Success from Failure: How Physician Executives Can Deal with Job Loss

Little is written about the differences between the career paths of physicians who are clinicians and those who are executive physicians, but one significant difference is the greater frequency of job loss for executive physicians compared to clinicians.

The contrast between physician executives and clinicians with regard to longevity in position is striking: Only 1–2 percent of clinical doctors experience job termination during 20 years of clinical practice, according to a survey of more than 2,000 senior American College of Physician Executives members and 30 anecdotal cases. However, risk of termination for physician executives is 20 to 40 times higher than for clinicians.(1)

This higher job-loss rate for physician executives compared to clinicians is related, in part, to disparate career trajectories. A clinician’s typical progression is college student, medical student, resident, clinician, senior clinician. Each step has a well-defined goal that the clinician must reach to progress to the next step. For the most part, time and success in position are prerequisites to advancement.

When physicians fail clinically, their strong self-esteem and determination cause them to reframe their failures as earned and essential wisdom, according to Helen Meldrum.(2) Consequently, for the most part, their linear career trajectory continues and another job likely awaits them.

Contrast that with the career trajectory of the physician executive, which can be nonlinear and almost haphazard. Job loss may come unexpectedly to physician executives who may have no previous experience with political maneuvering or who are unable to detect that their position may be in jeopardy.(3) Consequently, physician executives often are surprised when their employment is terminated.

The physician executive’s response to job loss is shaped by the career phase in which the job loss occurs. For example, research suggests that late-career job loss can be more difficult for physician executives to adjust to than job loss in early career.(4)

Newly minted physician executives who are unsuccessful in the executive position may have their administrative responsibilities stripped and given the opportunity to continue as clinicians so as to help share a high clinical load. They may move on with the explanation that it wasn’t a “good fit.” Several of the common reasons today’s young employees give for moving on to a new job are lack of compensation (59 percent), lack of work/life balance (51 percent) and bad management (45 percent).(5)

Determining Risk of Job Loss

These unsettling times in healthcare often demand that organizations change positions, directions, or goals quickly — which can be a blessing or a curse for physician executives. Every change in philosophy, goals, or direction may lead to a change in personnel, meaning potential job-loss for physician executives.

When physician executives detect a change in organization direction, they can and should attempt to predict the path the organization may take and thus look for signs that their job is in jeopardy, even if they, themselves, are high performers. Kent Bottles, in discussing physician executives’ job performance, points out that “you can be right and still be wrong.”(6)

H.L. Kirz developed a risk profile tool to determine the likelihood of being fired. Indicators include:

• Being the first hire into a new position.

• Two years of organizational financial losses.

• Conflict with boss/board.

• Recent departure of boss.

• Merger/consolidation.

• Widespread organizational downsizing.

Kirz recommends employees ask themselves when several such predictive variables are present whether they really want to stay in the job. Sometimes it’s best to just “fire yourself,” he says.(7)

Job Loss Prevention

Physician executives can take steps to maintain their positions. One job-loss prevention strategy is to volunteer to help the organization by learning new skills and knowledge.(8) This may show the physician executives in a new light, as agents of change. They might consider becoming involved with e-business, developing people skills, staying abreast of healthcare trends, and finding ways to be more efficient. Additionally, finding passion in their work can turn physician executives into stars.(9)

Networking is an important job-loss prevention strategy, as it keeps physician executives abreast of trends in healthcare.

In the Face of Job Loss

What if a physician executive loses his or her job? Barbara Linney describes eight stages that physician executives go through after job loss: shock, denial, anger, bargaining, guilt, depression, grief, acceptance.(10) They are remarkedly similar to the stages of grief described by Kubler-Ross.(11)

Despite the possible shock upon hearing the news, it’s important that the physician executive listen respectfully without forcing explanations. Kennedy suggests that the more the employee pushes for explanations, the more likely the employer is to look for or fabricate flaws in performance.(12) The physician executive should instead focus on what the organization will do for him or her upon departure, such as providing a letter of recommendation or reference, reasonable severance pay, outplacement assistance, etc.

The physician executive should contact an employment attorney regarding the employment contract and the circumstances of the job loss. It’s also a good time to determine how much money is available for living expenses given the five- to six-month period required for a physician executive to find another job.

There is no specific data tying job loss to depression or suicide among physician executives, yet many participants at Helen Meldrum’s AAPL Success Through Failure course described fleeting suicidal thoughts after job loss. One must consider the issue of physician executive burnout as a possible contributor to this issue.

