A wise friend used to tell me, "You need to have a Plan B." So right he was.
Are you so wrapped up in your current job that you haven't thought through Plan B for your career? If so, this is an ideal time to invest in that task. Many of us probably spend more time planning our vacations than our careers.
As you look at the rapidly changing healthcare environment, do you get an uneasy feeling? How will reform affect your career?
Look at what's happening in markets across the country, especially in California and Minnesota. There's continuing consolidation of providers; integration of hospitals, physicians and payers; and emergence of capitation as the preferred method of reimbursement. The result is fewer and leaner hospitals; increased demand for primary care; decreased demand for specialists; and continued growth of managed care and formation of group practices.
The impact on hospital administration careers is obvious. Hospital executives are being laid off or phased out. Too many administrators are looking for too few jobs. So what's an executive to do?
Surveying the field.Hospital executives
have a vast and growing array of healthcare options. When looking at the avenues available, it's important to keep a few key questions in mind: How do my current skills fit with these markets? How enthusiastic am I about this area? How does this market fit with my goals?
The central market options include:
Staying in hospital administration. As hospital managers know, doing more with less is the important skill here. The requirement is to improve quality while reducing costs. As hospitals become cost centers, the chief executive officer often will function much like a plant manager. Administrators will have less autonomy, and the pressure for cost control will be much greater.
Integrated delivery networks. As hospitals, physicians and payers merge, a new style of leadership is needed to run these entities. Power sharing, building continuums of care and demonstrated effectiveness at a system level will be the keys to success.
Many hospital executives see integrated networks as the next natural step in their careers. However, the hospital is no longer the power player. Covered lives and primary care are where the power is shifting. Physician executives are taking the leadership role in many of these networks, meaning the top spots will be limited with lots of competition. Hospital executives need to broaden their experience base to include managed care, group practices and the full continuum of care.
Managed care. HMOs and other managed-care organizations are a big growth area because they control the covered lives. Managed-care leadership requires skills of provider network management, health plan marketing, claims, risk management and membership services. Here, hospital executives will be competing with insurance executives.
Group practices. Leadership in this arena, which is also experiencing major growth, requires one to be skillful at building physician trust.
According to Chuck Hulse, vice president of Contemporary Management Associates in New Hampshire, "Hospital executives may have difficulty moving from a control style of management often characterized by confrontation with physicians to a style of collaboration and compromise." If you understand clinic operations and know how to build rapport with doctors, this could be your niche.
Entrepreneurial enterprises. How about starting your own business? First, it's necessary to recognize trends and discover an unmet need in the market, then develop a way to provide that service in a profitable venture. A good bit of capital and more than a little nerve also are helpful.
One example is David Spencer, a former hospital executive who developed Clini-Risk in Tampa, Fla. The system, which has been called a major breakthrough in quality improvement and cost reduction, helps providers reduce the amount of "rework"-the medication errors, patient falls and other adverse events requiring additional treatment that could have been prevented. Mr. Spencer identified an underserved market and set up a service to fill the need.
Home care. Employment in the home healthcare market has been growing by more than 15% per year since 1990. Such growth should fuel the need for more innovative management. The big demand here is for managers with both clinical skills and regional management and marketing abilities. For those who came up through the clinical ranks and know how to run a sales-driven organization, this sector may be worth a serious look.
Long-term care. For executives who can demonstrate the ability to operate a skilled-nursing or subacute-care facility, this sector will continue to be a growth market well into the next century.
Consulting. For too many hospital executives, this is the Plan B of choice. As the top consultants will tell you, consulting requires more than a briefcase, some slides and a frequent-flier card.
"Successful consultants are creative problem-solvers and consensus-builders," says Dave Ping, a managing partner at the San Francisco office of Hamilton/KSA. "You need integrity to have the courage of your convictions while working with high-powered people." Executives need to have plenty of experience in the trenches before considering this step.
Putting a career plan in place.Your career plan should carry you through to retirement and should reach a balance between personal and business priorities. Think in broad terms, such as income goals, geography, amount of travel, job demands and family considerations. Then take a close look at your talents and abilities. Considering the "reform" environment, which skills need improvement or which are lacking altogether?
Next, what's reasonable to expect in the next two to five years? Who do you need to get to know? Identify two or three hot issues within your target field and then work to become an expert.
Network, network, network.The best time to be networking aggressively is when you're still employed. Projects, lunches, conferences and even vacations are great opportunities to develop contacts. Remember, networking is a mutually beneficial exchange.
By creating and executing a career plan that always includes an alternative route, executives can gain a tremendous feeling of control. That uneasy feeling will begin to disappear. Most importantly, it will help you regain the confidence needed to make the big decisions in the best interest of the community's health. Even if that means turning to Plan B.