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Are you doing what you love to do?  Are you any good at it — are you in the top 10 percent performance-wise of hospital executives in the country?

If you are not consistently a top performer, then prepare yourself for the probable bad news — your career will not go the way you envisioned it when you started your journey. You may have to find a different line of work, either in healthcare or some other field, or retire early.

The sad part of this analysis is that far too many healthcare executives — actually, executives in any industry — keep plugging away because they are either misguided in their self assessment of their performance and value, or they simply do not know what else to do.  As I have written several times over the past year, the transformation of America’s healthcare delivery system will exact a high toll on those who are not at the peak of their game and now, before the mass disruption occurs, is the best time to create an alternative career strategy.

“Many people die with their music still in them.  Why is this so?  Too often it is because they are always getting ready to live.  Before they know it, time runs out,” said Oliver Wendell Holmes, Sr., an American physician, poet, professor, lecturer, and author who lived in Boston in the 1800s.  The first time I heard that quote it struck me as so profound and so very sad — that people would fail to realize their dreams because they lacked the know-how, the courage to try, or both.

Several years ago (pre-PPACA) when I spoke to graduate healthcare students at a top university, I probably earned the ire of my host when I said, “The career you thought you would have, the career you are preparing yourself to have (most wanted to be hospital or health system senior executives) will probably not be the career you end up with.”  The emphasis in healthcare will shift from running big hospitals to managing the healthcare for geographic regions or population groups, I added.

The students reaction to my provocative statement — noticeable twitching in the chairs or a renewed focus on their Facebook page or email — reminded me of an event much earlier in my career that serves to provide a stark contrast in the importance of hospitals then and now.  I was a vendor attending a healthcare national conference.  Hospital executives were wandering around the exhibit hall sporting name badges with curious numbers in the upper left hand corner — 323, 425, 908, 1044, 75, 125 and so on.  The numbers were too large or too odd to correlate with discussion panels or anything else I could think of.  When I asked one executive whose number was particularly high — north of 1,000 — he proudly declared, “That is how many inpatient beds I am responsible for.”  Clearly there was a pecking order based on how many beds your hospital had.

That old order is about to change.

Today we know that bigger is not necessarily better.  Bigger will certainly be more challenging, if not prohibitively expensive to operate, and the downsizing of beds and the number of hospitals will create fewer leadership career opportunities in that traditional setting. In other words, as in the game of musical chairs, there will not be enough hospital executive jobs to go around.

For some, striking out in a new direction fuels terror in their hearts.  They are paralyzed with fear, not because they are defective human beings, but because God did not make all of us equal in terms of our ability to tolerate risk, or the creative imagination necessary to bring to market an idea or product from concept to reality.  But even if you are not a creator, you must be opened minded to the ideas and products of those who are.  There will be new technologies and service strategies to deliver healthcare in the new population health management environment that is fast approaching.  If you are unhappy and/or struggling in your current career path, look to the future and allow yourself to research a new phase in your career journey.

Home care, mobile healthcare, long-term care, and technology services to support those endeavors will all need top talent.

Do not turn up your nose.  There will be so much reward in these and other new businesses.