Barbara Linney recommends journaling, writing goals, and using positive self-talk after job termination. She recommends telling spouses, significant others, and family members about the job loss, and speaking to a professional counselor.(13)

Physician executives can turn adversity into opportunity, Meldrum says. She recommends writing down three positive things per day in a gratitude journal to help counteract sadness and attending professional meetings to keep the brain stimulated. She suggests that post-traumatic growth actually can exceed “regular” growth.(14)

Philosophical Thoughts, Practical Steps

Research implies that preparing for job loss can lessen the impact when it happens. Dan Ariely, a researcher in this field, says, “Knowledge of the end…increases tolerance.”(15) That is not to say one should aspire to this “learned helplessness,” but remembering it when going through or preparing for job loss may soften the emotional blow.

One might look at physician executive job loss as a “way closing.” Way closing is the Quaker concept of being on a path, finding the path blocked, being startled, but looking to the side and finding another path, a better path, one not yet considered. This concept brings awareness that one’s original path was not necessarily the right path.(16) For the physician executive, it might mean considering positions not previously considered.

Additionally, the growing knowledge base on resilience may be applicable to physician executive job loss. (17)

Kirz recommends deliberate self-reflection, saying “take it easy on yourself, don’t indulge in self-recrimination…many physician executives credit the period right after they were fired as among the very best times in their lives.” He recommends taking advantage of this opportunity and make plans for the next fulfilling chapter in personal or professional life.(18)

Bottles shares, “Normally we aren’t brave enough to do what we are forced to do when fired. It forces one to get out of the Comfort Zone. Getting fired can be the best thing to happen in your career as long as you manage it creatively and learn.”(19)

Acknowledgments

The authors would like to thank Helen Meldrum, Barbara Linney, and all the physician executives who shared their stories and input. Len Scarpinato would also like to thank Charisse Jimenez, a former AAPL employee who facilitated the development of the ideas for the AAPL webinar upon which this article is based.

References

1. Kirz, H. Congratulations … You’re Fired! Physician Exec. 2000;26(4):19–25.

2. Meldrum H. Wisdom Through Failure: Exemplary Physicians Discuss Their Regrets. Physician Exec. 2012;38(2):26–8,30.

3. Author conversation with Helen Meldrum, October 2013.

4. MSNBC Morning Joe, 1/10/14, Reset Your Future. Dwain Schenck. http://www.msnbc.com/morning-joe/excerpt-dwain-schencks-reset

5. Lagasse J. What Millennial Doctors Want When Job Hunting, and Reasons They Leave. Healthcare Finance, April 16, 2018. Available at https://www.healthcarefinancenews.com/news/what-millennial-doctors-want-when-job-hunting-and-reasons-they-leave

6. Interview with Kent Bottles, MD, October 29, 2013.

7. Kirz, H. Congratulations … You’re Fired! Physician Exec. 2000;26(4):
   19–25.

8. Reece R L. Hired, Fired, and not Retired: An Interview with a Physician Executive who has run the Career Gauntlet. Physician Exec. 2000;26(4):
   26–33.

9. Tiffan W R. Thriving in Change. Physician Exec. 2000;26(4):46–51.

10. Linney B. Hope for the Future: A Career Development Guide for Physician Executives. Tampa: ACPE Press, pp.148–151.

11. Kubler-Ross e, Kessler D. On Grief & Grieving: Finding the Meaning of Grief Through the Five Stages of Loss. New York: Scribner, 2014.

12. Kennedy M M., Fired? Here’s An Exit Strategy. Physician Exec. 2000;26(4):34–37.

13. Linney B. Hope for the Future: A Career Development Guide for Physician Executives. Tampa: ACPE Press, pp.138–39.

14. Meldrum H. Successful Failure. ACPE Annual Conference Course Presentation, 2013.

15. Ariely D. MIT white paper on Pain. http://web.mit.edu/ariely/www/MIT/papers.shtml

16. Discussion with Dr Anthony Suchman, November 2, 2012, about the Parker Palmer book Let Your Life Speak.

17. Clopton J. The Power of Resilience. WebMD. March/April 2019.

18. Kirz, H. Congratulations … You’re Fired! Physician Exec. 2000;26(4):19–25.

19. Interview with Kent Bottles, MD, October 29, 2013.