such as PDCA (plan – do – check – act),
   • performing root cause analyses for serious errors or sentinel events;
4. Monitoring public reporting (Hospital Compare, HealthGrades, LeapFrog, Truven Top 100 and others);
5. Hiring, directing and evaluating the director of QI department and often the Patient Safety Department; and,
6. Developing and promoting a culture of safety and quality.

I described my vision of the ideal QI program in Building a Great Hospital Quality Improvement Program.

I’ve seen tremendous growth in this field. This is primarily because CMS is penalizing hospitals financially that don’t meet quality, safety, length of stay and readmissions benchmarks. So, it now makes sense to invest 200- to 300-thousand dollars to avoid paying millions of dollars in penalties. And a CQO will promote quality of care and the hospital’s rankings and reputation.

Suffice it to say that there is a growing demand for physicians who meet the qualifications needed to lead hospital quality efforts.

My Roadmap to Chief Quality Officer

As I thought about her situation, there were several ideas that came to mind, and I shared those with her. Thinking more about the question later, here is what occurs to me:
In general, there is a pretty standard approach to shifting from a strictly clinical career to one in hospital administration, including a role as CQO. It involves these basic steps:

1. Overcome mindset issues
2. Demonstrate commitment
3. Utilize mentors
4. Obtain unpaid real-world experience
5. Get formal education
6. Acquire certifications and degrees
7. Obtain formal or paid experience
8. Actively pursue a CQO position

It’s sometimes possible to skip a step or rearrange the order. Some clinicians are thrust into a formal, paid position out of necessity and have to address multiple steps concurrently. Some physicians may obtain an advanced degree, such as an MPH, while completing medical school, not realizing it will help them in the search for a CQO job later. But most of us need to follow the steps I’ve outlined.

And there are tactics along the way that help accelerate the process, like joining appropriate associations, obtaining coaching, and networking.

1. Mindset

I’ve previously discussed the issue of mindset and self-limiting beliefs with at least two of my guests – (Episodes 10 and 18). Nina had already overcome that barrier. She was really excited about quality improvement and knew it was something she’d be good at.

2. Demonstrate Commitment

In the hospital setting, in order to be involved in formal and informal QI projects or standing committees, those in charge must understand that you have both interest and expertise. In an absurd example, the president of the medical staff is not going to recommend someone in the finance department to work on quality initiatives due to lack of both of these attributes.

Physicians already have the necessary expertise to get started. We know medicine, epidemiology, statistics, and basic infection control and quality improvement principles. But unless someone in a leadership position knows we’re interested, they won’t seek out our help.

Our interest can be demonstrated in only 2 ways: what we say and what we do.

In my conversation with Nina, I started by asking her if she had talked to the director of the Quality Improvement Department at her hospital. She had not. I told her the director would be the person who'd have the most information about the quality improvement enterprise there.

If there was a chief quality officer, she'd know who that person was, and she'd also know which physicians had been most active in the quality initiatives. If there's no chief quality officer, there might be a medical director or two that were involved in certain projects.

Photo by Dan Gold on Unsplash

And during that conversation, of course, Nina would tell the director that she was interested in working on QI projects, even if they did not involve her specialty. She’d also express this interest to the chair of her department and to the chair of the QI Committee and the president of the medical staff.

She’d also have a conversation within her medical group, to the extent there was a formal QI department or team.

Finally, she’d really demonstrate her interest by consistently attending the meetings, and contributing her input and time to the projects she was working on.

3. Mentors

I told her that based on those conversations, it should be possible for her to identify a mentor or two to begin speaking with. The Director of Quality, generally a nurse with special training, could be one of her non-physician mentors.

The best mentor would be a physician already deeply involved in quality, such as the CQO or medical director for quality. Remember, the typical mentor is generally a step or two ahead of you. I described how to identify and engage a mentor in Episode 4 of this podcast.

If there's no mentor readily available in your organization, it’s possible to identify mentors outside the organization. There are associations that physicians like Nina can join. They provide access to education and certification, but a big benefit is the networking and access to mentors.

The National Association for Healthcare Quality is probably the best known. There is also the American College of Medical Quality.

Another way to find a mentor is by using LinkedIn. Membership is free, so there's really no barrier to joining. On LinkedIn search for PEOPLE with the designation of chief quality officer or medical director for quality. You can filter the list by geographic LOCATION. If there are any reasonably close by, you can start by asking to connect on LinkedIn. Later you can speak with them directly, or even meet them face to face.

Then begin a dialogue, ultimately creating a relationship in which you can ask for advice as you pursue a career in quality improvement.

4. Informal or Unpaid Experience

I suggested to Nina that while speaking with the Director for Quality Improvement, she should inquire about ongoing quality projects that she can help with, and committee meetings she can attend.

The committee structure at a hospital is fairly formal. And each committee has assigned members. Nina was concerned that she couldn’t attend a meeting if she was not the appointed committee representative.

