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Negotiating Change: Making the Switch from Practice to Administration

Peter D. Wallace, MD, MS, FAAP
Many of our pediatric colleagues have made the switch from clinical practice to administration. Some have done it full-time, while other have opted for part time. Most have made this dramatic career decision with forethought and some have done it quickly and rashly.

Making the switch from practice to administration involves three important stages: 1) thought, 2) preparation, and 3) implementation. The first is the most important and time-consuming and requires research and self-evaluation. It is beneficial to talk with physician executives about their jobs, what made them make the switch, and their satisfaction with it. Your family and colleagues also can provide you with ides and insight. The American College of Physician Executives (ACPE – has a wealth of information, including the publications The Physician Executive, edited by Wesley Curry and Hope for the Future by Barbara Linney.
More important is the soul-searching that is crucial in contemplating a career change. Two distinct thoughts will occur to you – am I doing this because of a positive motivation or because of dissatisfaction with my present situation? Most physicians move into administration because of a motivation for the change. Several factors attend here; the most prominent is the challenge inherent in taking on different issues in a different venue using a different skills. Many wish to take a leadership role in dealing with the ever-present changes around us. Some look at a desire for professional growth. Others genuinely feel that they can make an impact on health care at a higher level than in their offices. A smaller number choose to change because of a dissatisfaction element. Competition may be forcing practices to contract or to be unpleasant. Some may feel stale and tired of doing the same thing every day. Some may feel unable to keep up with the changes in practice and the limitations imposed by third parties. Other may be attracted to the concept of more regular hours with no call.
The second stage involves the process of preparing oneself for a transition. This stage requires a plan and may be expensive. Many of my executive colleagues and I dabbled in seminars, books, and meetings with and about physician executives. These activities were part of the first stage to contemplate and make a decision; however, they are also very helpful in educating the clinician on the necessary skills and exposing the clinician to the milieu in which they will find themselves.
Another area of preparation involves experience in management such as participating in the AAP in chapters, committees, and sections, directing or managing your office or division, serving on hospital committees, or holding a leadership position with an IPA, PHO, or HMO. These experiences will help provide you with a more complete pictures of the executive without making a commitment and will serve you well when you are job-hunting.
Formal education also is beneficial in preparing for the career change. An MBA or similar degree was not important fifteen years ago, but now most recruiters insist on it, especially for the full-time positions. Formal, degree-granting graduate business programs are available throughout the country with many specifically designed for physicians. Many of these programs are conducted extensively on the Internet and accommodate part-time on-campus attendance. I received my graduate degree at the University of Wisconsin (affiliated with the ACPE), which was fabulous training for me as a Vice President of Medical Affairs. There are alternatives to obtaining a business degree. The ACPE offers a series of courses called "Physicians in Management" and a number of meetings and educational experiences in print and through the Internet. Unfortunately, these and other introductory courses do not supply the depth that a graduate program provides. In addition to business education , many physician executive positions require three or more years of clinical practice and board eligibility or certification.
Now, you've decided to go for it. Consider several steps. The first might be to become aware of, and inquire into, a position in your area, such as a hospital, clinic system, insurance agency or HMO. Go through the process or inquiry, resume and CV preparation, and interview. Respond to ads in Pediatrics, The Physician Executive, or hospital journals your CEO can feed you. If the situation doesn't appeal to you at all, withdraw your name, clarify your feelings, and learn from the experience of being interviewed (something with which few clinicians have any experience).
A key point here is that executives must be prepared to move away form their community; if not initially, then when they desire advancement or a change in duties.
Let your hospital and clinic administrators know what your wishes are. Like the clinical side, health administrators have a network and can alert their own colleagues of your interest.
The already mentioned ACPE meetings and seminars are excellent venues to meet physician executives and inquire about opportunities. Prepare a resume or a CV and begin calling some physician executive search firms. There are several - I've worked with the Physician Executive Management Center in Tampa, Witt Kiefer, and Heidrick and Struggles. They can keep your inquiry on file (and in confidence if you wish), and will ask you for preferences such as job desires and locale.
You will find that the recruiters are fond of pediatricians. We are many times more represented than our 5% share of the physician population. For reasons not elaborated, our surgical friends are very under represented.
In sum: think carefully, talk with people, do your research and educate yourself, and talk with physician executives locally or through meetings. Do I regret the move? No, although I was very happy with my 25 years of clinical practice. I'm challenged on a different plane, and can see my work as affecting far more people than I ever could in my private practice.
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