For many years I have belonged to a national network of healthcare executives. In recent years, after serving in 15 hospitals in nine states as an interim healthcare executive, I have become a "go-to" person within the network for people who are considering interim management work.
Nearly all managers who have called me seeking interim management were not currently working. Some are considering doing interim work temporarily as they search for a permanent position while others have chosen not to seek a permanent job because doing so would require them to relocate their families.
Interim management positions offer a "test drive" period for both you and the client hospital for potentially converting you to a permanent role. I recently learned from a company that provides interim healthcare managers that 31% of their interim placements converted to permanent employment in 2008. In 2009 the company's conversion rate was 45%. Another interim placement company that prefers to hire people who are only interested in interim assignments has a conversion rate less than 5%. Regardless of your decision, at the end of your interim assignments, you will have at least gained additional knowledge and skills for your next position, be it interim or permanent.
The interim manager's lifestyle
Whatever your reason for considering interim work, one of the first questions you need to address is the effect on your family and friends of your being absent from home one to two weeks at a time, possibly for several months. In addition, working away from home can be a lonely, trying experience. You will be among strangers in a new community and should expect to be treated as such. Don't expect to be invited into people's homes and churches, especially if you have not bought a house and moved your family.
Just finding your way around in a new town and hospital building is often time-consuming and annoying. Traveling home on weekends can be frustrating and exhausting. Obtaining suitable temporary quarters is an important priority no matter how busy your early days may be. You may find yourself doing your own cooking, housekeeping and travel arrangements. The appropriateness and costs of your accommodations should be based on the length of your assignment and be approved by your client.
Once settled, you run the risk of working, eating, and drinking too much while sleeping and exercising too little. Personal discipline and good time management are required to establish a healthy balance between your work and leisure time.
Finding interim work
The market for interim healthcare managers is growing, but the competition for interim work remains tough. There are many more people willing to take interim managerial positions than there are interim opportunities. Candidates with broad experience in several settings will be more attractive to prospective employers facing a temporary period of leadership transition. A progressive record of achievement within one organization can reflect this kind of experience and may fit a client hospital's needs. Consider rewriting your resume and cover letter before presenting yourself for interim work to highlight your adaptability and success in completing a variety of deliverables on time.
Several companies specialize in providing interim healthcare managers. These companies can be found through an Internet search. Your professional organization or network may also be able to provide you with leads. In addition, some consulting firms retain interim managers either as employees or as independent contractors to be used as the need arises. Finally, some executive search firms that primarily focus on permanent placements may occasionally be asked by a client to provide an interim manager during the search for a permanent replacement.
Interim managers can be either salaried employees or work as independent contractors at a daily rate. Living expenses and travel arrangements are negotiable and typically include reasonable allowances for meals, a place to stay, car rentals and airfare. If you serve as an independent contractor you will be responsible for providing your own personal insurance coverage. Before you begin an engagement it is essential to have a written agreement with the client or firm that retains you. Interim assignments are intended to be flexible for the client, and can end suddenly and unexpectedly. I recommend that the documented agreement with the client include at least a 30-day notice by either party.
Assessing the client
You are taking a professional risk when taking on an interim assignment because you can never know exactly what you are getting into. You should enter into an assignment as well informed as discretion permits. Have your questions ready and insist on answers from the client. This includes knowing the circumstances of your predecessor's leaving. Obtain as much information as possible about the client and their needs. Interim assignments are often offered with short notice, so you may not have much time to complete your due diligence. Try not to settle for the standard public relations package or a visit to the company Web site.
When working for an interim management company, you will probably report to a project leader who will serve as your initial resource for your assessment. The project manager may have already done an assessment or had one done by another member of the company. These assessments are usually very helpful in the short term. But in a complex and dynamic environment like a hospital, initial written assessments risk being incomplete and become out-of-date quickly. As an experienced professional you have a duty to yourself and the client to do your own due diligence.
