Arthur Lazarus, MD, MBA

Mentors and support groups can help you avoid being fired. And if the worst does happen, they can facilitate your comeback.

Arthur Lazarus, MD, MBA

Most chief executive officers who work in health care say they will retire soon and expect it will be a struggle to replace them due to a shortage of qualified candidates. Enter the physician executive, armed with medical knowledge and management know-how, to fill this void.

Gauging by the membership of the American College of Physician Executives (ACPE), which has grown steadily over the years, approximately 15,000 physicians in the United States consider medical management their primary specialty. Typical job titles are medical director, chief medical officer, and vice president for medical affairs. Increasingly, physicians are occupying CEO roles, although career pathways to the top are not so well defined for physicians as they are for nonphysician CEOs.

Often belittled

Despite the burgeoning opportunities for physician executives, there appears to be a dark side. Physician executives often are belittled by rank-and-file physicians for joining the "suits." Some physician executives have become unsympathetic to their practicing colleagues and are alienated from organized medicine. Others have become weary of company politics and butting heads with sundry stakeholders.

Working alone and in isolation, physician executives have no real support system. By all accounts, they are becoming increasingly stressed and disaffected. Physician executives in managed care, in particular, are burning out fast as big corporations bleed them and subject them to the whim of senior leaders who are not medically trained.

Physician executives also have had to contend with the health care industry's constantly shifting landscape, which has had an impact on "job mortality." In fact, the risk of termination is 20 to 40 times higher than for practicing physicians.

Fired, let go, laid off, terminated, downsized, displaced — you name it — physician executives don't appear to be much different from those in other industries when it comes to getting canned. Of 620 ACPE members who responded to a poll in 2000, 290 (47 percent) said they had been "involuntarily terminated" from a medical management job. The top reasons were:

  • personal conflict with boss/board,
  • downsizing or re-engineering,
  • financial loss by the organization,
  • departure of immediate supervisor, and
  • merger or consolidation.

No matter what the cause, losing a job is traumatic, and post-traumatic stress disorder may occur in fired physician executives. This renders them less effective in subsequent jobs because it alters their management style, affects their leadership ability, and creates chronic self-doubt, leading to indecision and aversion to risk. In essence, once fired, you are always looking over your shoulder for the ax to fall again. Job performance suffers when there is perpetual anxiety over job security.

Without a doubt, strategies are needed to better predict high-risk situations for physician executives, to prevent termination, and to increase the likelihood of professional and personal well being when job loss becomes inevitable.

Access to mentors, support groups, and multidimensional career pathways, and the option to practice part time, may be just the things physician executives need to enjoy greater job satisfaction.

Arthur Lazarus, MD, MBA, is director and regional medical research specialist for Pfizer. He is editor of MD/MBA: Physicians on the New Frontier of Medical Management (American College of Physician Executives, 1998). He can be reached by phone at 502/228-2480.

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