Wednesday, May 09, 2007

For Students -- Breaking into the club

Our Wednesday series continues with responses to questions from students. Erik asks below:

I have just finished my undergrad in Sociology and will be pursing an MSc in Health Management this fall. As one of the few students in the programme coming directly from undergrad (and without a medical background), I decided to intern with Senior Management at a hospital.

One of the issues for me is that everyone, except for the CFO, comes from a clinical background. When I look at many of the VPs, much of their learning progressed as they moved through various clinician roles and eventually into Senior Management. As someone who will not move through these clinician roles, but is nonetheless interested in working in hospital management, what core competencies should I be focusing on during this short (6 month) internship?

I do not think that someone is going to be trained in core competencies during a six-month internship. I think you take an internship to get exposure to a certain type of institutional situation, to meet interesting people, and to have a chance to "show your stuff." Rather than trying to learn one specific thing or another, go into an internship that provides you with an opportunity to take on a specific project, where you will have responsibility for a reasonably hard, but doable, assignment -- and then get it done well.

You will, of course, learn things along the way, but the more important thing will be that you will demonstrate to a set of senior managers that you are thoughtful and competent. This very often leads to a request to stay with the organization in a more permanent capacity. If it does not lead to that, it nonetheless provides you with a credible reference for your job search.

On the larger issue, there remains a prejudice against hiring non-clinical people in hospitals. This stems from several ill-founded beliefs. The same phenomenon occurred in many industries and only changed over time because the supposedly "expert" job candidates were found to be incapable of guiding their companies through the shoals of structural change. This was because they were promoted into positions of authority based on the qualifications of their discipline rather than the needs of their organizations. I have watched it happen in electric utilities, telephone companies, water utilities, steel companies, auto companies, and many others.

I'm not saying that non-clinicians are necessarily superior managers in a hospital setting. (The jury is still out in my case, for example.) I am saying, though, that non-clinicians can bring a useful perspective and aspects of managerial experience even in the highly technical world of medicine. The way for you to prove that, though, is to get into some position -- virtually any position -- in a hospital and prove your merit. Trust me, you will be noticed, and you will advance.

(By the way, isn't it interesting that the last positions filled for CEOs of three Harvard teaching hospitals -- BIDMC, Massachusetts Eye and Ear Infirmary, and the Joslin Diabetes Center -- were not doctors? All three places faced major structural problems, and the Boards felt that managerial experience trumped a medicine degree in their selection process. We'll see if they made wise choices.)


Dan Schawbel said...

I had a total of 8 internships during college and they involved a small degree of training, but nothing special. The idea is that managers who recruit interns are looking for them to do common tasks without the need for training.

Rob said...

I have to take exception to one thing here.

To take one example, the auto industry, General Motors was badly hurt by abdicating its upper management to "bean counters" who saw no reason not to make entire lines of cars identically across the various brands. They didn't understand that value does not equal cheapness does not equal cost saving. They did not understand the balance between business and craft.

Balance is the key. I absolutely believe that one can never have too many smart people around. It's the organizing principles that count. These define the priorities which, to work, have to be balanced between the rational and irrational. Between counting the beans and helping people because it's right.

I don't discount the importance of business-style perspectives, but I don't agree that those who rise from below are necessarily defective managers. I think they need very strong guidance to step into those roles without exhibiting turf-defense.

Paul Levy said...

Often true, which is why people who are looking for internships should really do their homework and make sure there will be something interesting to do.

Anonymous said...

In addition to taking on a special project, I would recommend setting up a schedule of rotations through various hospital departments during your internship (ie nursing, food services, environmental services, etc). This will give you the opportunity to see first hand if a hospital is the sector of the health care industry that you want to work in.

I would also recommend getting exposure to different types of physicians, ie primary care, medical specialists and surgeons. Physicians are very important to a hospital because they are the individuals who admit patients and don't ever forget that.

John Norris said...

Is there value in volunteering? It may be an easier way to get one's foot in the door.

The downsides that I see are that you would probably not get the kind of projects where you can show what you can do. You might also carry the stigma of being a volunteer, and not an Intern. I might be wrong here...

Any volunteer postions folks might recommend to get an idea of the over all workings of a hospital, or places where one can show what they can do / network?

Paul Levy said...


Volunteering can be a great way to get to know an organization, but the chance of being given authority for an important project is very small.

Maxine said...

On the question of whether or not medical people should be CEO's, I say no. As previously mentioned, I'm on the Board of a state contracted non-profit day care center. the previous director had all the qualifications of a Day Care Director, but did not have a business background. He came very close to running it to the ground. He had no idea about running it as a business, not necessarily for profit, but to not fail. You can bet the present director has, and whomever replaces her will have, a business background. It took too many years of hard work and fundraising to bring it out of the hole it was in.

Current Administrative Fellow said...

Internships/Fellowships offer great opportunities to meet mentors within healthcare organizations. Every early careerist need good mentors to settle and suceed in conservative business like healthcare.

Anonymous said...

Sometimes we forget...We are not selling automobiles. Healthcare has a certain amount of "calling" associated with it. Thus, it has been proven time and again that the best VP's and Directors are most often professionals with strong clinical backgrounds; Nurses, lab, and radiology managers.

It's a heck of a lot easier to get a person with a strong clinical background trained in the theory and practice of management than it is to take a career manager and put them in a position where their lack of clinical experience is a handicap.

I'm a big believer in leading from the front, and as a lay-person trying to lead a health-care organization, there's just too much disconnect for that to happen. You need to speak the same language as your staff.

Paul Levy said...

I disagree. We have excellent lay-people who are incredibly successful in leading clinical areas of our hospital.

Anonymous said...

Don't misunderstand me...We have lay-people here too, and for the most part they do an excellent job. Also, there are areas where clinical experience is less of an issue...Purchasing, dietary, etc.

There are certain business models that can be applied to segments of healthcare; Service line marketing, labor relations, process improvement, cost containment. But I have found that they need to be distilled and molded to fit the world of healthcare. Too often, it's the healthcare system that's being asked to mold itself to the business model. This causes needless friction and wasted energy.

I could be wrong. Rather than someday being a CEO BECAUSE of my allied-health clinical background, I'll just have to settle for being a CEO IN SPITE OF it. And, I'll have a blog too. Great idea.