Surviving Job Elimination in Healthcare Organizations

A 2018 Merritt Hawkins survey of nearly 9,000 practicing physicians in the United States found that despite the trend to leave private practice for employment opportunities in healthcare organizations, employed physicians are less satisfied with their jobs compared with independent physicians.(1)

Moreover, the job security of employed physicians is tenuous, threatened by mergers, acquisitions, downsizing, outsourcing, and increased reliance on technology, which can cause anxiety and stress. Job elimination has been associated with depression and increased disability claims. Individuals who have lived through layoffs have reported “survivor guilt.”(2)

During my 40-year career, I have held about a dozen positions, always as a salaried employee in industry or academia. As a psychiatrist, I was never self-employed or in private practice. Three of my positions were eliminated, yet I was able to move on to another job — always something different or better. I briefly describe here the circumstances surrounding my job losses and offer advice that might help physicians working in organizations large and small recognize their jobs may be in danger and offer steps they can take to help retain their position when their backs are against the wall.

Job 1: Vice President, Health Insurance Company

In 1999, I was working for a large health insurance company in the Midwest. The chief medical officer (CMO), a pediatrician, had recruited me as the first vice president of behavioral health. Following a series of financial losses, the CMO was dismissed in 2001. I believe the CMO was a scapegoat for the company’s ineffective leadership and unsatisfactory medical expense ratio.

A new CMO was hired six months later — a pathologist with some radical ideas about how health insurance companies should operate and which personnel were essential. He favored nurses over physicians in management positions and gradually replaced the corporate medical directors with less-trained individuals or did not replace them at all. I was not asked to be involved in the restructuring.

A few of my counterparts in the C-suite were eliminated eventually, but I felt secure because no one else had the equivalent of my background and training. In addition, I had recently been awarded a significant number of stock options as a retention incentive because the company feared many executives would depart under unstable conditions. The fact that the stock options had a three-year vesting period provided further reassurance. It felt good to be wanted.

One day the new CMO invited me to lunch in his office. Before I had my first bite of a tuna fish sandwich, he said, “Art, I’ve decided to eliminate behavioral health.”

I protested, “Mental health benefits are mandated by law.”

I knew the CMO was referring to my job and not to health benefits, per se, yet I still had the moxie to engage him. The CMO gave me one month to get my things in order; I was provided a decent severance package but lost the stock options.

A few weeks later, while still employed by the health insurance company, I was alerted to a job with a pharmaceutical company by a colleague who had received his “pink slip” a few months earlier.

Parenthetically, I was rehired by the same health insurance company 15 years later and worked for them for three years. When I left, it was on my terms.

Job 2: Senior Medical Director, Pharmaceutical Company

In 2014, I was three years into a job as senior medical director of a pharmaceutical company when a new CEO decided to consolidate research operations. My boss was squeezed out and replaced by a physician with different specialty training. Shortly afterward, my position was eliminated, but I was “invited” to remain with the company in a lesser position: as a medical director without the “senior” designation.

Because the new position was a demotion and the responsibilities were different (and not to my liking), I was entitled to a severance package in lieu of accepting the repurposed position. I accepted the severance package and cut my losses (stock options that had not yet vested). Once again, I managed to secure a new job before I actually left the company.

Shortly after my departure, the pharmaceutical company announced it was establishing new headquarters in a city 300 miles away. Had I taken the demotion and stayed on, I would have been given the choice to relocate or simply exit without a severance package. Looking back, I know I made the right decision in accepting the severance package because I would not have wanted to relocate. The company was acquired by a larger organization in early 2019, and some employees who had opted to relocate found themselves without a job in the wake of the merger.

Job 3: Medical Director, Global Health Company

Fast forward to April 2019. For two years I had been working from home as a medical director for a global health company with many lines of business. The company as a whole was doing well and had recently completed an acquisition; however, my division was struggling financially, and there were changes in senior leadership, including turnover at the CMO and VP positions. Although I was unfazed during a round of layoffs, my position was eliminated in the second round.

My boss delivered the painful news over the phone: “Art, I have some bad news to tell you….and HR is on the phone.”