However, I advised her that most medical staff committees can be attended by any medical staff member. Just to avoid potential confusion, it is wise to speak with the chair of the quality committee and the department chair about attending as a nonvoting member because of your interest in quality improvement. You’ll quickly become a regular member.

Doing so demonstrates commitment, offers another opportunity for networking and mentoring, and begins the process of acquiring experience in QI. By observing the chair, you will also learn about planning and running meetings, project planning and working on an interdisciplinary team, all useful leadership skills.

Nina can also volunteer to sit on any formal quality or process improvement teams that her medical group might have. Learning about process improvement is very useful. PI projects are more common in the outpatient office and procedural settings than formal QI projects.

Lean is the term used for process improvement methods originally developed and implemented by Toyota. Lean process improvement uses techniques to reduce waste and improve quality in manufacturing. It’s now been applied to the healthcare setting.

Nina and I talked about learning Lean methods in the office setting, and possibly becoming certified in Lean process improvement. Knowing Lean concepts and procedures is very useful for those interested in quality improvement.

5. Formal Education

This brings us to the next step involving formal education. You can become a green belt or black belt in Six Sigma, another PI methodology designed to reduce variation in care. As noted a minute ago, there are courses in Lean process improvement.

The associations mentioned earlier (NAHQ and ACMQ) provide formal education in quality improvement, as do other organizations:

• Institute for Healthcare Improvement
• American Association for Physician Leadership (see Episode 24)
• Many specialty societies

6. Certification and Advanced Degrees

The NAHQ provides a path to certification in quality improvement through the Healthcare Quality Certification Commission. After obtaining the necessary experience and education, you can take an exam leading to achieve the designation as a Certified Professional in Healthcare Quality. It's a national certificate in quality improvement that demonstrates expertise in the field.

You can take that a step further and complete a master's degree in quality improvement. There are multiple university programs. The AAPL has helped develop a program specifically for physician leaders. It’s called the Master’s in Healthcare Quality and Safety Management (MS-HQSM) offered by Thomas Jefferson University.

I did not discuss this option with Nina during our call. It might be best to wait on pursuing this degree until after working in a formal QI position. That might allow you to get your employer to contribute financially and with time off to pursue the degree.

7. Formal Paid Experience

At some point, you’ll want to get into a formal QI role. If you have enough meaningful experience in quality and safety projects and with the CPHQ certification, you may be able to transition to a full, or near full-time position as CQO or VP for Medical Affairs.

More likely, you’ll split your time between clinical work and quality activities as the Medical Director for Quality in a health plan, medical group or hospital. In the hospital setting, you’ll bridge the gap between clinical and management realms. You’ll be promoting quality initiatives, reviewing quality data, presenting quality reports to medical staff departments, and working with individual physicians to improve their metrics.

During this phase of your career transition, you’ll continue to hone your quality and management skills. You’ll need to focus on leadership skills also, since the Chief Quality Officer serves as a senior level executive.

Therefor, you will need to shift your educational efforts to focus on leadership topics. Organizations such as the AAPL, the American College of Healthcare Executives and the Advisory Board are just a few that offer leadership education that will help you.

Reminder: Think About Your Resume

As Nina pursues her career as a CQO, she should keep in mind that she will be competing with other highly qualified physicians. At some point she’ll be sending resumes to prospective employers.

Those employers will be looking primarily at what this new CQO can do for them. So, they’ll be looking on the resume, and soliciting during the interviews, evidence of what Nina has accomplished.

They won’t put much weight on what committees she’s been part of, or which projects she’s worked on. Instead they’ll be looking for the initiatives she’s led. They’ll be looking for evidence of metrics she’s improved. Did she get length of stay down significantly, or reduce mortality or complications? Has she increased compliance with core measures? Did she help reduce the occurrence of never events?

Keep this in mind as you participate in formal and informal positions. Don’t be a passive participant. Be a leader in these positions. Don’t just remain a committee member. Step up to committee chair when you can. And keep track of the measurable improvements that result when you and your team tackle each quality initiative.

Time to Pursue a Career in Quality Improvement

By following the steps I’ve outlined, you’ll find a CQO position.

It'll be easier if you’re willing to relocate, but if you live in a large metropolitan area, you might not need to.

The job is very rewarding, because you’ll be helping to improve the care of thousands of patients through your efforts. Quality Improvement was always one of my favorite departments when I was CMO.

Quick Review

Let me quickly review the steps I’ve outlined for Nina to follow as she pursues a career in quality improvement.

She should:

1. Overcome mindset issues
2. Demonstrate commitment
3. Find and utilize mentors
4. Obtain unpaid/informal experience
5. Get formal education
6. Acquire certifications and degrees
7. Obtain formal paid experience
8. Actively pursue a CQO position

Along the way she’ll find appropriate associations to join, like the NAHQ and AAPL, she’ll network with colleagues, and she’ll take advantage of educational opportunities as they arise.

