Healthcare CEO and NFL head coach are both high-pressure, high-visibility, results-driven, highly competitive, and well compensated occupations with high turnover rates. Think twice before you answer.
By the time you read this, thousands of fans will have goosed the Thursday night TV ratings and have found out who their favorite NFL team picked in the first two rounds of the annual draft. The league itself devotes copious amounts of time and effort toward publicizing what a few years ago was little more than a little-hyped back-office function.
But the real action at the top of the organization in the NFL starts happening on Black Monday in late December or early January, when the coaching carousel starts up. Fans of unsuccessful teams over the recent year wait expectantly to see whether their team's head coach will soon be looking for work (and many hope he will be) and speculate on who could effectively replace him.
Successful teams watch as the unsuccessful poach the assistant coach ranks on their own teams to fill the vacancies.
This is no surprise. Professional football is the most popular sport in the country, by a country mile. The NFL has not yet turned the annual coach sacrifice into a media event—not yet.
Hired to be Fired
But fans, TV sports pundits, and talk radio hosts speculate on coaches' viability from game to game, from draft to draft, from practice to practice, and from minute to minute. Even the New Yorker pays attention to the remarkably short shelf-life of most NFL coaches. As a coach, no matter your previous success, you're hired to be fired, the saying goes.
It comes with the territory. Professional football coaching is a high-pressure, high visibility, and results-driven business, and success—or failure—is there to see for anyone who is interested. Head coaches also are highly compensated, which puts a microscope on their achievement—or lack thereof.
Source: Carr Consultants |
So what does this have to do with healthcare?
The average healthcare CEO tenure is shorter than the average NFL head coach's.
I was initially shocked to learn this. Hospital CEOs have worse job security than a group whose job security is constantly in question—and microscopically evaluated.
Turnover among hospital CEOs was historically significant in 2013. It has hovered between 14% and 16% yearly since 1981. But it spiked in 2013, to 20%. That means one in five CEOs was replaced in 2013, a record high.
Why is this happening at a higher rate than normal?
Well, put simply, healthcare is in a state of upheaval, and leadership is no exception.
Autonomy Waning
Let's dive in a little further and look at some reporting I've done on the issues behind this. Certainly, CEOs are, as a group, an older segment of the population. And like the rest of their demographic cohort, a huge number of them are part of the baby boom generation, which is nearing or at retirement age.
Consolidation of hospitals into health systems and health systems into bigger health systems is part of the equation. Many CEOs who once led these formerly independent organizations don't want to work under circumstances of reduced responsibility and autonomy, and hey, they're pretty close to retirement anyway, so why not bait a hook and get out the golf clubs?
Another issue is that many large health systems that had previously worked as a holding company are making the transition toward being more of an operating company now.
What comes with that is less autonomy for former CEOs, and increasingly, if they're being asked to stay, their jobs are morphing to other titles and most importantly, to other responsibilities that are more in cohesion with the strategy of the whole—not their own local agenda. That's dispiriting to many CEOs.
Healthcare is a highly regulated industry, of course, so even a great leader can have a tough time against competition that is becoming national and global very quickly. She can be hamstrung by state regulation that isn't keeping up with the evolution of the industry while competitors operate without those constraints.
Jobs Dwindling
He could be hard-hit financially by the fact that his state has decided not to expand Medicaid through the PPACA. It can be tough for a hospital leader to find a place for his or her organization in this rapidly evolving world of scale and value seeking.
Further, the healthcare industry is morphing toward being less hospital-centric, and that means healthcare leadership is morphing along with it. Talent is needed that can develop sticky ways to interact with, and ultimately better serve, the patient in a more holistic manner than hospitals are used to operating.
That's a bigger deal than it seems—as coordination of care with entities outside the hospital becomes increasingly more important, talent is following the trend. Hospitals are not a growth industry anymore, and increasingly talent doesn't see hospital leadership as an end in itself, career-wise. In many respects, given the increasing pressure in the job and reduced autonomy and responsibilities, maybe it's not even a means to an end anymore.
Finally, there are simply fewer CEO jobs out there. If you lose your job as a CEO, there are fewer landing spots.
A well-worn joke is that the NFL stands for "not for long" if you don't produce. Hospital leaders these days understand that better than most.
Philip Betbeze is the senior leadership editor at HealthLeaders.