He had me at “bad news.” It was déjà vu. I experienced the same sinking feeling in the pit of my stomach as I did when my first job was eliminated. I became angry with people working behind the scenes, people unknown to me who had orchestrated my layoff: accountants, actuaries, VPs, and human resources personnel. They directed my boss to fire me and even provided him with a prepared script to read to me over the phone.

Being forced to retire at age 65 did not seem fair, yet, a Transamerica Center for Retirement Studies survey(3) of nearly 6,000 workers in 2018 showed that 37 percent to 56 percent of retirees leave the job market earlier than planned, sidelined by bad heath, layoffs, and age discrimination. (I was provided data to confirm my termination was not the result of age discrimination.) Responses from more than 1 in 4 workers indicated they were taking no action to ensure they can work past normal retirement age, by choice or necessity.

Workers are more likely to be prepared for changes in the labor market if they stay engaged, continue to learn and develop professionally, network to build professional relationships and expand career opportunities, and maintain a social presence to keep themselves “out there.”

The Aftermath

After my layoff, I found my mind was stuck on a lyric from the Jimmy Cliff song “The Harder They Come,” in which the reggae singer/songwriter proclaims, “I’d rather be a free man in my grave than living as a puppet or a slave.” I believe the lyric applies to my boss — not to me — for capitulating to management rather than advocating for my continued employment.

When physicians are too frightened to stand up for their colleagues because they fear reprisal or fear for their own job security, the “suits” have won the battle. This is a disturbing trend in healthcare that speaks to a lack of medical leadership and empowerment. Accountant puppeteers and countless other executives are pulling physicians’ strings to the extent that nearly half of physicians indicate their relations with hospitals are somewhat or mostly negative.(1) Truth be told, physicians and administrators have coexisted under conditions of mutual disdain and shared misunderstanding for decades.

Warning Signs

The effects of losing a job can be traumatizing. Job loss touches every aspect of a person’s life, from diminished psychological well-being to increased levels of physical complaints and somatic dysfunction. Employment is so important that many individuals are reluctant to change jobs even when under severe occupational stress. The axiom is to hold on to your job at all cost until you find a new one.

None of the following 10 signs singularly predicts that a physician leader’s job is in peril, but if several of them occur in the context of consistent and dramatic trends at work, there may be trouble in paradise.

1. You are hired into a newly created position.

2. Your boss or immediate supervisor is demoted, dismissed, or rendered powerless. You are not considered for the supervisor position. A new boss steps in and ignores you.

3. You are in the dark, increasingly out of the loop. You are not invited to important meetings or copied on important emails. You are no longer included in future plans or projects. Your ideas, perspectives, and opinions are not valued.

4. You are in an underperforming, nonrevenue-producing, or overstaffed unit. You — not your business unit — are underperforming and require corrective action for poor performance or disciplinary action for patient-related matters.

5. You are reassigned to a lower-profile position. Your “perks” and compensation structure are significantly changed. (Alternatively, you may be on the radar because your salary is excessive.)

6. You work remotely or your office is moved to a less-prestigious or less-strategic area.

7. You are watched and micromanaged, whereas you once enjoyed autonomy.

8. You do not accept a new position or relocation. You are given a “take it or leave it” or “no-win” option.

9. Your company is deeply in the red, involved in significant litigation, dealing with ethical breaches of conduct, undergoing major changes in operations, or experiencing revolving door changes in leadership and governance.

10. Your segment of the healthcare industry is ripe for takeovers, ignoring the “human side” of mergers and acquisitions.

Sometimes physicians can read the tea leaves and predict when their jobs are on the line. Although the winds of change created three job losses in my lifetime, as I look back, I note some signs I missed — and others I ignored — that signaled a storm was brewing. Here were the red flags:

Job 1

• My position was newly created.

• The company sustained financial losses.

• My boss was fired.

• A new boss, board certified in a different specialty, stepped in; he did not reach out to me, nor I to him.

• There were job eliminations prior to mine.

• I was in the dark, not communicating with other departments and leaders.

Job 2

• The company hired a new CEO and was in a restructuring mode.

• My boss was dismissed.

• A new boss, trained in a different specialty, stepped in.

• I was out of the loop.

• I refused to accept a lesser position.

Job 3

• The company recently completed a merger and was consolidating.

• My business unit sustained financial losses.