I hope you found this information helpful. If you have any questions, post them in the comments section below, or contact me at johnjurica@nonclinical.buzzmybrand.net.

Don't Forget to Download Your Free Guide to 5 Nonclinical Careers

As noted earlier, I’ve completed a Free Guide called 5 Nonclinical Careers You Can Pursue Today that outlines the steps for 5 more highly popular careers. It can be found at vitalpe.net/freeguide

Let’s end with this quote from John Ruskin:

See you next time on Physician NonClinical Careers.

The resources included in the podcast are all linked above.

Right click here and “Save As” to download this podcast episode to your computer.

The easiest ways to listen:  vitalpe.net/itunes or vitalpe.net/stitcher

The post Follow These 8 Steps to a Career in Quality Improvement – 027 appeared first on NonClinical Physicians.

It’s just me today. A new interview will return next week. So, I’m going to take this opportunity to talk about something that's near and dear to my heart. As stated in the opening of my podcast each week, the goal of this podcast is to inspire, inform, and support you as you pivot to a nonclinical career.

Since I have not personally experienced most of the nonclinical careers out there, I bring guests on so we can learn together how to pursue them. But I do have personal experience in one of the possible career options, that of hospital management and administration.

FEATURED DOWNLOAD: Get “8 Steps to Becoming a Hospital Chief Medical Officer” so you can pursue this awesome career!

My Story

Let me tell you my story. After residency, I joined 2 physicians in a family medicine practice. I did pretty much everything I could to build the practice. I did obstetrics, took care of newborns, cared for office patients, did hospital rounds, and took care of nursing home patients.

Side Jobs for Cash

To fill my hours and generate additional income, I started working at the family planning clinic. After a year or so, I took a part-time medical director position. So, in addition to seeing patients in the clinic, I would sign off on medication purchases, review and approve policies and procedures, and collaborate with nurse practitioners to meet state requirements.

I later began working part-time in the hospital-based occupational medicine clinic. I learned how to take care of workers' compensation injuries, assess occupational exposures to lead and other toxins, and screen workers for high-risk jobs.

Eventually, I became the medical director for the “occ-med” clinic. That’s when I decided to continue my education, completing the requirements for a master’s degree in public health, with a concentration in occupational medicine.

And so, it went. I had this need to fill my time, and a desire to try new things.

Finding a Mentor

As a surveyor for my state medical society, I visited hospitals so they could be accredited to grant CME credit. In the process, I came to know another surveyor, who was also the chair of the state CME committee. His name was Don. I’ve spoken about him in a previous podcast episode titled Why Both a Coach and Mentor Are Vital to Your Career. He became one of my mentors.

After learning more about Don’s work as the chief medical officer for a large stand-alone hospital, the light finally went on for me. I’d pursue a career in hospital management.

Be Intentional

My point is telling this story is that I don’t want you to meander from side gig to side gig, hoping to find the right career by chance, as I did. No, I want you to be much more intentional than I was. My hope is that you actively search for a career that’ll excite and challenge you.

That’s why this week, I’m going to tell you why you should strongly consider a career in hospital management. I’m talking about work in senior management, such as chief quality officer, chief medical officer, chief medical information officer, or eventually chief operating officer or chief executive officer.

Other Considerations

But before I get into the 10 reasons why you should pursue a hospital management position, let me address a couple of glaring issues that might affect your ability to do so.

• First, this option may be quite unlikely if you don’t work for a hospital system or are on the medical staff of a hospital. If you’ve spent years working in an outpatient-only position after residency, an opportunity to test the hospital management waters might not arise. This career might be ideal, however, for hospitalists, anesthesiologists, emergency medicine physicians, or medical and surgical proceduralists who spend lots of time in the hospital setting.
• Next, some will say that a bigger factor when choosing a career might be your personality type. I think that assessing your personality can be very helpful. And some types might be best suited for specific jobs, such as utilization reviewer, expert legal witness or a job in pharmaceutical sales. But, hospital executive teams work best when there is a variety of personality types on the team.
• Finally, how much do you desire challenges, personal growth and continuous learning? I don’t think you should work as a hospital executive unless you are committed to continuous personal growth. In most dynamic hospital settings, you must be constantly trying new management models, adopting new technologies and continuously growing. It’s a bit different from trying to remain current in your specialty. If you’re happy seeing patients every day and just maintaining your skills, then you may not want to be a hospital executive.

If none of those three issues are stopping you, then let's get to the topic at hand.

