Wednesday, September 26, 2012

8 Things Medical School Failed to Teach Me About Being a Physician Executive

You Will Have to Move a Lot

I went to medical school in Cleveland and did myj pathology residency in San Francisco at UCSF.  I was on the medical school faculty at UCSF, Iowa, Allegheny University of the Health Sciences, and Michigan State. 

Since leaving academic medicine, I have worked at a bio-tech start up in Cambridge, an educational and research institute in Grand Rapids, a $2 billion integrated delivery system in Iowa, and an evidence-based medicine consortium in Minneapolis.

In my experience physician executive positions do not always last a long time because the environment changes, my career aspirations changed, and getting the job done sometimes means alienating enough people to get in the way of long job tenure.

You Will Have to Reinvent Yourself Over and Over Again

My main professional roles have included: medical school pathology course master, surgical pathologist, division head, vice chair of academic department, chair of academic department, medical director of managed care, corporate operations officer of ambulatory care, special assistant to the president of a big ten university for managed care, search consultant, chief knowledge officer of a genomics bio-tech start up, president and ceo of an educational consortium, chief medical officer of a delivery system, president and ceo of an evidence based medicine institute, and health policy professor at a school of population health.

My only educational credentials are a bachelor’s degree in history and a MD degree.  Although I have taught in MBA programs, I do not have a MBA degree.  Although I headed up a genomics repository of DNA, I had to teach myself genomics and proteomics on my own.  Although I teach health policy and population health, I did formally study these subjects.  I have discovered that if I read a lot, go to conferences in different fields, and talk to smart people, I can pick up what I need to know without going on to obtain lots of graduate degrees.

Everything is in the New York Times and The Wall Street Journal 

I am amazed at how much I am able to keep up with payment reform, federal health care reform, and major trends just by reading these two newspapers every day.  It is also good to see how liberals and conservatives interpret the same story, often with dramatically different conclusions.

The Killer App in Social Media is Community

Twitter has become the most important technology in my career as a physician executive.  I follow about 2000 key opinion leaders in health care, and about 7000 people follow me.

I use twitter to crowdsoure subjects that I need to master in order to give keynotes or consult with health care systems.  For example, Einstein Medical School asked me to come give a presentation on social media and undergraduate medical school education.  In order to prepare for a subject that I had not thought about much, I tweeted the following: “Help; need best practices of social medical and medical school education.”

I received responses from all over the world that formed the basis for my all day seminar that was well received and consisted of concrete examples of medical educators from the Cleveland Clinic to the UK using twitter and facebook in ways I had never imagined.

An important point here is that it is now my obligation to my social media community of practice to provide knowledge to others when they are reaching out for assistance.

If I can’t understand it, I don’t believe it

When I started out in leadership roles, I did not always trust my own judgment.  I sometimes thought I was not smart enough to grasp situations that made no sense to me.

When I was Interim Head of pathology at Iowa, I thought my lack of training in clinical pathology was the reason I could not understand the classification of all the technologists in the hospital labs.  It took a while to grasp that job classifications and titles had multiplied and proliferated in a way that did not serve us well in a changing health care environment.  It was only when I truly understood that the system did not make sense that I could lead a simplification of job titles that made more sense in that time of managed care. 

I will never forget going to a meeting in Palm Springs of venture capitalists.  What made them different from others I had encountered was their skepticism and insistence that they understand how start-up companies would make money.  If they could not understand the business plan, they did not invest. 

You Will Fail; Do it Quickly and Cheaply

A successful entrepreneur in Iowa taught me that failure is inevitable.  The trick is to recognize when you have failed, learn from it, and move on as quickly and cheaply as possible.  When I was helping to raise $36 million dollars for a genomics company, I was amazed to learn from venture capitalists that they do not try to predict winners and losers.  They do not think it is possible.  When they invest in 20 companies, they are hoping that one of them will be a Google or apple.  They fully expect the others to fail. 

I have noticed that health care organizations have a hard time killing programs that are simply not working. 

You Must Become a Life Long Learner

When I graduated from Case Western Reserve School of Medicine in 1980, there was no Internet, no Google, no disease called AIDS, and no smartphones.  You must continue to learn about the world you live in, and the world will continue to change in amazing and confusing ways.

Master the Gartner Hype Cycle and Learn Behavioral Economics

Do yourself a favor.  Master the Gartner Hype Cycle to understand why all those revolutionary disruptive technologies fail and those startup stocks go down (

Read Nobel Prize winner Daniel Kahneman’s book Thinking, Fast and Slow; you will understand why you and those you work with are often irrational and annoying.


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