Charles K. Van Sluyter is a former hospital CEO and has worked for several interim management companies, including Cambio.FTI Healthcare, the Hunter Group and Quorum Intensive Resources Group. He may be reached at cvansluyter@yahoo.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Speaking to supporters at a fund-raiser, President Obama presented a plan to move forward with comprehensive healthcare legislation, the New York Times reports. President Obama said that he wanted to meet with Democrats, Republicans and independent experts, lay out the facts for the American people and then, he said, "I think that we have got to move forward on a vote." He also said that he would take the time to refute false statements and misunderstandings about the healthcare legislation and to hear alternate ideas from Republicans, the Times reports.
In her column published in the New York Times, Pauline M. Chen, MD, says that in the busy day-to-day pursuit of becoming a good doctor, she had "telescoped in on the clinical details" and neglected to embrace the social and economic aspects of healthcare. She cites a 2009 report showing that the vast majority of students felt they had received adequate clinical training during their four years of schooling. But fewer than half felt they had had adequate exposure to healthcare systems and practice, which includes subjects like medical economics, managed care, practice management, and medical record-keeping.
Jacksonville, FL-based Baptist Health said it has merged existing neurology practices and hired new staff to form Baptist Neurology Group. It will be a nine-doctor, three-location neurology practice that will ultimately be consolidated to a dedicated inpatient unit for neurology and neurosurgery at Baptist Medical Center.
The American Medical Association has developed a new Web site registry to help coordinate the deployment of physicians who are willing to volunteer with federal and private sector response organizations in Haiti. The information physicians provide through the registry will be used specifically for disaster response deployment to Haiti, and it may also be used should future disasters occur around the world, according to the AMA.
Innovation has become one of those buzz words that connotes different things to different people – newness, discovery, or perhaps an advance in technology. But no matter how it's defined, constant innovation has undoubtedly brought the science of medicine to dizzying new heights, and we are all beneficiaries of an ever-improving healthcare system.
Unfortunately, many of these improvements have also been blamed for exacerbating the systemic problem of rising costs. The result is a longstanding contradiction in our attitudes toward healthcare--new technologies are both embraced as a lifeline to better medical care and vilified as a determined path to self-collapse.
Making sense of this paradox requires that we first understand that innovation is not just about new breakthrough technologies, but more importantly about how those technologies are used. The technologies themselves can be quite simple, but the accompanying changes they create in the workforce are responsible for transformative changes throughout entire industries.
Below are a few historical and forthcoming examples of these "disruptive" innovations that illustrate how the cost-quality paradox in healthcare can be resolved by enabling the delivery of quality care that is also more accessible and cost-effective.
The balloon catheter created an entirely new field of vascular interventionalists by making it possible to treat diseases that were previously amenable only to risky and expensive surgery. What started as a low-tech device eventually became much more sophisticated with subsequent add-on technologies, particularly stents and drug-elution, and catheterization has proven to be the preferred mode of treatment for increasingly complex vascular diseases.
More importantly, the new interventionalists did not come from the same highly-skilled—though expensive—pool of surgeons, but rather they came from a less-costly and more numerous set of providers known as cardiologists. This was vital to making this new treatment both affordable and widely available.
Edwards Lifesciences Corporation's transcatheter heart valve is a more recent attempt to redefine the landscape of the healthcare workforce, potentially adding to the growing legion of interventional radiologists, cardiac electrophysiologists, virtual colonoscopists, and other fields enabled by disruptive technologies. And these changes don't always require a new crowd of cross-trained specialists. The advent of portable ultrasound systems meant that obstetricians, cardiologists, emergency medicine physicians, and others didn't always have to refer patients out to a radiologist.
More recently, Ethicon Endo-Surgery is aiming to introduce a computerized sedation system that will allow minimal sedation during GI endoscopy without the supervision of an anesthesiologist. By reducing the number of specialists or referrals involved, these innovations promise cost savings, as well as added convenience for patients.
On the other hand, the money saved by replacing one or several doctors with another type of doctor seems marginal when compared to that saved by technologies which help obviate physician intervention altogether. Some of these devices fall under the "set-it-and-forget-it" variety, such as implantable cardiac defibrillators and insulin pumps. These require surgical intervention for implantation, but subsequent monitoring is minimally taxing compared to the alternative. Similar devices such as Medtronic's implants for treating seizures and chronic neuropathic pain all hold promise to greatly reduce the need for constant medical intervention.