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Why You Should Pursue Hospital Management

I’ll list all ten reasons first, then discuss each one individually. They are:

1. Leverage and Impact
2. Quality of Life
3. Personal Growth
4. Job Security
5. No Special Training to Start
6. Multiple Entry Level Options
7. Transferable Skills
8. Opportunity to Help the Profession
9. Opportunity to Improve Healthcare
10. Financial Rewards

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1. Leverage and Impact

I enjoyed providing medical care to patients. To a point. But it often seemed incremental. With many patients, the care seemed trivial. Treating the common cold and minor self-limited injuries, and reassuring the worried well just didn’t meet my definition of making a difference.

I became more energized by measurably helping groups of patients. As a physician executive, I was improving mortality and complication rates, and inpatient length of stay. You can too.

You can identify process breakdowns and eliminate them. With a multidisciplinary team, you might develop new service lines and new programs.

You obviously won't do this alone. In fact, that kind of impact happens because of leverage. The leverage involves leading teams, engaging staff and physicians, developing protocols, and implementing best practices together. I found that to be exciting and rewarding.

2. Quality of Life

Physician executives are busy, sure. But, we generally have better control of our schedule than most practicing physicians, especially employed physicians. Vacations can be taken without the need to find coverage for patients.

Staffing is handled by the HR department. The stress of malpractice is gone. Continuous learning is necessary, just as in clinical medicine, but it is easier to find time to attend educational conferences. And your direct reports manage the day-to-day. Taking call every 3^rd to 4^th day is a thing of the past.

3. Personal Growth

It’s true that as a physician, you’re trained to be a lifelong learner. And most of the physicians I know want to continue to grow intellectually, emotionally, and vocationally.

Once in an administrative position, there is a tremendous opportunity for personal growth.  Just as you learned medicine through an intense period of study that spanned up to a decade after college, you will need to devote several years of learning new business, management, and leadership skills.

New challenges will occur daily and you will be asked to take on ever-increasing responsibilities. You’ll continue to learn by being mentored and coached, by attending conferences, and by interacting with the rest of the senior management team on a regular basis.

After serving as CMO or CMIO, you may be asked to step into a COO or CEO role. Or you may make a lateral move to a much larger hospital or health system.

Such opportunities for growth don’t often arise in other non-clinical jobs.

4. Job Security

When I began, my research indicated to me that there was a new trend in hiring physician executives. I was the first VPMA and CMO at my hospital. The number of hospital physician CEOs continues to grow.

It seemed a fairly safe choice to make when I started, and it continues to be an area of growth and continuing demand.

5. No Special Training Required to Start

You already have many leadership skills. With a little mentoring, reading, and self-reflection, you can easily take the first steps to a management career.

Yes, you'll need to learn to collaborate and listen more; to let your direct reports occasionally fail so they can learn. You’ll need to continue your learning and growth as you mature in this new role, but you already have most of the skills and attributes needed to get started.

In fact, you have many more skills than the typical MBA or MHA trying to join the C-suite, because you already have an intimate knowledge of medicine and healthcare.

6. Multiple Entry Level Options

Most of us can’t just jump from full-time practice into a corporate position, whether in the pharmaceutical, insurance, governmental, or hospital setting. We must start at a more entry-level job.

Thankfully, in hospital management, there are many jobs that don’t require a special certification or an advanced degree that can lead to the C-suite. These include jobs such as medical director of a service line or unit, medical advisor for case management or utilization review, or medical director for quality improvement, patient safety, informatics, or continuing medical education.

Each of these jobs can serve as a stepping stone to a career as a chief medical officer, chief quality officer, or chief medical information officer.

7. Transferable Skills

With the business acumen and leadership skills developed as a hospital executive, pivoting to a position in a large medical group or an insurance company is quite doable. This is not an option for the chart reviewer, expert witness, or medical writer.

As a hospital executive, you’ll learn to better negotiate, communicate, run projects, plan strategically, set management goals, and read financial reports. And those skills can be applied in a medical group, in other corporate settings, and even as an entrepreneur.

8. Opportunity to Help the Profession

Physician disillusionment, frustration, and burnout can be improved by working in an organization that is led by physicians. The engagement of physicians is better, in general, when there is meaningful involvement by physician leadership in these organizations. As a physician leader, you will have the chance to address these issues directly.

When I was CMO, I was able to fight on behalf of one of my physicians to increase his salary when he was clearly being underpaid, for example.

9. Opportunity to Improve Healthcare

Would you hire an orchestra conductor who had never played a musical instrument? Would you hire a baseball or football coach who had never played the game? Yet most of our hospitals and health systems are run by businessmen and women who have never cared for a patient.

As I shared in my blog post Become a Leader and Save the Medical Profession, there is good evidence, both anecdotal and empirical, that hospitals run by physicians have better physician engagement, more cohesive teams, and better patient outcomes, in general.

Many of the top-rated hospitals in the U.S. are run by physicians, even though less than 6% across the nation have physician CEOs.

10. Financial Rewards

As an experienced vice president or chief medical officer, it should not be difficult to achieve salary and benefit levels that easily exceed the average income of most physicians, except for the busiest medical subspecialist or surgeon.

