These days "You're Fired!" is heard often in physician executive ranks. The April issue of ACPE News contains a survey with 620 American College of Physician Executive members, 47 percent of whom said they had been involuntarily fired.[1]

This should come as no surprise. Hospitals and HMOs, which hire many physician executives, had a bad year. Hospitals had record low operating profits of 4.3 percent in 1999, and the predicted hospital CEO turnover rate will be 18 to 20 percent in 2000, compared to the normal rate of 10 to 14 percent.[1] Nearly half of HMOs lost money, and HMO profits plunged from $274 million in the first quarter of 1999 to $69 million in the third quarter.[2]

To gain a perspective on fired physician executives' prospects, we turned to Bill Frank, Chairman of CareerLab, in Denver, and to Lorne Weeks, MD, Executive in charge of CareerLab's Physician Career Network, a confidential sounding board for physicians seeking new careers. Since 1978, CareerLab has worked for more than 275 major U.S. corporations on the issues of career management and outplacement. Weeks, an orthopedic surgeon, joined the firm in January of 2000 after retaining Frank's services to prepare for a career change. They spotted an opportunity to serve disenchanted physicians attempting to survive in the turbulent managed care environment.

The job search campaign
What should a fired physician executive do? "First, let the dust settle and evaluate your career in terms of what's a good future fit," says Frank. "Often a corporate job doesn't work out because it's the wrong chemistry, the wrong size organization, or the wrong political structure. Sometimes it's a merger and acquisition, but often it's an interpersonal dynamic that causes a job to fail. Second, approach the market and start a job search campaign."

"Doctor up—no pun intended—your resume, emphasizing the triples and home runs. Broadcast that résumé to everyone—80 percent of jobs come from friends and business acquaintances. You get jobs from informal sources and not from want ads, recruiters, and more formal job-hunting sources. Always start by engaging your personal network," emphasizes Frank.

Weeks says being a physician carries its own psychological baggage. "Physicians are used to controlling their destiny and enjoying successful careers. When 'you're fired' news arrives, it falls initially on deaf ears. Once you're over the shock, take a critical look at your transferable skills, inside and outside of health care. I tell physician clients to develop skills, clinical and non-clinical, to serve as a safety net against managed care and health care industry uncertainties. To assess these skills, we use the Birkman Method to measure about 66 factors and to paint a career profile that fits best with a person's skills. Usually the new career will be tangentially related to past career paths and there will be a 75 to 80 percent overlap with what they've done before."

Frank elaborates, "New careers for physicians may include quality assurance in manufacturing companies; doing medical research in facilities such as Battelle Labs; becoming CEOs and executives of internet websites and e-businesses; consulting for law firms; teaching at the high school, college, university, and medical school level; becoming military physicians; or consolidating their backgrounds a physicians, scientists, and executives to run biotechnology or e-health companies. Physicians' talent banks make them highly marketable—if they conduct a carefully thought out job search."

Diversification is a safety net
Frank says it takes three to six months for physician executives to launch a job campaign and secure an equivalent or higher level position. Weeks adds, "Career variety is one's best protection against career and professional burnout, and can also generate diversification of the physician's income sources, which again protects against market place vagaries. Diversification is a safety net, and it's based on the physician's transferable skills."

Age isn't the barrier it once was. Says Frank, "Our experience has been that professional growth and career satisfaction bears no relationship to one's age and appeals to the 65 to 70-year-old retiree just as much as it does to the first year intern fresh out of medical school. We placed my father, a retired 67-year-old internist, in a new career with the American Association of Retired Persons.

The Harvard Business Review recently had a piece about an experienced MBA who didn't enjoy working for large organizations and yet had diverse and powerful executive talents. He declared himself a "virtual CEO" and now works for multiple companies as a temporary CEO. [3]

Similarly, a physician executive could become an advisor to half a dozen different technology or biotechnology companies and create a very nice living and lifestyle. A major problem in the e-health, biotechnology, and managed care industries is that those in the executive suites don't truly understand the physician mindset and culture. Physician executives can bring that knowledge to the table—how doctors think, what products they will accept, and what organizational directions they will take. This knowledge is a huge asset.

A sword with two edges
"Working for someone else or working for yourself is like a sword with two edges," concludes Weeks. "When you work for yourself, your pay may be higher, but your hours may be longer and you may have no family life. When you work for someone else, you may have more time with your family, but the pay is lower and the potential always exists that you may receive that pink slip saying 'you're fired.'"

"You can't have it both ways. If you want an improved lifestyle, the ability to walk out of the office at 5:00 p.m. and turn off the beeper, you also have to realize the potential of that sword falling. And you have to prepare for that eventuality by identifying and recognizing those transferable skills that will catapult you into another—and often better job."
—Richard L. Reece, MD

Our doubts are traitors,
And make us lose the good we oft might win
By fearing to attempt.
—Shakespeare, "Measure By Measure"