From the start, Jerry Wollman's career in healthcare strayed from the norm.
In 1986, Wollman graduated as one of six men in a class of 220 from the University of Maryland's School of Nursing. But perhaps the most unorthodox professional move for Wollman, now 42, came in 2002 when he joined a Silver Spring, Md., radiation oncology group as its chief financial officer. "It was a leap," admits Wollman, who by his own admission lacks the financial finesse of an accountant.
Few nurses have made a similar leap into corporate healthcare's top finance spot, say executive recruiters, educators and industry officials. Two prominent professional associations, the Healthcare Financial Management Association and American College of Healthcare Executives, scoured membership rolls at Modern Healthcare's request but unearthed no one who fills the bill.
"I just don't know of anyone who goes that route," says Karen Barnes, president of Barnes & Pledger, a consulting and recruiting company. Barnes, a nurse, spent 25 years of her career as a healthcare executive. In the past five years, she's worked as an interim chief operating officer. "I don't see nurses as CFOs," echoes Brenda Doherty, an executive healthcare recruiter for Korn/Ferry International.
Elsewhere in the executive suite, nurses have made significant headway. Why so few nurses seek out careers in finance is open to speculation. Executives and educators say CFOs' narrow, less strategic focus and the necessary accounting expertise likely dissuade many nurses. The two careers are separate specialties with different technical expertise, says Thomas Dolan, president and chief executive officer of the ACHE. Finance demands a technical grasp of accounting; nursing requires a command of medicine. "You'd have to start over to become a CFO as a nurse," he says, or vice versa.
CNO, COO or CEO would be a more natural choice for nurses choosing to advance into the C-suite, say nurse-executives and recruiters. Nurses' bedside experience, professional passion and operational savvy may be a better fit for No. 1 or No. 2 in hospitals or health systems. "They're strong operators with tactical know-how," says Doherty, who began her professional career as a nurse.
Diane Cecchettini, president and CEO of MultiCare Health System, a three-hospital health system in Tacoma, Wash., says her path from nursing to the top job grew naturally from her experience and opportunities. "I didn't set out to be CEO," she says. "It was kind of a surprise."
But at least one retired CFO, who spent 10 years as an acute-care and public health nurse before switching to finance, says more nurses should pursue the atypical career route from bedside to CFO. "It's a great combination," says Mary Bednar, who retired in June 2004 after six years as the top finance executive at Penn State Milton S. Hershey (Pa.) Medical Center.
"It's been a wonderful experience," says Bednar, who earned a master's degree in business administration before making the switch. Her varied career gave her a stronger voice in operations than most of her peers, she says. "People can't buffalo a CFO that knows the clinical side."
That's not to say finance and budget expertise are overlooked among ascending nurse managers. Both are staples in graduate nursing administration degrees, notes Pamela Thompson, CEO of the American Organization of Nurse Executives. Others seek MBAs, she says.
`No one can leave out finance'
The opportunity for nurses to bolster their business savvy appears to be on the rise. Nursing schools offering joint master's degrees in nursing and business administration rose 28% from 2000 to 2004, up to 74 schools, according to the American Association of Colleges of Nursing.
Holy Names University's Department of Nursing, Oakland, Calif., launched a joint business and nursing master's degree last fall, with an inaugural class of 20 students. "It's the best of both worlds," says Fay Bower, the department chairwoman. Nurses who seek only an advanced business degree don't graduate with an advanced knowledge of nursing and vice versa, she says. "It creates greater opportunities," Bower says.
A formal business education also gives nurses necessary preparation to handle increasingly complex budgets as they gain experience, says nurse Mary Ann Thode, president of Kaiser Foundation Health Plan and Hospitals' Northern California Region.
Thode, who oversees an operation with 55,000 employees and $12.5 billion in annual revenue, gained a financial education on the job and in graduate school, where she earned a master's degree in health administration. "As a nurse, you begin learning about finance in the early stages of management," she says.
Indeed, nurses at any level of healthcare management need to understand the books, says Judith Bradle, director of the University of Pittsburgh Medical Center's Beckwith Institute for Innovation in Patient Care. From its start six years ago, the institute's one-year leadership fellowship recruited nurses and emphasized finance in its curriculum, Bradle says. Last year, the institute expanded its offerings to include midlevel and novice managers, not just executives. "It's one big balance between cost, quality and safe care," she says. "No one can leave out finance in today's environment."
Ultimately, that improves efficiency, says Bradle, citing an estimated $580,000 in savings to the University of Pittsburgh Medical Center created by managers, including nurses, on its payroll who graduated from Beckwith's one-year management fellowship.
Financial literacy gives nurse managers an edge when advocating for capital projects or budgets with upper-level management, says Rosemary Mesisca Bloser, managing director of healthcare management executive education at the University of Pennsylvania's Leonard Davis Institute of Health Economics. The institute oversees the nurse-executive fellows program jointly sponsored by the university's Wharton School and Johnson & Johnson.
"They need to be able to go toe-to-toe with the CFO," Bloser says. "They need to be able to understand what the CFO is saying."
One CFO's journey
During Wollman's two-year stint as CFO at Maryland Regional Cancer Center, a radiation treatment provider, he relied on others to bolster his financial sophistication.
Wollman moved from patient care to management after six years of caring for cardiac and burn victims. "Being a floor nurse is like being in the infantry," he says. At the time, Wollman and his wife wanted to start a family so he enrolled in Johns Hopkins Bloomberg School of Public Health to prepare for a healthcare job that didn't come with a shift nurse's unstable hours. "Eventually you want to move up," he says.
Wollman pursued a master's degree in health finance and management, which included a one-year paid internship with the University of Maryland Medical System, Baltimore. "That went well enough," says Wollman, who, upon graduation in 1996, became the system's assistant vice president of corporate affairs. His responsibilities expanded and five years later he left to become CFO at the cancer center.
As CFO, he consulted outside auditors and relied on two accountants on staff to handle the technical accounting questions. Two years later, he returned to the University of Maryland system for a less finance-driven job. Now, as senior administrator for the system's Radiation Oncology Department, Wollman, along with two other executives, oversees 80 employees-but not the day-to-day management of the finances. "We have a CFO," he says.
"I don't miss the day-to-day financial management," he says. "I prefer the bigger-picture role." His current job includes recruiting, fund-raising and regulatory compliance, among other operational responsibilities.
"I've made choices that keep me close to the clinic," he says. "I'm in radiation oncology because I'm able to walk into a clinic every day and see us treating patients." Wollman considers his nursing career a "great background" for his tenure in management.
He also says he gains credibility with nurses because he's been one. "They know I'm not some money-counting hatchet." And with years spent caring for patients, he understands the mission of his business. "The product we're here for is health," he says. "If you touch patients every day for six or seven years, you understand that. Being successful on the financial end is only to allow you to deliver patient care."
Calling all nurse/CFOs
Are you a chief financial officer with nursing in your background? If so, Modern Healthcare wants to hear from you. Write us a brief letter telling us what took you from the bedside to the business side. By e-mail write us via [email protected]; by fax, dial 312-280-3183.