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Movin' On: The Path Not Taken

Last week I got an email from a former physician colleague. He still works at a health care organization that I left years ago. The re-connection got me thinking about what I would have missed in my life and career had I remained at that organization. Now that I'm about three months away from leaving ACPE after three and half years as CEO, I've been in a reflective mood.  

First, leaving the traditional health care organization, with its typical hospital-physician-insurer tugs of war over reimbursement, culture, and authority dynamics, was a breath of fresh air for me. Never comfortable with the status quo, I wanted to get out and find new approaches to improving health care. 

Freed from the constraints of orthodoxy, I signed on to join a small start up company focused on changing consumer behavior in the workplace to reduce health care costs, and create a healthier workforce. I learned how to find investors. I learned how to assemble office furniture from IKEA because frugality, functionality, and teamwork was required of everyone on the senior team. I liked the idea that our work and execution of strategy would determine whether the business concept would succeed. When a couple of senior professionals left, I understood that I would have to take over some of their responsibilities of consumer research. I enjoyed doing that. Even though the company eventually closed its doors (like most start ups), the experience was a good one.  

Next, I joined a couple of system safety engineers in their growing consulting group to learn about how aviation, nuclear power, manufacturing, and other industries had become highly reliable. It required learning new concepts and language, then translating that to health care. It was exciting to work with health systems, physicians, and nurses who were committed to being pioneers in adapting the safety science of engineering to health care. I soon discovered that several other physicians were intrigued by the same concepts. We could talk the same language, and see a path to improving performance and patient safety. The consulting work was part-time, which allowed me to travel, and get a major stonemasonry project moving along. Could life be any more interesting or satisfying?

When ACPE's founder and CEO announced his retirement in 2008, the opportunity came to build on everything in my background. I found the new challenge that made my life more interesting and satisfying. I'm convinced that having worked in the insurance, hospital, medical practice, consulting, and entrepreneurial sectors of health care was attractive to the ACPE Board. I viewed the College more as a nimble, creative start-up opportunity than a thirty-five year old professional association. The strategic thinking and business plan execution required of start-ups was far more important than having a background in association management.  

Learning how to listen to the staff, which includes journalists, artists, educators, and professionals in marketing, IT, and finance, was key to surviving the recession, and rebounding from it. I asked our creative artists and journalists how they would redesign our journal - pej - to give it a more contemporary look and feel.  Who would have thought that changing to small case, big blocky letters would have such an impact?  The quality of writing - both from physicians and free lance journalists - increased.  

From my private equity market experience, I paraphrased a quote from Malcomb Forbes with my Board about their role and my role:

"There are but two questions a board should ask at each meeting.  The first question is always the same: 'Should we fire the CEO today?'. If the answer to the first question is "yes", then the second question is, "Then who among us shall serve on the search committee?". If the answer to the first question is "No", then the second question is, 'Then how can we support the CEO and the staff to be successful?'

Some said that was "too harsh" a way to look at the governance-management issue. Not for me, nor for the great board chairs I had the privilege to work with. All are great friends - but we all understood the harsh reality and consequences of running a business.  

I was left thinking that if I'd stayed with my previous organization, I would have had a nice salary, important title, pension plan, and nice people as colleagues. But I most certainly would not have found my way to ACPE, learned how to lead and manage through the recession, or have the opportunity to work with talented people outside of health care, who have a lot to offer to those of us working in the health care industry. I'm looking at my next transition at the end of the year as adventursome, exciting, and fulfilling. One way or another, I'm "leaving the tribe" again - a topic I'll be speaking on in Las Vegas at the Medical Fusion Conference in November.

Reader Comments (1)

Great post Dr. Silbaugh. I wish other physicians would open up a little and discuss what their thoughts are around their careers. We could all learn from those who are actually 'DOing' more than just punching the endless time clock that is now clinical practice.

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