TRANSITION: FROM THE CLINICAL TEAM TO THE EXECUTIVE TEAM

1. TRANSITION: FROM THE CLINICAL TEAM TO THE EXECUTIVE TEAM Richard J. Flaksman, MD, MBA, CPE Vice President Medical Affairs Marion General Hospital

2. This poster describes a journey from 33 years of full-time neonatology practice to full-time hospital administration

3. Education College: BS 1970 Medical School: MD 1974 Pediatric Residency/Neonatology Fellowship Completed: 1978 Post-training Career Experience Children’s hospital-based Level III NICU (14 years) Regional hospital Level II NICU (5 years) Owned private practice (16 months) Four subsequent Level II NICU positions (13 ½ years) All positions, except the self-employed, were salaried All Level II employments were by the respective hospitals

4. Each venue was accompanied by increasing non-clinical responsibility: • Medical Director, Neonatal Transport • Medical Director of fledgling Level II NICU (as part of Level III position) • Medical Director of subsequent established Level II units • Administrative Director of one of the Level II’s • Chaired Department of Pediatrics in two facilities Committee experience, either separate from, or as a result of, the above responsibilities, included: • Utilization Review • Medical Records (also chaired) • Ethics (also chaired) • Credentials • Peer Review • Med Exec • CME • Transport

5. These experiences revealed a flair for certain administrative aspects of medicine, with one notable exception: Lack of understanding of the “business” aspects of medical practice, both private and hospital-based As a result, the private practice completely failed, resulting in substantial loss of time and money. Also, it was occasionally a struggle to understand the business processes and “language”. It became apparent that sustained successful blending of clinical and administrative activities required further education.

6. EDUCATIONAL OPTIONS CONSIDERED • Pick up “basic” knowledge, e.g., finance, quality, HR/legal and others? • Obtain a graduate degree in business, management, public health, public policy? • Which organization or institution of higher learning to consider? • ACPE • ACHE • University

7. OTHER POINTS TO CONSIDER • Time required vs. time available Continue to work fulltime AND take courses? • Cost Reimbursable? Educational tax deduction? • If coursework, “live” (e.g., conference) or off-site? and most important: HOW AND WHERE DO YOU APPLY WHAT YOU LEARNED?

8. FIRST EDUCATIONAL ENDEAVOR: Started taking ACPE courses, beginning with Physicians in Management (PIM) in April 2003, combination of live and online Shortly after PIM, decision made to qualify for Certification in Medical Management (CPE), thus took exams following each course (see below) Completed 150 CME hours of coursework (required for CPE tutorial) in April 2004 Attended CCMM Tutorial September 2004, achieved CPE designation Costs covered by contracted CME allowance, live courses attended using vacation and CME time

9. GRADUATE DEGREE DECISION 9 Spring 2001: Received postcard from Regina University advertising an MBA for Physicians, to be completed entirely online. Over the next several months started researching the idea of on online MBA, consulting various websites which had compiled information concerning schools, courses, admission requirements, costs, etc. Decided to pursue graduate degree of some kind: MBA, MMM, MHA, MPP? Some schools required GMAT in addition to standard requirements and GPA, others did not. Elected to forgo the GMAT as well as other prerequisites. Due to successful experiences with online ACPE courses, as well as time constraints of clinical duties, decision made to pursue a degree where campus time was NOT required.

10. GRADUATE DEGREE DECISION (cont’d) Summer term 2001: Took course in “Research Methodology” at Indiana Wesleyan University Further pursuit of graduate degree interrupted for two years by family illness. Subsequently began the ACPE coursework leading to the CPE. Coincidentally, this also led to qualification for application to the three schools offering the MMM, and to the newly-affiliated UMass MBA program. After studying school websites, communicating with physician colleagues, hospital execs and the MMM and MBA recruiters, decided to pursue the MBA at UMass. Took one course per semester starting with the spring of 2005, graduated in the spring of 2009. All costs but the last year borne out of pocket (~$21,000)

11. IS THERE LIFE AFTER AN ADVANCED DEGREE? 11 Clarity of reason for pursuing advanced degree or certification is helpful. In this case, the initial reason was “to do better at the things I already do.” VPMA or similar position NOT on horizon! After graduation, asked by physician and non-physician leaders to assume lead roles in IT (as Medical Director) and Medical Affairs (as Interim Medical Director). Still maintained a full-time, two-physician neonatology service (Level II, ~1100 deliveries per year). When full-time VPMA position came open at the hospital where I was located, I applied, went through the vetting and interview process, eventually appointed to the position, with the CAVEAT of maintaining at least some clinical practice.

12. POINTS TO CONSIDER ON THE JOURNEY 12 Define ultimate career goal (may not be apparent initially, may evolve over time) Determine requirements for goal (e.g., does VPMA/CMO position require an advanced degree, and, if so, what type? Of the VPMAs responding to the 2011 ACPE Physician Executive Compensation Survey 94 percent were board certified in medical management, 33 percent had either an MBA or MMM Assess position description: does it meet your needs? Is clinical time part of the position? If so, how much? In other words, is this considered full- or part-time, and does the compensation reflect that? Is prior experience required for placement with an organization? Is the reporting responsibility line (up and down) clear? Many, many other questions: Consult with physician and non-physician colleagues, executive search firms, staff and resources of organizations such as ACPE/ACHE, perhaps obtain formal career counseling.