A note to graduate students in healthcare administration:  The career and the career progression you thought you would have are probably not going to happen the way you envisioned it.

iStock_000018120735XSmallConsider this scenario:  Dan landed his dream job at age 47. He was CEO of a multi-hospital health system located in a medium-sized metro area. The salary, easily seven figures with an incentive bonus. Based on his package, Dan realized that this could be his last job if all went well. Financial security and a comfortable retirement were all but guaranteed if he remained with the system.

Why would he leave? His family loved their new home, the schools, the club – everything had fallen into place. His flagship hospital was 500 beds. There was a 225-bed suburban affiliate and a 75-bed specialty hospital, primarily cardiac care.  The System employed more than 100 physicians and operated four ambulatory care centers throughout the region. The system was comfortably profitable but initiatives Dan had launched quickly generated across the board improvements in the bottom line. The Board was pleased.

This was the job he dreamed about since the day he graduated with his Master’s of Hospital Administration. 

By 2025, everything had changed. In 12 years, the job Dan thought he would have until he retired was dramatically different. He wasn’t the CEO of a health system as he knew it. With 11 years to retirement, Dan was frustrated by the transformation that had occurred. He felt like a stranger in the System he had helped build.

The 500-bed hospital was now operating 150 beds. The 225-bed hospital was closed as a hospital and reopened as a nursing home and assisted living facility. The 75-bed specialty hospital now had only 25 acute care beds. Twenty of the remaining bed capacity had been converted to hospice and the rest of the space in the building sat vacant awaiting the outcome of a space utilization review.

The hospital business was no longer the big revenue or profit driver for the System. The physician practice division had passed them by several years prior. The physician leader of the practice seemed to have more sway with the board than when he first started. Most of the payments were bundled and routed through the physician practices. Dan found himself spending more time refereeing disputes between the clinic CFO and the hospital staff regarding how much revenue inpatient care should be allocated.

The second biggest revenue generators had become the mobile health system/house calls and community case management program. The ambulatory care clinics were also successful. Home care, a necessary bridge for population health management, was thought of as a loss leader.

Dan also realized that his cordial but hardly endearing relationship with the medical staff – he was accused at times of not being physician friendly – was wearing. There had been occasional and recurring conversations regarding the need for a physician led/physician centered approach.

Dan had done a fairly good job at staying abreast of these issues, but he knew that the health system’s overhauled business lines did not play to his strengths. He knew change would come, he just did not realize how dramatic it would be.

“I am not having fun anymore,” he confessed to his wife. “I never thought I would be saying this, but I do not enjoy going to the office like I used to. It is just so different. The things I always liked and excelled at are not part of my job any more. There is more emphasis on strategic contracting than traditional operations.” 

Transformations are hard, and the toll it exacts from leaders and the employees can be significant.  

On a Friday afternoon before a long holiday weekend, Dan called the Chair of the Board and announced his intention to resign once a successor could be appointed, probably a physician. Financially he would be comfortable, but this was not the ending he had planned for.

So, to all you hospital executives, ask yourselves these questions: 

1. Are you prepared – professionally and emotionally for this type of dramatic transformation? 

2. Can you move beyond being a brick and mortar leader and began leading a market?

3. What skills will you need to develop to be successful?

4. How would you define your relationships with the medical staff? Are you a physician friendly/physician centered leader?

5. Is this the job you want?