Most CMOs receive salaries in excess of $300,000 per year, plus bonuses, deferred compensation, and generous benefits. A quick scan through Form 990 of many nonprofit hospitals listed on Guidestar.org will often demonstrate total compensation well in excess of that number.

FEATURED DOWNLOAD: Get “8 Steps to Becoming a Hospital Chief Medical Officer” so you can pursue this awesome career!

Final Thoughts

It’s difficult to capture in words what it’s like to sit in a board room with 10 to 12 seasoned senior executives, creating strategic plans that will positively affect the lives of thousands of employees, and tens of thousands of patients.

If you’re looking for a career that can improve your quality of life, provide financial stability, job security, and growth, and the ability to positively impact populations of patients, a career as a physician executive is worth considering.

I’m recommending you look for mentors and network with physician executives to see if it’s a fit for you.

Let’s close with this quote:

Thanks for listening to today’s episode of Physician Nonclinical Careers.

Please sign up for my email newsletter so you’ll be notified of each new episode.

Next week, I’ll bring you an interview with medical writer Dr. Mandy Armitage.

So, join me next time on Physician Nonclinical Careers.

Resources

Resources are linked above.

Right-click here and “Save As” to download this podcast episode to your computer.

The easiest ways to listen:  vitalpe.net/itunes or vitalpe.net/stitcher 

If you'd like to listen to the premiere episode and show notes, you can find it here: Getting Acquainted with Physician NonClinical Careers Podcast – 001

The post 10 Reasons Why You Should Pursue a Hospital Management Career – 020 appeared first on NonClinical Physicians.

Leadership Favorites – July 2017 Edition

This month's favorites follow…

Accumulate More Wealth as an Administrator

Medscape recently presented the findings from its most recent salary survey. It included a list of factors that correlate with higher levels of accumulated wealth. The authors identified ten such reasons, beyond specialty and years in practice.

The physicians who were considered rainmakers and superstars fell into this group.

But the reason that caught my eye was this: moving into an administrative role. According to Medscape, even part-time administrators tend to earn and accumulate more.

Some of the other reasons were fairly obvious: seeing more patients, and not working in “low-paying practice venues.”

Check out the rest of the reasons in 10 Reasons Why Some Doctors Earn More

Why Don't Organizations Embrace Physician Leadership?

In an interesting opinion piece by Larry Sobal of MedAxiom Why Aren’t We Embracing Physician Leadership? the author describes his continued confusion around the fact that “some organizations simply can’t (or don’t want to) go beyond lip service when it comes to building a culture, structure and processes where physicians have a predominant (or at least equal) voice in the Board Room, C-Suite, at the service line, at the department, and even at the physician practice level.”

Sobal is Executive Vice President and a Senior Consultant at MedAxiom (a cardiovascular consulting firm). He has a 35-year career as a senior executive in medical group and hospital leadership and health insurance. He contributes weekly to MedAxiom's blog.

I was drawn to this article because it aligns with one of my core beliefs: that physicians need to take on a much bigger role in leading healthcare.

I've been frustrated by the failure by many hospitals and health systems to fully engage physicians, to be transparent with physicians, and to place physicians in major leadership roles.

In his article, Sobel describes why he believes healthcare institutions need to involve physicians more in leadership roles. His primary reasons include:

1. The need to design complex systems to address quality, access and cost, and meet pay for performance initiatives mandated by CMS and other payers;
2. Maintaining a sense of ownership and accountability by physicians in their organizations.

Possible Reasons for Leaving Physicians Out

He then goes on to describe the reasons that organizations don't recognize the need for more physician leadership:

1. They have never had the opportunity to experience the multiple benefits and successes enjoyed by physician led organizations [VPE: e.g., Mayo Clinic, Cleveland Clinic and many smaller but equally dynamic regional physician-led hospitals and group practices];
2. They, therefore, do not believe that physicians can add value to key decisions and strategies.

[VPE: I have some of my own cynical reasons that administrators don't want to involve more physicians:

1. It's time-consuming. Schedules must be accommodated. It takes time to have delicate or uncomfortable conversations and engage physicians;
2. They don't want to take physicians away from direct revenue-generating activities seeing patients and performing procedures. They don't understand that the benefits of involving committed, passionate physician leaders will return much more in the long-term;
3. They're intimidated by their intellect and educational achievements;
4. Keeping them in the dark maintians leverage with physicians;
5. They would rather not invest the resources needed to provide management and leadership education for physicians;
6. They don't trust physicians to maintain confidentiality fearing they might leak important strategic information.

I'm not saying that all administrators think this way. But I have witnessed all of these sentiments expressed by healthcare executives during my career.] 

He finally offers advice for changing the current situation:

1. Place physician leaders in important positions, give them more authority, and see what happens;
2. Use dyads (partnering a physician leader with an administrator) to get things started.

