Climbing The Ladder To CEO Part I: The Credentials

This is the first of a five-part article series. Parts I and II were originally published in The Physician Executive in 2006.

Last year, I had the distinct pleasure of attending a conference with a captivating keynote speaker, Barbara Bush. A remarkable woman, Bush has maintained a grounded personality and a warm sense of humor despite being both married to a president and raising one.

A member of the audience inquired, “How do you raise a president?” She paused, and then went on to explain that you don’t raise a president. Everyone has opportunity in his or her life. Those that reach the top are always preparing so that when a door of opportunity opens they are ready to walk through it. And throughout life, each door leads to another. Brilliance is often simple, as was her response.

None of us was ready to be a doctor after college, after medical school, or after our first year of residency. We prepared to walk through each successive door of opportunity on the road to our final goal.

Becoming a CEO is no different. We are neither ready-made hospital CEOs by virtue of being a medical director, nor are we qualified after earning an advanced management degree.

The unique skill sets and attributes required for the position need to be acquired through a combination of education and experience — a series of successive doors. The question is: “When that final door to the CEO suite opens, will you be ready to walk through it?”

To answer this question, I interviewed consultants from seven well-recognized search firms. The questions were framed for hospital CEOs, but the concepts are transferable to other health care organizations.

Hiring the CEO

The hospital board of directors, often comprising community members and a smaller number of medical staff members, has fiduciary accountability for the health of their organization. The board members take this legal responsibility seriously and their single most important decision is hiring the CEO. They will be judged by their decision.

The CEO will be given the reins of a complex business with thousands of employees and annual net operating revenues and total assets that may exceed hundreds of millions of dollars.

Not surprisingly, search consultants unanimously agree that board members are risk averse. Not slightly risk averse, but really risk averse. The board is very unlikely to take a chance on someone with “good potential” or an “up and comer.” They want to know with certainty that their candidate can do what the organization requires. Understanding this concept is critical to your preparation.

Past success is the best predictor of future success. Convincing a risk averse board that you can do the job requires you to demonstrate appropriate accomplishments of sufficient scale and scope. It is important to understand the difference between “accomplishments” and “experience.” Accomplishments demonstrate what you have done, while experience speaks to where you have been.

What type of accomplishments are important to a board?

Just as a cardiologist is not qualified to perform neurosurgery, CEOs do not all possess the same competencies. The skills required to run a small rural hospital are entirely different from those needed to lead a large university teaching hospital.

Additionally, each organization may have its own unique challenges such as fiscal insolvency, strained medical staff relations or the need for facility expansion. The message is clear — building breadth into your career will expand your CEO job market.

You will also need to demonstrate business acumen. An advanced management degree is insufficient for this purpose; however, lack of a degree could eliminate you as a candidate.

A minimum of two to five years of operations experience will be required. Most consultants agree that it is not sufficient to manage non-revenue-producing support departments such as housekeeping, facilities, medical staff office, etc.

Rather, you must have significant experience with profit and loss. Important metrics will include annual net revenues, number of employees, and net income. Examples include service lines, inpatient units, radiology services, laboratory services, etc.

It is important to realize that operations experience does not make you competitive — like an advanced degree, it is a baseline requirement to play. The breadth, depth and scope of your accomplishments are what set you apart.

MD — Asset or Liability?

Is having an “MD” after your name an asset or a liability when applying for a CEO position?

Opinions among the search consultants varied from neutral to positive with the most sobering answer being “It’s neutral; my clients could care less too.” The majority of consultants concurred that all things being equal the MD would have a competitive edge.

Surprisingly, all but one consultant added the caveat that board certification is mandatory. Several went on to say that the candidate must have practiced clinical medicine, with one consultant specifying a minimum period of 10 years.

Why would this matter, since the majority of today’s CEOs are not physicians? The answer is consistent. All CEOs must manage physician relations. Physicians are highly unlikely to respect an MD who never practiced medicine. They don’t have this expectation of non-physicians.

As a physician, your career trajectory is expected to be different from that of the traditional CEOs, whose career paths progress from humble beginnings in entry level management positions.

Most likely, you will have advanced from clinician, to committee member or department chair, to paid medical director, to vice president of medical affairs or chief medical officer.

What is a search consultant’s first impression when seeing the title VPMA or CMO on the resume? Most said it was neutral. All consultants commented that titles were less important than what you have done, but then went on to confirm that the initial resume review could be as brief as 30 seconds.

This is why a previous CEO or COO title gives an immediate edge. Your viability as a VPMA or CMO candidate requires that your CEO credentials immediately pop right off your resume and hit the recruiters between the eyes.

Communication Counts

A common theme arose throughout the interviews: communications skills are paramount. You can’t lead if you can’t effectively communicate. One consultant put it this way: “A CEO needs to know how to relate to the common man.”

Body language, including your physical appearance and dress, are also important. Most consultants agree that boards look for charisma, presence, and polish, as the CEO must lead employees and staff while representing the organization to the public.

Competency in public speaking and media interviews are not innate to a physician’s training and background. These skills must be developed. Do not make the mistake of considering this a soft skill, as all the consultants emphasized it as an absolute requirement.

There is no evidence that physicians as a whole make better CEOs than our non-physician counterparts. In fact, the overwhelming majority of today’s U.S. hospitals are not physician-led.

To some extent, this may change as more physicians earn management degrees and gain administrative experience at earlier ages. For those physicians aspiring to be CEOs, understanding what it takes to be a competitive candidate is critical to career management.

All the search consultants were asked if there was any single factor that they would· look for in an aspiring CEO. Answers varied, but the underlying message was that there was no single factor.

In our next installment, we’ll look at how to get the credentials you need co lead. We’ll explore how to prepare so that you will be ready to enter each successive door of opportunity.

ACKNOWLEDGMENTS

Special thanks to the following search consultants who helped shape this article:

Cejka Search, Lois Dister

Grant Cooper and Associates, Susan Cejka

Korn/Ferry International, Tom Giella

Quick Leonard Keiffer International, Bob Kuramato MD and Roger Quick

Spencer Stuart, Charles Falcone MD

Tyler and Company, Larry Tyler

Witu’Keiffer, Mike Doody