Thursday, November 03, 2011

Entitlement or naïveté?

I make it a practice of saying, "Yes," to any student or young professional person who wants career advice.  This serves two purposes.  One is to provide (hopefully) helpful assistance to someone starting his or her career.  The other is for me to be rejuvenated by the energy and idealism of the next generation of community leaders.

This week, a person who is involved in health care consulting at one of the big firms sought advice about how to move from that environment to a job "somewhere in the provider-payer space."  (By the way, I hate the term "space" when it is used in this manner, but I have learned to expect it from consultants and venture capitalists.)

The person thought that the ideal job would be to join the internal strategic planning group in a large academic medical center.

I advised against this.  I pointed out that such groups are often marginalized in AMCs.  They tend not to be respected by the doctors and nurses, because they are viewed as not understanding the obligations, work flows, and other issues associated with delivering clinical care.

I suggested, instead, that this person seek a "line" job in a hospital, helping to run an ambulatory clinic or some other operational role.  "Learn what it is like," I said, "to organize how care is delivered, dealing with nervous patients, stressed out nurses, and doctors with strongly held views.  Over time, you will demonstrate good work and initiative and how make changes.  Based on that, you may be asked to participate in task forces that help set the strategic direction for the hospital.  By then, too, you will be known and respected by clinicians and therefore less likely to be marginalized."

The response was firm and immediate: "No, I don't want to do that.  My salary would take a cut, plus I want to be involved at a higher level in the institution."

I was struck by this.  Just a short time out of MBA school, followed by a stint as a consultant, this person was confident s/he would provide value in the corporate planning function of the most complicated type of business in the world.  Whatever happened to the idea of starting low, learning what life is like on the front lines, demonstrating ability, and working one's way up the ladder?

Instead of being rejuvenated by the energy and idealism of someone in the next generation, I felt like I was facing an overabundance of entitlement.  Perhaps, though, I took it the wrong way.  Maybe it was just naïveté.


Barry Carol said...

I think what you saw is a combination of entitlement and arrogance. Many large operating companies like General Electric shy away from Ivy League MBA’s precisely to minimize that mentality among their new entry level management hires.

Beverly said...

From Facebook:

This person is right in the job where s/he belongs and should stay there.

Andy Tarsy said...

I hear this and see this all the time. Very hard to break through it.

One "group" that I was not exposed to until the last couple of years that totally defies this trend is entrepreneurs. There is a subculture of idealistic, talented go-getters (many have fancy degrees too, including MBAs) who seek to create value and to be more creative and ingenious than their competition 24/7.

Many also have an un-self-conscious way of saying they are trying to make a difference via their execution of a new idea.

@paninya_m said...

From Twitter:

Thank you @Paulflevy for the post! Honored to have my plan endorsed -- 1st yr MBA student planning on going to Gemba!

Paul Levy said...

Brava, Paninya!

Paul Levy said...

Right, Andy! They are fearless, but in an engaging and fun way.

Jesse said...

I, like you, coached soccer (elementary school level in a rec league) for a number of years, so I suspect you are familiar with the phenomenon that "everyone gets a trophy for just showing up." There is a lot of talk (and writing) that this kind of philosophy has created a generation entering the workforce that believe they should be treated as stars without having to actually demonstrate their ability. Likewise they should be able to enter as leaders because they have been told their whole lives how great they are (i.e. most everyone is on the honor roll, so long as you have no grade below a "B"...Seriously?!?!).

I believe that is the definition of entitlement.....(which I guess votes for your naïveté for being surprised by this...)

David Joyce MD said...

As a MD MBA having one more expert in the corporate planning suite will get us no where. All physicians need to learn basic business. It is not hard to understand strategic planning in a step wise orderly process. Yet physicians, who can really make the difference, will never be taken seriously because they do not have the business skill. But they can learn it without an MBA.

NE NoseDoc said...

Commenting as a faculty member in an AMC in the Northeast: what this young man/woman doesn't seem to understand is that at most AMCs the biggest currency is credibility. I think this is why right or wrong physicians involved in patient care actively or remotely move up in the ranks. I agree with your advice wholeheartedly....hopefully he/she will see the light of your advice. He should probably stay in the consulting "space".

Andy Tarsy said...


The issue is really not whether all get trophies or not; rather it is whether all players are cultivated to love playing whether they are the champion or not. The premise that champ=validation and not champ=not is ridiculous as a matter of math never mind human development.

When coaches get that right, there is no sense of entitlement even when teams lose.