Finally, he then lists ten questions that should be answered when building these dyad teams.

I encourage you to read the entire article at Why Aren’t We Embracing Physician Leadership?

Leadership Blunders

Dan Rockwell, the Leadership Freak, lists what he believes are the 7  biggest blunders of the experienced leader. Lo and behold, item #4. Hanging on to poor performers is the greatest shortcoming that I discussed in My Greatest Shortcoming as a Senior Hospital Leader.

He describes 6 other blunders. The other one that rings true with me is #5. Getting stuff done while neglecting people development.

Read the whole list at The 7  Biggest Blunders of the Experienced Leader.

More on Listening

I've written about the importance of learning good listening skills. In an article on Medium, Elle Kaplan (CEO & Founder of @LexionCapital) explains why she believes listening is the most important leadership skill.

She goes on to list simple ways to improve active listening that will ultimately enhance your ability to influence and lead. Here is her list:

1. Don't just stand there, but verbally encourage questions and delve deeper.
2. Build others' self esteem by avoiding critical comments while listening.
3. “Ditch the digital” by silencing phones and closing laptops.
4. Practice by spending time trying different techniques to enhance listening.
5. Clarify and dig deeper.
6. Keep your body language in check.

Please check out Learning This Simple Skill Will Make You an Exceptional Leader and read more about the science behind listening and examples for each of Kaplan's tips for better listening.

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Monthly “Dose” of Humor

To wrap things up this month, I think it's best to stop being so serious for a few minutes. [VPE – the following articles are satirical, not real.]

For example, the authors at GomerBlog might be on to something. They write about an ingenious way to improve health while cutting out the need for physicians in McDonald’s Introduces Value Meals With Cholesterol and Diabetes Medications Blended In. This might be one of the solutions to our ongoing healthcare crisis.

In a related article, a hospital has come up with another combination of food and medications to prevent the frustration of long waits in the emergency room. This is described in New Haldol Creamy Spread Added to Emergency Room Sandwiches

In Closing

Those are some of the articles I found inspiring, educational, and humorous.

To keep this content coming Subscribe here.

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Contact me: johnjurica@nonclinical.buzzmybrand.net.

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See you in the next post.

The post Monthly Leadership Favorites – July 2017 Edition appeared first on NonClinical Physicians.

With the recent release of the Merritt Hawkins 2017 Review of Physicians and Advanced Practitioner Recruiting Incentives, I thought you might like a deeper review of that topic.

When recruiting physicians and advanced practitioners (physician assistants and nurse practitioners), the primary determinant of success in attracting good candidates depends on:

• Compensation offered;
• Quality of life (location, hours, cultural fit, etc.); and,
• Other recruiting incentives.

I addressed compensation and the use of RVUs and salary surveys in Physician Employment Agreements and More on Understanding RVUs.

But it is equally important to understand recruiting incentives that might be offered and how they have evolved in recent years.

Physician Recruiting Incentives May Determine the Outcome

Each physician candidate is generally concerned with a handful of issues when seeking a position.

It might be primarily salary, location and loan repayment. For some, it is signing bonus and salary. For others, it might be opportunity for advancement and retirement plan options.

I once spent over a year in the recruitment of a urologist. He was very meticulous and somewhat demanding, but always cordial during our conversations. He was pleased with the basic components of our offer, which included a standard set of perquisites.

Cystoscope – a urologist's best friend.

Other issues that concerned him were his involvement in setting up the office, interviewing his prospective staff, and helping to create protocols to be used in the office. As a surgeon, he was interested in rapidly building his practice. He wanted assurance that referrals would allow him to perform sufficient surgeries to maintain his skills and prepare for board certification.

We addressed all of these issues during interviews, on site visits, and numerous phone conversations. With urologists being very difficult to recruit, we included a generous signing bonus as part of our offer of employment.  Our usual practice was to pay such a bonus when the physician started seeing patients.

In this case, however, we agreed to pay part of the bonus when the employment agreement was executed, many months before he was to start seeing patients. He would receive the second installment when he had successfully been credentialed by our hospital medical staff. We would make the final signing bonus payment once he started seeing patients.

It was this flexibility in structuring payment of the signing bonus that ultimately enticed him to accept our offer.

Let’s take a quick look at the current status of incentives being offered by the almost 3,300 physicians and advanced practitioners that are described in Merritt Hawkins’ review.

Current State of Physician Recruiting Incentives

In spite of efforts to encourage the use of quality or value metrics, the approach to bonus is still heavily productivity based.

Seventy-two per cent of offers included some kind of bonus in addition to a guaranteed salary.  Of those offers that included potential bonus payments, 52% were based on RVUs, 28% on net collections, 14% on patient encounters, and 6% on gross billings.

Types of productivity incentives used.

