Climbing the Ladder to CEO, Part IV: The Journey

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

In 2005, I applied for the CEO position at a stand-alone Chicago area hospital. My first (and only) interview for this position was with the executive search consultant. Ten minutes into our conversation he stopped the interview and said, “If you want to be a CEO you need to learn how to interview like one.”

At that time, I was chief medical officer for a suburban hospital, where I had originally been hired as medical director of emergency services. I had a master of medical management degree coupled with 10 years of senior leadership experience.

The consultant’s feedback compelled me to better understand what it would take to be a CEO. I reached out across the country to interview well-known executive search consultants and senior physician executives, many of whom were hospital CEOs. I shared the findings in a three-part series of articles in the Physician Executive Journal in 2006 titled “Climbing the Ladder to CEO.”

Following the advice obtained in the interviews I set out to build my career. Today, I serve as chief executive officer for UW Health, a $3.2B academic health system with six hospitals, 17,000 staff members, 1,500 employed physicians, and the majority ownership of a 355,000-member, $1.7B health plan. Over a decade since the original three articles, I have written this fourth part to assist other physician leaders seeking to advance their careers.

The Better CEO

I have been asked many times if physicians make better CEOs. My answer: “The person most qualified to be the CEO is the better CEO.” It is common for CEO search committees to request physician candidates; however, it is far less common for physicians to be selected as the final candidate.

I have worked for highly effective CEOs; none were physicians. I have worked side-by-side with talented non-physician executives who became CEOs before my appointment. They were all capable leaders who earned and belonged in their role. All other things being equal, being a physician can be a plus, but the search committee first and foremost must be comfortable that you are qualified for the job.

Readiness to be the CEO is not defined by any particular credential (e.g., DO, MD, RN, MBA, MHA, MMM) but rather by a broad set of demonstrated capabilities. My journey was one of proactively building skillsets, seeking challenges of progressively greater scope and scale, and actively pursuing self-development. The path was not always smooth or straight. There were setbacks, failures, and disappointments along the way. Reaching my goal required clear directionality, persistence, and resiliency.

Preparing for the Next Door of Opportunity

With a better understanding of the requisites to be a CEO, I had a new appreciation of the need to develop “soft” skills important for the role. As a physician, I was proficient in one-to-one and small-group discussions; however, in front of large audiences I was stiff and boring. I obtained communication coaching complete with video recordings and feedback, but this only more clearly demonstrated that I was a science major in college.

So, I went bold. I joined an improv group! I didn’t go once or twice, I went several hours a week for nearly a year. The training took me out of my comfort zone; however, I emerged a comfortable and capable public speaker. In my opinion, developing this skill was the single most important effort for my career progression. If you cannot communicate effectively, you cannot lead.

Four years had passed since my failed hospital CEO interview when I received a call from the same executive search consultant. He was conducting a CMO search for the Iowa Health System (now called UnityPoint Health) based in Des Moines, Iowa. He told me it may be a stretch going from a single suburban hospital to a two-state health system with nearly 20 but he felt I had transferrable skills and would be a good culture fit.

Over the prior few years I had worked diligently on building my resume. I had taken on additional responsibilities, such as leading information technologies, supply chain, biomedical engineering, laboratory, and pharmacy. Meanwhile, emergency services, which were my foundation, had grown from a single department serving 34,000 patients annually to a highly profitable, multi-site program serving more than 130,000 patients.

I had been born and raised in the Chicago metro area. Moving to Des Moines had not been on my radar; however, I had 14 years of tenure in my current role and was topped out with no room for growth. If I were to follow the research in my previously published articles, the right career move was to step up to a larger role, even if that meant relocating. I applied for the Iowa position. Little did I know at that time that I was the only applicant without “system” experience and thus viewed as the “underdog” candidate.

My lack of large health system experience was certain to be a liability. So, I reached out to several system CMOs to listen and learn about their roles, their areas of focus, and their challenges. Still unsettled, I hopped in my car and, over the course of several days, traveled 650 miles to visit four of the health system’s regions. Through this journey I gained a sense of the system’s branding, services provided, area competition, medical staff make-up, and facility design. The road trip strengthened my familiarity with the system and my self-confidence going into the interview; however, it turned out to be a lot more.

There were nine candidates in the first-round interviews, and I was the last. When I mentioned the regional visits, the room lit up, conversation flowed easily, and time went fast. Later, I learned that the regional leaders had felt disconnected from prior CMOs, who they felt were corporate-centric and did not take the time to learn about the challenges intrinsic to the various regions. After the second round of interviews, I was offered and accepted the position.

Demonstrating Leadership & Business Acumen

In my CMO role at UnityPoint Health I was a member of the system’s senior leadership team, a liaison to the regional CMOs, and assigned accountability for system quality. Two days after arrival, the CEO informed me that I would also be accountable for building an “ACO.” This was in 2009, before the passage of the Accountable Care Act. I had no idea what I was expected to build! I went to my office and entered “ACO” into a search engine.