• Senior leaders turned over.

• There were job eliminations prior to mine.

• I was working from home.

• I was out of the loop.

Protecting Your Job

In a study(4) of 620 physicians, most of whom were employed and had significant administrative responsibilities, 47 percent reported they had been “involuntarily terminated” within the past five years. The top reasons were personal conflicts with their bosses; financial losses by the organization; departure of an immediate supervisor; and mergers, downsizing, and re-engineering — all similar to what I experienced.

Based on my experience, I offer 10 tips for protecting your job while working in healthcare organizations. Bradley G. Richardson, author of Career Comeback(5) is the source of many of these tips, as well as the aforementioned warning signs. Career Comeback is must reading for all employed physicians.

1. Establish a strong presence. Always be front and center and remain visible to coworkers. Don’t hide in the office or operating suite.

2. Know the organization’s priorities and align your goals to demonstrate your value.

3. Justify your role by making your numbers, hitting your goals, and documenting your results.

4. Understand the criteria for evaluating your performance and make changes indicated in your performance reviews.

5. Stay current in your specialty and be on top of your game.

6. Use your leadership skills and social networking to achieve changes that benefit patients and the organization.

7. Use your soft skills to influence individuals and advocate for positive change in the organization.

8. Avoid naysayers who only serve their personal interests without regard to their effect on the organization.

9. Develop your network beyond your department and immediate supervisor.

10. Establish a good relationship with your boss, but don’t rely too heavily on your boss as your career savior.

High Turnover

Despite efforts to actively strengthen their positions within the organizations, employed physicians are not bulletproof or immune to turnover. No matter how hard they work, how productive they are, or how well liked they are, it may not be enough to keep their jobs. The pressures of practicing are causing physicians to seek alternatives to traditional practice or to remove themselves from clinical roles altogether.

For those interested in medical management positions, the odds of being jettisoned are actually quite high, with physician executive turnover rates estimated to be 10 percent annually.(6) Job eliminations can render physicians less effective in subsequent jobs because being terminated has the potential to alter management style, affect leadership ability, and create chronic self-doubt, leading to indecision and aversion to risk. In essence, once fired, some physicians always are looking over their shoulders for the ax to fall again. Performance suffers when there is perpetual anxiety over job security.

Conclusion

Better strategies are needed to predict high-risk situations for physicians, to prevent termination, and to increase the likelihood of professional and personal success. There is no greater priority in medicine today than to improve how physicians feel about their profession and themselves. According to the Merritt Hawkins survey, “Physician professional satisfaction and engagement...are matters of public concern from a quality of care, access to care, and economic perspective.”(1,p28)

Unless you are in a position to retire, remember the words of the inimitable Oliver Wendell Holmes, Sr., who said, “I find the great thing in this world is not so much where we stand, as in what direction we are moving: To reach the port of heaven, we must sail sometimes with the wind and sometimes against it — but we must sail, and not drift, nor lie at anchor.”

When physicians come to terms with job loss, they usually find clear sailing ahead. Basketball great Michael Jordan put it this way, “I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.”(7)

The only real failure is failing to learn. Physicians are too smart not to learn how to rebound.

References

1. The Physicians Foundation. 2018 Survey of America’s Physicians: Practice Patterns & Perspective. Survey conducted on behalf of The Physicians Foundation by Merritt-Hawkins; https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf .

2. Noer DM. Healing the Wounds: Overcoming the Trauma of Layoffs and Revitalizing Downsized Organizations. San Francisco: Jossey-Bass; 2009:3-15.

3. Transamerica Center for Retirement Studies. 19th Annual Transamerica Retirement Study. April 2019. https://transamericacenter.org/docs/default-source/retirement-survey-of-workers/tcrs2019_sr_what_is_retirement_by_generation.pdf .

4. Kirz H. Congratulations . . . You’re Fired! Physician Executive Journal. 2000; 26(4):20-5.

5. Richardson BG. Career Comeback. New York: Broadway Books; 2004.

6. Tiffan WR. Healthcare Downsizing: A Survival Guide. Physician Executive Journal. 1995;21(9):22-3.

7. Goldman R, Papson S. Nike Culture: The Sign of the Swoosh. London: Sage; 1998:49.