Quality incentives were incorporated into 39% of offers. When used, the quality-based bonuses averaged 20% of the total potential bonus.

Other, very common incentives (over 95% of searches) include:

• Relocation Allowance (averaging about $10,000)
• CME Expenses (average amount $3600 per year, with a range of $500 – $30,000)
• Health Insurance
• Retirement Benefits

Disability insurance was also offered most (91%) of the time.

Liability Insurance

Merritt Hawkins included liability insurance as a benefit. But I consider it to be a business expense, as I wrote about in Why Demoralize Your Employed Physicians Over Tail Coverage?.

The review did not list “tail coverage” (extended reporting endorsement) as a specific type of bonus. However, it is commonly disputed in negotiations and should be addressed in future studies, in my opinion.

Signing Bonus and Loan Forgiveness

Signing bonuses were common but not universal (offered 76% of the time). When offered, the average signing bonus was $32,600. However, the range was zero to $275,000. I suspect that last figure was an outlier due to some very unique circumstances.

I was surprised to see that for the MH searches, only 25% included an offer of loan forgiveness, or what we called loan repayment. This is something that is quite common for hospitals in the midwest to offer.

When included, however, the amounts varied substantially. In this report, the amount forgiven or paid was distributed over one to three years, and ranged from $10,000 to $260,000, with an average of $81,000. It’s important to remember that most organization will cap this figure. And the need for loan forgiveness will vary greatly between candidates.

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Summarizing

So, that’s the snapshot of physician recruitment incentives based on the most recent MH survey. You can find the complete summary at Merritt Hawkins 2017 Review of Physicians and Advanced Practitioner Recruiting Incentives.

It all seems pretty consistent to what I have personally found to be true:

• Salaries continue to climb for almost every specialty.
• Bonuses are generally based on productivity, mostly using worked RVUs to track it.
• Quality bonuses are becoming more common, but only account for about 20% of the total annual bonus offered.
• Relocation expenses, CME allowance, health insurance, and retirement savings options are common and expected by most physicians.

I was surprised that loan forgiveness was offered in only one-quarter of assignments. I expect that percentage to rise as medical school loan amounts continue to increase.

Cost Considerations for Employers

Physician leaders working in hospitals and medical groups should understand these incentives, and their cumulative costs. With signing bonuses, relocation expenses and loan forgiveness, the first year total compensation costs will be 140% or more of the base salary.

For example, if a family physician or hospitalist is offered a salary of $230,000 to $260,000, he is likely to be provided:

• $10,000 in relocation expense,
• $32,000 in signing bonuses,
• $12,000 in health and disability insurance,
• $3,600 in CME expenses,
• $7500 in matching 401(k) or 403(b) deposits, and
• $25,000 in loan forgiveness.

This will bring the total expense to $320,000 to $350,000 for the first year.

For organizations that are heavily recruiting new physicians, those figures can quickly run into the millions of dollars in costs that will not be recouped for years.

There are some IRS issues that these incentives create. If you pay a signing bonus to a resident before she has officially started, do you report that as 1099 or W-2 income? And physicians being recruited need to understand that all of those bonuses will be treated as income by the IRS and that the amounts actually received may be smaller, due to withholding by the employer.

Next Steps

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

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Thanks for joining me.

Until next time.

The post What You Need to Know About Physician Recruiting Incentives appeared first on NonClinical Physicians.

Modern Healthcare quoted the DOJ: “When physicians are rewarded financially for referring patients to hospitals or other healthcare providers, it can affect their medical judgment, resulting in a overutilization of services that drives up healthcare costs for everyone,” said acting assistant attorney general Chad Readler.

The hospital system acquired the infusion center from a group of oncologists. It was then able to charge hospital based fees and take advantage of 340(b) pricing for its medications. This is a common tactic used by hospitals to access favorable payments from CMS for hospital based services.

Inflated Physician Compensation

The DOJ alleged that the hospital paid the oncologists inflated amounts for management services following the transfer of ownership. This led to allegations of Stark Law and False Claims Act violations, ostensibly for exceeding fair market value and potentially encouraging referrals.

According to a National Law Review article regarding this case, the complaint alleged that “the compensation amount for the physician supervision work at the infusion center was approximately 500 percent of the wRVU for in-clinic work where the physician was actively involved in patient care… was not fair market value, nor was it commercially reasonable.”

Mercy agreed to pay $34 million to settle the lawsuit.

I addressed a similar issue in a popular post in 2016 (Physician Salaries and OIG Risk). I am re-publishing the content here for new readers. The previous article addresses inflated salaries. But the tactic of paying inflated management fees in order to maintain referral patterns has the same effect.

Pitfalls Involving Salary Surveys and OIG Allegations

I have been following news reports about recent OIG (Office of Inspector General) investigations related to physician compensation. These investigations have resulted in fines for alleged Stark Law and FCA (False Claims Act) violations. There seems to be more activity recently, including investigations in response to whistle-blower lawsuits.