So to connect to Paul's point and yours - young professionals (maybe in every era) who are brought up with a particular lens of what = value are going to see opportunity through that lens. Its really shame on us, not just on them, if we teach like the coach who lets the kids believe winning=trophy.

Cant say it as well as Coach Taylor on Friday Night Lights but he had it right.

Anonymous said...

It makes complete sense for a young professional nursed on elite education and corporate offices to want a comfortable seat at the top of the food chain. They have been cultivated for just that position, if not for the responsibility and power that comes with it.

The disconnect between consultant knowledge and the very complex and human realities of work and care parallels the distinction that often exists between science and intervention.

Once upon a time, tradition had it that anthropologists would spend at least one year, often more, in the field observing, describing, living and working with people before they could call themselves a 'student' of the culture. It is the raw world facing you, not a textbook, when the plane takes off and you are not on it. 'Development,' on the other hand, might sweep in with officers and equipment, and an airplane warming on the tarmac to take away the 'experts,' as just delivered 'solutions' begin rusting in the forest. How many providers wonder 'what am I supposed to do with this?' How many patients wonder why each visit becomes more complicated, rather than less? Why not put systems improvement training resources into the human capital that already exists? Why perpetuate shallow rather than deep and broad knowledge?

Healthcare needs people who deeply care about the people who are served and who serve. It needs leaders at every level with the strongest sense of intellectual curiosity and humanity. Every job description should first begin with this.

On the other hand, I can whip up a strategic plan in a heart beat, if you need a fix. And I'll overcharge if you would like me to.

Robin Eichert said...

Like the others who have commented here, I agree that nothing replaces the respect one earns from performance. Having the mindset of the individual you describe will always limit his potential.

Anonymous said...

I believe time spent "in-the-trenches" provides the foundation and experience you need to confidently move up the career ladder.

Holly said...

I had the same discussion at a meeting today. One of the things I do in my spare time is work on the substance abuse committee for the Board of Registration. Three of us on the committee got into the discussion today that this younger generation does no like to hear the word no, and the entitlement issue is often out of control, such as "no these rules are meant to be followed by everyone, including you!"

Sometimes I feel like I am doing parenting 101 all over again.That being said, there are a lot of great people to be mentored and we should not forget our role in this process!

Anonymous said...

Preach it, brother; preach it.... I saw it all the time in Pharma, especially the last 10 years or so, across all companies.

It's not just you.

Paul Levy said...

From Facebook:

Marilyn: Entitlement +naïveté = arrogance.

Alex: Whichever it is, it is nonetheless nauseating.

Paul, You are seriously forgetting that students come out of school with a large amount of debt. Any pay cut is simply not something some people can do. This is not a case of arrogance or naiveté. We are all in a rat race to get out of our situations in the quickest way possible. I know that mid-level managers do not make much in terms of salery and often they have very limited resources to make a difference.

As a peer of this person, I would advise them to stay where they are and to try to get on more involved consulting projects and they could easily become involved in some clinical problems.

The younger generations have no mentors and that is one of the main problems.

Alex: Failure is a fabulous teacher. Time for one.

By the way, I have sent out e-mails for mentorship and some "professionals" don't even respond. Maybe you should also include them in your post on "entitlement and naiveté". Thanks!

Sometimes advice like that lingers in the back of someone's mind and comes forward later as a great idea (not yours but theirs). Late hearing is a very interesting and powerful way of communicating with people who aren't getting the answers they want.

John said...

Good advice. There's no substitute for hands-on, front line operating experience, whether it be in a hospital or, in my instance, starting up and running chemical plants (which is what I did for several years before finishing an MBA at night, then joining a consulting firm.)

Mary said...

I always enjoy your blogs. This one made me wonder though if you’re hanging out with the wrong young people.

Check out some of the MIT, BU, NEU activists down at Occupy Boston. (Step over the homeless who have sought refuge there, having moved over from South Station where they hung out previously).

They’re a very optimistic, take charge, group of independent thinkers concerned about creating a better world for themselves and I really believe concerned for the common good.

Adam Joseph said...

As a young student myself, I can relate to his over-eagerness. I do not think that this ambition is necessarily arrogance in everyone, however. He may not feel that he is better than the people doing "front-line" work, but instead may feel better equipped to help in the higher levels of administration.

But I definitely do understand the value of being on the "front lines". My professor recently told my class that "the best way to understand anything is to live it". Even in my experience working in high school, that was the best experiences I had.

Very well put, Mr. Levy.

Denise Vincent said...