Even more noteworthy, however, are technologies that empower non-physicians and patients to do for themselves things that they used to rely on professionals to do for them. Nurse practitioners, armed with point-of-care diagnostics and evidence-based treatment algorithms, have proven to be more than capable of providing basic medical care in retail clinics conveniently located in pharmacies, grocery stores, and retail outlets. As their arsenal of diagnostic tools expands, so will their patient pools.
The safety hurdle is much higher for developing care routines which patients can manage themselves, but the potential for impact is enormous. NxStage's home hemodialysis machine, Invisalign's invisible braces, and Hill-Rom's chest wall oscillation vest (used to clear bronchial secretions) all rely on patients or their family members to use the devices on their own.
Direct-to-consumer genetic assays from 23andMe and Navigenics are newer additions to a market that already includes more widely-used diagnostics like home international normalized ratio (INR) and early pregnancy testing. There are a number of well-intentioned skeptics whenever patient-directed care is discussed, but lest we forget, we already rely on millions of diabetics to manage their own insulin regimens using home glucose meters.
Further, empowering patients doesn't simply involve sophisticated devices and diagnostics. HealthPartners in Minneapolis allows patients to schedule their own clinic appointments online, Kaiser Permanente e-mails test results to their patients at the same time as their doctors, and a growing number of systems, including Palo Alto Medical Foundation, provide their patients with online access to their medical records. This democratization of access to information is vital to getting patients more involved with their care and will serve as the gateway to future products, such as personally-controlled, fully portable electronic health records.
Few of these innovations involve breakthrough technologies. More often, they are old inventions repurposed and simplified in such a way that they open up access to a broader set of users. It is this reinvention of the workforce surrounding the technology that has immense impact on lowering costs and adding convenience, and this is where innovation in healthcare really gets interesting.
There are a host of physician assistants, nurse practitioners, clinical pharmacists, and other allied health personnel just waiting to take on more lucrative responsibilities, not to mention a burgeoning group of patient "participants" wanting to manage more of their own healthcare. They seemingly fight an uphill battle against physicians who express fears for patient safety (or perhaps for their own livelihoods), but in the long run, it is the physicians who face the tougher fight.
Disruptive innovations like retail clinics, direct-to-consumer diagnostics, and patient-controlled electronic health records may seem like radical threats to the system, but they merely represent a continuation of changes in the healthcare workforce that have always shifted toward accessibility and affordability.
In the end, these innovations should not simply be viewed as threats to physicians and their hard-earned careers, but as opportunities for them to focus their talent and abilities where they are most needed. Interventional cardiologists may treat most single-vessel coronary artery disease patients nowadays, but we must still turn to cardiac surgeons for more complicated cases and ones in which percutaneous intervention has failed.
If surgeons were occupied with managing all cardiac interventions, there would be many sick people without access to care. Likewise, if we can use technology to release anesthesiologists, radiologists, primary care providers, emergency medicine physicians and every other physician from activities that could be safely performed by a less-costly individual, access to health services would be less of a problem than it is currently.
Finally, how quickly these changes come about ultimately boils down to money. The medical payment and reimbursement system in the U.S. has created incentives for providers to continue offering services that could be done by someone else. More importantly, there are disincentives to take on more complicated cases that offer little or no additional compensation.
Thus far, the solution to these market distortions has primarily been to cut payment rates whenever possible – and as far across the board as physicians will accept. However, if we are to expect cardiac surgeons to manage only the most complex cases, anesthesiologists to focus on the high-risk patients, and primary care physicians to coordinate increasingly fragmented care, we must pay them accordingly.
Investment in the right kinds of innovation–not blanket cost-cutting–is the path to better quality and affordability, which do not have to be mutually exclusive. By understanding what innovation means to healthcare and the types of innovation that ought to be supported, we can all be better off than we are today.
Jason Hwang, MD, is the co-founder of and executive director for healthcare at Innosight Institute, a not-for-profit think tank devoted to applying the theories of disruptive innovation to problems in the social sector. He is the coauthor of The Innovator's Prescription: A Disruptive Solution for Healthcarewith Harvard Business School Professor Clayton Christensen and the late Jerome Grossman, MD.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.