Here is my take: Hospitals and health systems that use survey data (such as MGMA and AMGA) to set compensation levels for newly employed physicians are under intense scrutiny. This scrutiny results because:

• it appears that collections generated by the employed physicians do not support the salaries being provided, or
• salaries of newly employed physicians significantly exceed compensation previously generated in their independent practices.

The Stark and FCA regulations require that physicians that care for Medicare patients not be paid for referrals. And health systems must pay employed physicians based on fair market value. In the past, it was assumed that direct evidence of payment for referrals (e.g., emails, memos, board meeting minutes, etc.) was needed in order to demonstrate such a violation.

More recent cases seem to indicate that indirect evidence can support such an allegation. If a practice is not profitable, and a hospital system continues to pay a physician in spite of losing money on the practice, the OIG will infer that such losses are only being allowed as a result of referrals.

Example

It is fairly common for a procedural specialist such as a cardiologist or orthopedist to be paid at the median salary survey level. This may hold true even as their collections and worked RVUs only reach the 25th percentile or less.  This may represent a loss to the practice in excess of $100,000 per year.

I once asked a physician that was unable to build a practice to leave our medical group, in part because of his inability to generate the income needed to justify his salary (in spite of years of aggressively marketing his practice).

Such losses may be acceptable in situations where the system is the only provider of important services. But if board members or executives indicate that such losses are balanced by “downstream” services like imaging and surgical care, the OIG may interpret that as a violation of Stark and FCA regulations.

Recommendations

What can you do to reduce this risk as you hire new physicians into your medical group? Here are five suggestions:

1. Be aware of these issues and NEVER imply that your system can afford to pay a higher salary because of “downstream revenues.” Instead, focus on the actual patient encounters and procedures that the new physician must provide to generate collections needed to cover her salary.
2. Once hired, assist new physicians with marketing themselves. They need to build visits and worked RVUs as quickly as possible. Your organization can allow for a negative bottom line for a practice initially, but must strive for a financial break-even after a year or two.
3. Work closely with the billing office and teach new recruits about billing and coding. They must learn to appropriately capture the payments for the work that they do.
4. Provide employed physicians with regular (at least quarterly) reports listing the following: encounter volumes, coding distribution, billings, collections, worked RVUs and income and expenses for the practice. Teach physicians how to interpret these reports.
5. Require your management team to meet with their physicians regularly. During such meetings review their reports, track their performance, define goals for the practice and develop joint plans to meet those goals.

With teamwork, clear communication, and effective goal setting and execution, you should be able to:

• build a practice for your new physicians that they can be proud of,
• reach a financial break-even, and,
• avoid allegations of Stark and FCA violations.

[Disclaimer: I am not an attorney and I do not provide legal advice. I offer advice about management and leadership topics that can assist physician executives in addressing common management issues. You should always engage a qualified attorney in negotiating and executing employment agreements with physicians and in evaluating your organization's potential risk for OIG investigations related to physician employment.]

Summary

When recruiting highly trained proceduralists, it's easy to forget that their salaries cannot be linked to downstream (e.g., imaging and facility-driven) fees. There must be a reasonable relationship between the direct patient care revenues and expenses, and their compensation.

Is this a challenge for your group practice or health system? How have you addressed it?

What other employment issues have you had to address in your organization?

Until next time.

John Jurica

The post Inflated Physician Compensation Prompts OIG Scrutiny 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.

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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.

As an administrator dealing with employed physicians, it is easy to become cynical about this topic. It seems as if some of our physician candidates and employees are concerned more with their compensation than with finding a positive, supportive practice, dedicated staff or satisfied patients.

However, we should remember that these physicians have taken delayed gratification to a new level. They postponed starting their careers for years as they pursued medical school, residencies and fellowships. They have seen their friends complete bachelors and masters degrees, begin their careers, and begin to live a “real” life. Your physicians feel like they have been postponing their “real” lives for years.

And when they're ready to begin practicing, they're facing the possibility of school loan payments that may go on for decades, with loan balances in excess of $200,000 that are still accruing interest. Young physicians can come to feel very uncertain about their families' financial security. Under these circumstances, it is easy for them to appear to be obsessed with their salaries.

Contracting and Compensation Advice

I have posted several articles on the sister blog to this one called Contract Doctor. In them, I offer free advice to physicians seeking employment on a variety of contracting issues, including compensation. I just posted one called What Doctors Need to Know About Maximizing Income, which I wrote in response to a question sent to me by a reader last week.

If you want to understand some of the concerns that new physicians have and why they make certain contract requests, or if you are new to contracting, you might scan that article, as well as some of the other articles at Contract Doctor.

And let me know if you have questions about contracting you want to explore further.

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The post What’s Driving Physician Obsession with Compensation And How Can You Help? appeared first on NonClinical Physicians.