Then came my second major challenge. The CEO appointed me as president/CEO of the largest of our employed medical groups, which was comprised of 250+ providers. The appointment was announced publicly in a national journal; however, there was one small glitch. No one told the medical group or its current president.

To complicate matters, being the leader of this medical group put me at odds with the competing independent physicians, whom I would need as partners to build the ACO. This quagmire required that I exercise all the skills I had developed over the previous 14 years of senior leadership.

Leaders take people to a place where they are unlikely to go on their own. A prerequisite for success is building followership, which begins with developing credibility. This requires being visible, listening, asking questions, learning, and respecting. You may take an element of abuse along the way, especially if your introduction into the organization is as awkward as mine had been. It is not personal, but rather a reflection of the situation, organizational history, current environmental stressors, and an ambiguous future.

I put in significant windshield time and visited with as many individuals and groups as reasonably possible. I listened, expressed appreciation of past accomplishments, and shared my observations. I redirected anger by asking questions that deepened my understanding. Most times it was friendly and fun, other times less so. Regardless, it was time well spent.

During my tour, it became evident to me that we were not going to achieve our organizational goals unless we could better organize our medical community, which was extremely fragmented.

My initial focus was the employed medical staff. Across the system, physicians were employed by different entities and had wide-ranging contract terms, varying degrees of accountability, and minimal alignment of goals. At the extremes of the system, these groups were as far as 460 miles apart.

I thought the answer was obvious: We should transition into a single, strategically and operationally aligned medical group. I communicated this great vision only to quickly realize that I may have skipped a few steps in Kotter’s eight-step change model. Clearly, I was not the first to communicate this vision and those who preceded me were no longer with the organization. Interestingly, the resistance was not just the physicians, it was the regional CEOs. Armed with a propensity toward persistence I remained undeterred.

The regional CEOs had personally built their local employed medical groups and were reluctant to cede them to a system-level medical group. After a year of spirited debate, we constructively worked through the issues to reach consensus and build a coalition to move forward. In parallel, we developed a robust physician leadership academy and the first cohort included participants from each region. Beyond the educational benefits, the academy developed camaraderie and trust among the physicians.

With the support of the regional CEOs, we took the next step. We brought our graduates together in a closed room — physicians only. There was tension in the room. They knew my intent was to merge the medical groups, but they did not anticipate the “how.” They were empowered to design the ultimate medical group, applying their knowledge of what has worked and what has not worked in their current situation and in the past.

Over the course of four 6-hour sessions they designed “Newgroup.” They owned it! With this coalition as ambassadors, we steadily gained additional buy-in and within one year we merged most of the employed physicians into a single corporate entity with a unified compensation plan and aligned quality goals.

Soon thereafter, all remaining providers were on a timetable to join. Newgroup had initially merged more than 600 providers and had assumed strategic oversight for 1,000+ employed providers across three states. Today, this medical group exists as UnityPoint Clinic.

In addition to bringing the physicians together, I served as a member of the system’s senior leadership team; influenced strategy; and participated in merger, acquisition, and integration activities. I also had profit and loss accountability for our medical group and home health enterprise with combined annual operating revenues of $420M.

Doors Begin to Open

In 2014, five years after joining UnityPoint Health, I was contacted regarding the CEO search for a nationally renowned health system. I was the only candidate who was not a sitting health system CEO. I thus entered the process with no expectation of getting past the first round of interviews.

The search consultant seemed equally surprised when I progressed as a semi-finalist. In the end, a well-credentialed and accomplished leader was offered and accepted the position. This was another good failure serving as a learning experience and instilling confidence that my ultimate career goal was within reach.

Just as this search was concluding, a change in leadership unfolded at UnityPoint Health. Our CEO announced his upcoming retirement and his successor was named. The successor was my peer. He was a highly qualified, high-integrity individual whom I deeply respected. He was not a physician.

My goal was to support him fully; however, before a full year had passed, opportunity came knocking again. An executive recruiter called me about an opportunity at UW Health, a premier midwestern academic health system. They had recently merged their hospitals and medical foundation and were seeking the inaugural CEO for the integrated entity. I participated in the search and was ultimately offered and accepted the position.

Later I learned that I was the only candidate who did not have academic health system experience. This created trepidation among members of the search committee; however, they concluded that they had plenty of academic experience within their ranks. Their preference was a healthcare executive who has demonstrated enough leadership and business acumen to give them confidence that he or she can lead and operate a large complex health system.

Paving Your Own Path

This path to becoming a CEO typically is not linear, with inevitable hardships and disappointments along the way. I did not originally set out to be a CEO. My initial ambition was to be the medical director of an emergency department. After achieving that, my aspirations progressed to setting my sights on being a hospital CEO, which didn’t happen.

My career then took unexpected twists and turns in unanticipated geographies, which ultimately led to my current CEO position.

It is likely that your path will not look like mine; however, there were lessons learned along my journey that are transferrable to all physicians navigating a career in leadership. I will share these with you in the next article, “Climbing the Ladder to CEO, Part V: Lessons Learned.”