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Hospital executives will face a daunting challenge in the post-reform business climate. Career management.

Competition and ongoing reductions in Medicare payments to healthcare providers will doom financially weaker hospitals resulting in fewer jobs at a time when more executives are looking for work.

This once comfortable industry, characterized by cost-based Medicare reimbursement and physicians who viewed competing with the hospital where they admitted patients as being unseemly, is about to experience a prolonged period of turmoil that one analyst described as having all the pain and impact of combining DRG reimbursement and the Balance Budget Act of 1998. Both events created an unprecedented periods of financial instability and executive turnover. Some senior healthcare observers argue that post-reform will be more tumultuous.

Those who survive this perfect career management storm will be the executives who deliver exceptional results and who are adept at managing their careers, including the thorny political challenges posed by concerned board members and restless physicians seeking to protect their incomes. The more CMS cuts from physician reimbursement, the thornier those issues will become. Managing one’s brand, expanding one’s personal network of industry contacts, and continuous education for professional development, will be essential tools for success or career transition.

CEOs and other senior executives who become too comfortable are at the greatest risk of being pushed out of their jobs. The experience, skills, and style that helped an executive achieve success in the past may not work in this new healthcare economy. “What Got You Here Won’t Get You There,” Marshall Goldsmith’s book on adapting leadership styles is a great resource for leaders who are serious about change. It is not the typical management book filled with big ideas and new buzz words. With regards to networking, Harvey McKay wrote what I think is still the best book on the subject:. “Dig Your Well Before You’re Thirsty : The Only Networking Book You’ll Ever Need.”

Regardless of which healthcare reform bill reaches the President’s desk for signature, the estimated reductions in federal healthcare costs will probably fall short of those needed to reduce the current deficit projection. The proposed savings in this reform measure are only a drop in the bucket when you look at the very big and very bad numbers that graphically highlight the federal government’s longer range fiscal crisis which is being fueled by the 78 million new Medicare beneficiaries that will enter the program over the next 20 years. There will be more people on Medicare than are paying taxes to fund the cost of their care.

The reimbursement cuts that the hospital industry agreed to make in return for their support of reform are not a one-time shot. There will certainly be more reductions in reimbursement. Rationing of services through “case management” will continue to occur under the radar of most consumers and politicians as CMS installs new rules and continues to reduce payments to healthcare providers.

Healthcare leaders will face some of the toughest times of their careers over the next 10 to 15 years. Managing their careers will require more focus than ever before. There will be less competition in some markets. There will be fewer hospital management jobs in all markets.

As one CEO prepared for early retirement, the local newspaper reporter asked why he had decided to leave now? “It is just not fun anymore,” was his response. This CEO was no underperformer. In fact, his hospital consistently was one of the best in the state and routinely earned high marks for clinical performance and patient safety. He had simply reached a point in his life where he realized that the success he created for the organization would be difficult to sustain. “This job will require more energy, intensity and focus than ever before. I have had a great career. I have a wonderful family. It is time.”

On Monday I will outline some of the career management tools that I routinely share with candidates in transition and young graduate students who are beginning their careers.

John G. Self is Chairman and Senior Client Advisor of JohnMarch Partners. He is a Co-Founder of the Firm.

A former investigative reporter and crime writer with more than 30-years of healthcare leadership experience in public relations, national marketing, business development and as Chief Executive Officer of hospitals and consulting firms, Mr. Self is highly regarded for his keen insight into operations, business culture and for his ability to consistently select the right leaders.

John is a highly rated speaker on inspirational leadership, career brand management and the future of healthcare in America. To contact Mr. Self regarding a speaking date, contact him at JohnMarch Partners.

You can contact Mr. Self at 214.220.1234 or He is an active member of LinkedIn and a frequent editorial contributor.

Or, you can follow him on Twitter at Self_JohnMarch.

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