I'm inclined to agree with Andy about coaching. When you're operating as part of a team, entitlement is basically meaningless. However, I'd guess that naivete is a bigger problem for the young MBA than entitlement. This young person has not yet learned that Culture Eats Strategy (for breakfast, lunch and/or dinner, your choice). All those shiny MBA skills account for maybe 20% of success on the job. The other 80% of success depends on building relationships and navigating the organizational culture. It's a lot easier to learn those skills working on the line than hanging with the other suits in Strategy. I think your advice was dead on, Mr. Levy.

Diana said...

You weren't naive, you were spot on. You can't possibly be a good consultant in hospital operations or in any function of hospital business unless you've "walked a mile in their moccasins". Before I accept a physician to treat me I recommend they watch the movie, "The Doctor". More people need to go back to the way "we" were brought through the trenches.

Anonymous said...

Isn't it interesting that medical schools graduate 25-year olds each year who have more power over our bodies than any strategic plan?

Following the same logic, shouldn't med students spend a few courses lying in a hospital bed hooked up to a dozen tubes, or sit for 8 hours in an emergency room with nothing to eat and or to console? Shouldn't their teachers test them on what feels like quality from a wheelchair?

Why in the world would we expect patient-centered care from this curried population of professionals? Isn't this also the great disconnect between provider and patient?

Pamela said...

This is such a huge problem in healthcare that very few people seem to recognize. There is a path to leadership (and to consulting "expertise") that is completely divorced from "line operation"-- i.e., the clinical side of things. People make decisions as though their theoretical knowledge substitutes for a hands-on knowledge of their operation. And clinical folks often feel they are "above" the business nonsense and so they go along their own way, assuming non-clinical leadership is clueless. And non-clinical leadership think clinical folks are clueless. Sigh. This is a strange industry.

Paul Levy said...

Dear Anon 11:38,

A very good point. Every now and then, I see an article published by a doctor who has been hospitalized, describing with surprise how unempowered and vulnerable s/he felt in that setting. Usually, that person is 50+ years old, and it is the first time they have had the experience from the patient point of view. Being on "the other side of the bed" during training would be a useful exercise.

Anonymous said...

I am confused. I think your advice is good in general, but I don't feel I have enough information to understand if it really answered the young man's question.

1. It seems harsh to call his desire not to take a pay cut "entitlement". When you are already making a certain amount and can continue to do so, it is not entitlement in any sense of the word unless you felt he was overpaid to begin with.

2. What was the status of your internal strategic planning group when you ran an AMC? If these organizations are marginalized and yet pay big bucks, there seems to be a failure here. Also, high compensation is not usually aligned with marginalization. I have served on internal task forces and the only time your voice is heard is if you are passionate, respected, AND willing to put in a huge amount of uncompensated time. Is it possible that even a marginalized strategic person doing the work full time may have a bigger overall effect than a line person serving on task forces over and above their regular duties?

3. Finally, it is possible that our culture has changed to the point where there is no point in climbing the ladder. Income inequality is at the highest level in a century I believe and income mobility is at its lowest level. I don't necessarily think this is so, but it might be that your idea of how to make it is no longer applicable.

Paul Levy said...

1 -- It is always nice to earn more, rather than less, money. But if you really want to make a ocntribution in this environment, you need to spend time learning the place and gain the knowledge necessary to do so. YOu can't just walk in and say, I am worth so many $, so pay me to impart my knowledge.

2 -- We didn't have a separate group in our place. The Chiefs and VPs were the strategic planning group.

3 -- I don't agree we have gotten to that point. People move up the ladder all the time in hospital settings, based on accomplishment, skills, knoweldge, and interpersonal skills.

Mark Graban said...

As somebody who has always worked with front line people in healthcare (and back in the manufacturing world), I don't see the appeal of working on "strategy" (and I say this as an MBA graduate). Why would an organization put an inexperienced person in a strategy role? This has always puzzled me.

Anonymous said...

I am a young professional person, and I want you to know that you were not so naive. I have worked in policy for a while and I came to your exact conclusion. I am in the process of leaving in favor of "line work" so I may gain the knowledge and skills needed to identify and enact change.

I will also soon become a young person asking for advice. I'm glad to know you have a hard time not providing it...

Paul Levy said...

I was not suggesting that I was the naive one, but thanks!

Anonymous said...

You gave sound advice. A person from the consulting world without time in the trenches will not have credibility in a hospital. Period. Strategy takes vision and you can't have that if you're blind to the whole picture.